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It’s All About Me

It’s all about me, so here’s my wishlist for the profession. It’s difficult to place these in order of importance, because some of them depend on each other, and in my little corner of massage, they’re all important. It’s election time–aren’t we all just about sick of hearing about it–candidates mudslinging and making campaign promises? If I was the President of Massage Land, here’s what I’d do:

The Federation of State Massage Therapy Boards would sit down at the table with the National Certification Boardand hammer out an agreement to a) help ease the NCBTMB out of the entry-level test market, b) contract with them to collaboratively administer continuing education instead of trying to take it over and c) forget their MOCC-ERY plan.

The NCBTMB would a) graciously accept that it’s time for them to get out of the entry-level test market, b) focus on cleaning up the CE approval program, and c) get it together with their new plan of raising standards of certification.

Both of these entities would cease and desist in sending out Job Task Analysis Surveys that are flawed from the get-go….they both supposedly pay psychometricians to help them out with these things, and still they are falling way short of the mark in ascertaining what they really need to ascertain. Stop worrying about how many times a week we give a massage, and stop ignoring the relaxation benefits of massage as if they don’t exist.

There will continue to be Leadership Summits. They will stick to the agreed-upon agenda at their meetings and not allow major surprises  to slide in from any of the organizations, and they will practice complete transparency and stop sending out press releases that contain no more information than an invitation to a baby shower.

Every one who is involved in massage therapy education will join the Alliance for Massage Therapy Education.

The profession will come to a consensus on what constitutes required core competencies for entry-level education, while still giving school owners the autonomy and individuality to rise over and above that.

All unregulated states will get state-wide regulation and all localities will honor those and not place ridiculous additional burdens on licensed therapists.

All massage schools will be required to teach research literacy to their students, and will only hire instructors who are capable of doing so.

The NCBTMB will stop approving woo-woo courses for CE credit, and all entry-level massage schools will stop teaching it. I don’t care if you study Interplanetary Voodoo with the Archangels, but you don’t deserve any credit for doing that.

Our professional associations will conduct annual surveys that have NOTHING to do with a Job Task Analysis–the sole purpose of it will be “Tell us what you think we are doing wrong and give us your suggestions for how we could do it better.”

The Alliance for Massage Therapy Education will develop a program to offer instructor training to the masses that will be accessible and affordable–perhaps online.

Board members of all representing organizations will recognize their responsibility to not blindly follow the leader; to avoid not only conflicts of interest, but the appearance of conflicts of interest; will not put up with any cover-your-ass type behavior within their organizations; will hold their hired leadership accountable, and will have enough gumption to get rid of them if and when such behavior occurs.

All massage schools would seek COMTAapproval. If your school can’t afford that or doesn’t qualify because of not meeting the hour requirement, may I say that their standards are on their website for all the world to see for free, and you could still go about the self-study process and getting things up to snuff, even if you don’t formally seek the accreditation.

All school owners would be bound to have their school bonded, so that no school goes bankrupt and leaves students in the lurch in the middle of their program.

All schools would be required to post their pass rates on the licensing and certification exams on their websites and in their catalogs.

No school owner will be allowed to say to a potential student “Don’t worry, your criminal record won’t keep you from getting a license.” It should be mandatory for it to be disclosed that they may not receive a license. The state of Texas has a non-binding review, where for $50 a person seeking a career in any licensed profession can submit their criminal record for review prior to spending their time and money on pursuing education. Every state should do the same.

There should be a national exam for instructors to prove they are competent in teaching methodology and a subject matter expert in whatever area they intend to teach.

Each state should require a jurisprudence exam. Your licensees can’t adhere to the law unless they know what it is, and the percentage of applicants who actually read your practice act in its entirety is probably less than 5%–I’m basing that on asking that question in all the classes I teach. Hardly anyone reads them, but if they had to pass a test on it, they would.

The Massage Therapy Body of Knowledge would be about massage.If you want to have an energy work body of knowledge, create that.

Everyone involved in the profession would give financial support to the Massage Therapy Foundation. Give $100. Give $5. Give $1. Give whatever you can afford to give, just do it.

 

I could probably go on for days, but I have other chores to get to today. I invite my readers to add what they will. What’s on YOUR wishlist? What’s on mine that you object to, and why?

 

 

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If at first you don’t succeed….

Try, try again. That’s what the regulatory board in my home state of North Carolina is recommending when it comes to getting the Federation of State Massage Therapy Boards to do something about the confusing status of continuing education approvals.

Two years ago, the NC Board of Massage & Bodywork Therapy introduced a resolution at the Annual Meeting of the FSMTB (which was held in Puerto Rico). This document instructed the Federation’s Board of Directors to “begin the process of developing a new national approval program for continuing education providers and courses.” The organization’s leadership responded positively to the resolution, and announced to the profession in the Spring of 2011 the launch of a comprehensive project to do just that. They also invited AFMTE, AMTA and ABMP to work with them to provide input that would help shape the project.

In spite of this clearly stated intention to develop a “centralized quality assurance process for all courses taken by massage and bodywork therapists for the renewal of State licensure or State certification” (quoted verbatim from the FSMTB press release dated 3/29/11), the outcome of this process missed the mark by a country mile. The MOCC Proposal, which stands for Maintenance of Core Competencies, failed to deliver what the state boards asked for, and what FSMTB promised.

To remind you, the MOCC Proposal was based on a new (and unproven) concept of separating continuing education that relates to “public protection” from all other CE that is taken for “professional development”. MOCC recommended that only CE related to “public protection” be required by state boards for renewal of licensure, and everything else be put into the voluntary category, to be regulated by… well, the proposal didn’t even mention NCBTMB. If this all weren’t bad enough, FSMTB would become the exclusive provider of coursework needed to maintain “core competency” in the subjects related to “public protection”.

For more background on the MOCC issue, refer to my blog posts of 3/14/12 and 4/15/12. It’s also illuminating to read the press release AMTA issued on 4/23/12 which contained a complete repudiation of the Federation’s proposal.

In a friendly game of golf, you can take a “mulligan” every now and again–a “do-over”. My colleagues at the NC Board are giving the FSMTB leadership an opportunity to take a mulligan on this vitally important CE approval issue. They have recently submitted another resolution to be discussed by Member Boards at the upcoming FSMTB Annual Meeting in New Orleans on September 27-29. This resolution is much like the original from two years ago, and its appearance at this point in time indicates that the need for a single-source national CE approval program has not gone away.

The primary rationale is contained in this statement from the new resolution:
“Reliance upon the NCB Approved Provider program has been problematic for state boards because (a) NCB is a private, non-profit corporation that lacks oversight from and accountability to state regulatory boards; (b) its program has not adequately evaluated the quality or relevance of CE courses; (c) administration of this program has had notable service delivery problems over an extended period of time.”

That’s all true, but the opera ain’t over ’til the fat lady sings. The NCBTMB has the infrastructure already in place–and this will be nothing more than another case of duplicated efforts if the Federation steps in and tries to take it away without consideration of the NCB’s position in that marketplace. I think a collaboration would be more appropriate; by contracting with the NCB to administer CE approvals, FSMTB could establish the accountability structure that state boards must have with NCB, and FSMTB wouldn’t have to reinvent the wheel. They could just improve upon it.

Yesterday, I conducted one of my Scientific Facebook Polls, and asked the questions: How many MTs REALLY care what is happening with our professional organizations and what they are doing? How many people care about the MTBOK, the ELAP, the MOCC (don’t y’all love all these acronyms) or even know what they really are? How many people care about the legislation and regulation of massage? How many people care that there are initiatives to raise standards for teachers of massage therapy and for massage education in general? Do you care about all those things, or would you rather just be left alone to do massage?

I got 75 replies in a 24-hour period, and one thing is apparent: to the average massage therapist trying to make a living, many perceive our organizations to be all about politics and all about money. To some extent, that’s true…the one with the most money wins. The perception is also that they all have their own agendas. Actually, recently some of them seem to have the same agenda, but they’ve wasted time and money in duplicating efforts, or opposing each other’s efforts, and scrapping over turf wars. In a recent blog I urged the NCBTMB to take themselves out of the entry-level exam market and suggested that the FSMTB assists them financially in return for their doing so. Earlier this week, in a piece published in Massage Today, Ralph Stephens called on AMTA and ABMP to offer “substantial and ongoing financial support” to COMTA and AFMTE, to further their important efforts to improve the quality of massage therapy education.

FSMTB and the NCB have recently conducted new Job Task Analysis surveys, both of them seriously flawed, in my humble opinion. These surveys show a strong bias towards the clinical/medical side of massage therapy, and contain virtually nothing about the KSA’s related to delivering massage therapy as a primary means of facilitating well-being and integration. From my perspective, the latter is of equal or greater importance.

In addition, the FSMTB survey has a special add-on section to gather data for the Entry-Level Analysis Project (ELAP). This dual-purpose survey does ask lots of questions about specific medical conditions, but it contains nothing about the client/therapist relationship. The word “relax” does not appear anywhere, and the word “relaxation” shows up just once.

There’s also an over-focus on the huge number of modalities that are marketed in this field. Many of these listed are obscure and little-understood. It’s wrong to ask a therapist to define themselves by a single named modality. Practitioners typically use a broad range of methods with clients. The modality is not the treatment — it’s the totality of what a practitioner brings to the session.

Finally, this Federation JTA is similar to the recent JTA from NCBTMB: another duplicated effort that still falls short of giving an accurate picture of what happens in the real world of massage therapy. You can count how many times a week we give a massage or take SOAP notes, but that’s not what it’s really about. It’s about our rapport with the client, and what kind of results we are able to produce, and what kind of trust we can inspire in our therapeutic relationships. The MTBOK generally missed the boat on this as well, although I have high hopes that the line-by-line analysis and re-mapping of the MTBOK that was conducted by AFMTE will give us a usable body of knowledge.

As a result of these large-scale projects, it’s likely that the kind of incomplete and disjointed training that is typical in our field will get further enshrined as the baseline for education. Skewed survey questions produce skewed data. Using that data to build a new standard for the entire field is not just wrong, it’s a crime against the lineage of massage therapy. Just look at what has happened to the other health care professions who have organized themselves around the mechanistic/reductionistic model. People are treated as parts, and no discipline ever looks at the whole person. Massage therapists still have the ability to treat holistically. Relaxation is being relegated to a lower-class status of therapeutic effect, when it’s one of the most valuable aspects we offer with this work.

This whole scenario illustrates one thing: the time has never been more ripe for getting our act together, and that isn’t going to happen while there’s all this push and pull and one-upmanship going on with the organizations. When the leaders of the seven primary stakeholder groups sat down at the table for the first time last September, the ELAP proposal appeared out of nowhere–it wasn’t even on the agenda and it got slid in anyway. I would like to see them sit down again, and take a serious look at these issues. Put ego and profit aside. Take a real look at the flaws in your information-gathering processes. If you want to see what massage therapists really think, sign on to my Facebook page and you might get a rude awakening at their opinions of you. You wouldn’t exist without us, and what we think does matter. A Job Task Analysis survey asks what we do--and frankly, it isn’t near as important as what we think. Consider that.

 

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NCBTMB: Quit the Small Stuff and Take the Bold Step

Nearly two years ago, the Tennessee Board of Massage Licensure voted to change its rule pertaining to the examinations approved for licensure of massage therapists. They chose to adopt the Massage & Bodywork Licensing Examination offered by FSMTB as the only approved exam – and sunset the use of the National Certification Examination for Therapeutic Massage & Bodywork offered by NCBTMB.

That decision was entirely within the Board’s authority, and was based on the fact that the MBLEx is owned and administered by FSMTB, which consists of its Member Boards. This structure gives state regulatory boards direct ownership and supervision over this exam, which has never been the case with the use of NCBTMB’s private certification exams for state licensure purposes.

Rule changes can sometimes take a long time to make their way through the administrative process, and Tennessee’s exam rule just came up yesterday for final approval before a committee of the State Senate. This could and should have been a simple legislative rubber stamp of an agency decision, but NCBTMB threw a monkey wrench into the works by sending in a representative to oppose the rule change.

I was told last year by former NCBTMB CEO Paul Lindamood that they were swearing off the battle against the MBLEx, and would no longer challenge state massage board actions around exam approvals. He stated to me at the time that he knew they weren’t making any friends by doing so. The new CEO, Mike Williams, who came on board last September, apparently does not share that point of view.

At the committee hearing, the Senators stayed the decision on the rule change for another 30 days and sent the matter back to the Board for further consideration. According to my sources, the hearing went poorly, with legislators failing to understand the difference in the exams, state board members unable to answer the question about what the pass rate is on the exam, and general confusion leading to the stay instead of a decision.

I spoke to NCBTMB President Alexa Zaledonis today, who stated that “We didn’t go to Tennessee to fight, but to state our position. There are still people who want to take our exams and we support them having a choice. We never desire to create controversy in the states. We have quality licensing exams, a lot of people do like them and ask us to help keep them available in their states. No malicious intent, just a desire to let those people have a choice and so we try to stand up for them in an appropriate fashion.”

Earlier this year, there was an ugly ruckus in Ohio over a similar kind of rule change. It ended in a Massage Therapy Advisory Committee member being removed after he asked the NCBTMB during the hearing: “How much money will it take to make you go away?” It was deemed unprofessional conduct at best, and an offer of a bribe at worst.

While I hate the way the question was put forth, it has more than a little basis in reality. I personally would paraphrase that to: “How much money will it take for you to get out of the entry-level licensing exam business?” 38 states are still accepting the NCBTMB exams, but all you have to do is look at NCB’s financials (available on Guidestar.org) to see that they’ve had their butt kicked by the MBLEx. The MBLEx is a licensing exam used for licensing purposes. It’s the right tool for the job, and the marketplace has affirmed it by an overwhelming margin. The state boards themselves don’t derive income from the MBLEx; FSMTB is a non-profit organization (as is NCBTMB) and the Member Boards pay annual dues to the Federation.

If you’ve been reading my blog for long, you know that this is a relatively new opinion of mine –that the NCBTMB should get out of the entry-level exam market. I argued against that for a number of years. Rick Rosen, (a fellow North Carolinian and industry thought leader), has argued that point with me here on this blog and in other forums a number of times, as have others, and I resisted that change for a long time. However, I finally came around to Rosen’s point of view. A few months ago when NCBTMB announced the creation of a new post-graduate Board Certification credential and the ending of the current entry-level National Certification credential, I truly felt like it was the best move to be made.

The issue is that ever since the appearance of the MBLEx, the value of being Nationally Certified has largely gone by the wayside. I’ve heard many accusations that the MBLEx is an easier test than the National Certification Exam. This is not a valid argument, because these are two different tests created for entirely different purposes. The real point here is that National Certification no longer distinguishes therapists from the pack like it did back in the days when it was the only credentialing exam in the massage therapy field. I have personally been NCTMB for 12 years. I have always maintained my certification, even after the MBLEx appeared, but I know many therapists who have let it go because they’ve reached the belief that it doesn’t mean anything in the marketplace.

Under the new plan, Board Certification includes the requirements of 750 hours of education, passing a new higher-level exam, 250 hours of hands-on experience, keeping CPR certification current, and a criminal background check. Those who are already Nationally Certified will not have to take the new exam. In our conversation today, Zaledonis stated “Our Board Certification exam is created to test individuals who have achieved 750 hours of education and are at a level of expertise that exceeds an entry level graduate. Over 8000 individuals responded to our JTA, these answers (after psychometric interpretation) along with a panel of subject matter experts were used to differentiate between a entry level licensed practitioner and a certified practitioner. Our Certification test is different from a licensing exam in that it uses more cognitive thinking over just recall using innovative items over traditional. This test, coupled with the other requirements, are the start of a program that truly differentiates licensing from certification.”

I personally know many of the people on the staff and on the Board of the NCBTMB. I have no doubts about their dedication to the profession, and when it comes down to it, the organization isn’t an island. A CEO serves at the pleasure of the Board, and Board members have to reach a consensus. Apparently the members who are currently serving the NCBTMB have agreed to follow this path of continuing to challenge state boards, and that distresses me. I think it is a misguided effort, no matter how good their intentions. Even the name of the organization speaks to that: National Certification Board. It isn’t the National Licensing Board. There isn’t a National License. There is no portability, and the swirling sewer of argument and confusion around the exams is not helping the situation. I think the time is ripe for the NCBTMB to get out of the entry-level market altogether and focus 100% of their resources on the development and rollout of their new post-graduate credential. This IS something that our profession needs, and I urge the NCB leadership to let go of the past and turn towards the future.

I imagine that money is a primary factor in the organization hanging on to entry-level testing, and in the decision to continue challenging state boards that are ready to drop them. It doesn’t take a rocket scientist to figure out that states don’t want a private certification organization coming in and telling them how to run their business. State board members are normally unpaid volunteers who give up home, family and work time to serve a board….and to have an outside party come in and tell them they did the wrong thing doesn’t sit very well, (as I personally know). I don’t want to see the NCBTMB crippled to the vanishing point. Going around challenging state agencies is expensive, and it doesn’t win them any friends.

So here we are with a Catch-22. It’s time for NCBTMB to exit the entry-level testing business, but they don’t have the money to sustain them while the new Board Certification program is getting built. They need a bridge to help them get where we would like them to go.

There is a straightforward solution to this situation. Since the lion’s share of revenue from entry-level testing has shifted over to FSMTB, they now have a significant cash reserve. It is in the best interests of their Member Boards to bring a quick and painless end to the “exam wars” and to establish the MBLEx as the single standardized exam for state licensure. The profession as a whole will benefit, and portability for therapists will be improved.

What needs to happen is that NCBTMB declares that it will no longer offer any of its exams for state licensure purposes as of a certain date. In exchange, FSMTB will give NCBTMB a certain amount of money over a period of time to compensate it for this move. The mechanism for this process is called a Transfer Agreement, and there is a clear precedent we can look at.

For many years, the American Physical Therapy Association owned and operated the national exam used by state PT boards for licensure. APTA (like our own AMTA) is a private non-profit membership association, with no accountability to state PT boards. Because of the same inherent problems we’ve finally come to recognize, the Federation of State Boards of Physical Therapy entered into negotiations with APTA, and engineered a Transfer Agreement to take over that exam in the late ’80s. It’s worked like a charm ever since. Physical Therapy has 50-state licensure, and a lot more consistency in their state-to-state regulations than we have in the massage field.

Having one standardized national licensing exam is one of the hallmarks of a profession. We are at a critical juncture, where the opportunity to take a major step towards professional status is within our grasp. This will take the willingness and cooperation of the leaders of both NCBTMB and FSMTB to come together to work out the details of this agreement.

Let’s stop wasting time on the small stuff. Take the bold step, for the betterment of all.

 

 

 

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Report from the FSMTA Meeting

Champ and I spent the weekend at the Florida State Massage Therapy Association meeting in ChampionsGate, FL. It was our first time attending this event, and we went there to work in the Soothing Touch booth with Gurukirn Khalsa and his family. The event was  held at the beautiful Omni Resort…a lush tropical setting and superior accommodations. It was hot as the devil–but it got up to 108 ° back here at home in NC while we were there, so I really can’t complain about it. The FSMTA meeting is huge. The organization has over 5000 members, and they had a great turnout.

In addition to working, we had plenty of socializing with friends old and new. I spent over an hour in conversation with Mike Williams, Executive Director of the NCBTMB and our interview will be appearing soon in a future blog. Our booth was right across from the NCBTMB booth so I spent a good bit of time chatting with Lori Ohlman and Donna Sarvello, and later Sue Toscano and Alexa Zaledonis. You may say whatever you like about the NCBTMB–it is staffed by great, dedicated people. Bruce Baltz of Bon Vital is also on the NCBTMB Board, and he gave me a great foot massage.

I spent some time with The Massage Nerd doing a few videos–I suspect they’ll be rolled out soon. Ryan Hoyme stayed busy doing videos for everyone present that wanted one. Since I was actually working, I had short visits with a lot of people instead of longer visits with a few people! Ruth Werner was there with her daughter Lily, as were Leslie Young Giase of Massage & Bodywork Magazine/ABMP and Paul Slomski, representing  the Massage Therapy Foundation. Pete Whitridge, Cherie Sohnen-Moe, and Iris Burman were there for the AFMTE; Kate Ivane Henri Zulaski and Cliff Korn were there for COMTA, and the FSMTB was represented…this is a big meeting, so all the major organizations were in attendance. Massage Today and Massage Magazine folks were there, too. Vivian Madison-Mahoney and her husband John, Leslie Lopez, Pat Donahue and her hubby Joe, Angie Patrick, Scott Dartnall, James Waslaski, Karen Kowal, David Kent, Anita Shannon, Lynda Solien-Wolfe, Michael McGillicuddy….too many people to name but it was like a reunion of some of the nicest and most dedicated people in massage, even when I only got to see them for a minute.

Champ and I attended the FB Meet and Greet…I always meet a few of my FB friends at those events, and it’s turned into such a popular thing that all the major conventions now have one.

Speaking of major conventions, the one glitch was the same that I have noticed at other conventions, and that’s vendors getting upset with the schedule and/or location. I’m not picking on FSMTA here, because something similar seems to happen wherever we go. The particular issue this time was that the vendor hall was slam full of people Thursday evening at 5 pm, and they shut down the vendors so the association could have a 2 hour business meeting. At other organization meetings I have attended, the hall was either so far removed from the mainstream that people practically had to walk a mile to get there, or the hours coincided with the times people are in class and not much over or above that. I encourage EVERY group who organizes a massage event, whether it’s small or large, to give these people a break! Booth space is usually expensive, especially at major events, and these folks go to a lot of expense and trouble to support your events. You need to support them. I’ve heard the suggestion several times that registration should be held IN the vendor hall so that attendees had to walk through it to register, and that’s not a bad idea. As I said, I’m not picking on FL. It is a problem at many places.

The FSMTA has been around since 1939 and has 15 chapters throughout the state. That’s a pretty big accomplishment. I was pleased to meet so many of their members. I had a great time at their meeting and plan to attend again.

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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.

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ELAP Work Group Members Announced

Anne Williams of ABMP has confirmed to me today the members of the group that are working on the Entry-Level Analysis Project that I have been blogging about for the past few weeks. Since the secrecy surrounding this project has been my main complaint about it, I will share that information here.  The members are:

Cynthia Ribeiro, President of AMTA (National), educator, and school owner.

Tom Lochhaas, University-level educator, author, editor with 24 years experience in developing college-level textbooks and ancillaries.

Elan Schacter, Massage therapist, instructor, text reviewer, contributing author.

Clint Chandler, Massage therapist and instructor, experienced in curriculum development.

Rick Garbowski, Massage therapist and instructor, experienced in curriculum development.

Jim O’Hara, Instructional designer.

Anne Williams, Director of Education for ABMP.

Williams stated that she was in the process of compiling the comments of those who were present at the Leadership Summit; that everyone present was now in support of it, and that much more information about the project would be forthcoming in the next two weeks. She further stated that this was intended to be a research project, and that what people do with the information will be their choice. As I said in my last blog, neither ABMP, AMTA, or any of the other organizations present at the Leadership Summit are regulatory organizations, and none of them have the power to dictate legislation. (Clarification: the FSMTB is an organization of regulatory boards, but is not regulatory in and of itself).

I am acquainted with several of the people on the work group. Cynthia Rebeiro, Pat Archer, and Elan Schacter do good work in all they endeavor to do. I would have liked it if this information had been put out there immediately, along with the rest of the details, but you don’t always get what you want. And actually, the fact that you don’t always get what you want is sometimes a good thing. As I also previously stated, the wheels of legislation turn very slowly…and just because our organizations want something to happen doesn’t mean it’s going to. If the evidence produced by this project turns out to show that 750 hours ought to be required for entry-level education, it will take many years for that to happen in every state. That’s my prediction, and I’ll be glad to take any bets on that.

I’ve been reviewing COMTA standards for the past couple of days in preparation for a site visit, and it would be great if those were a requirement for every school. I think the quality of education would increase exponentially if every school had to jump through the hoops to prove they’re doing things diligently and going beyond what most of the state boards require. I’ve also been revisiting the MTBOK, and while I still have a few issues with it, I certainly hope it is taken into consideration.

I personally still think that education should be about quality, and not quantity. 500 hours is arbitrary to me–and so is 750. Look at some of the Canadian provinces…their required hours are 4 digit numbers. Those are arbitrary too, when it comes down to it. It should be about competency, not about hours. From my own experience, and someone has made this comment to me before–in entry-level massage school, you learn what not to do. It’s when you begin practicing that you begin knowing what to do. My real education started when I walked out the massage school door, and it’s been that way for a lot of us.

This project is going to be released for comment in a couple of weeks, according to Williams. I urge everyone to take the opportunity to comment–beyond any job task analysis survey that gets spread around. Those show tasks, and don’t reflect opinion. This is of too much magnitude to the profession for opinion not to be considered. School owners in particular need to speak up. If you run a 500 hour school, how many of you can afford to increase that be 250 hours? How many would just fold? I advise you not to sit on your hands.  It’s like an election. If you don’t vote, you can’t complain, and complaining after the fact doesn’t have any impact. Express your opinion.

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Top Secret Standards Project: No News is NOT Good News

I’ve been on vacation…I took a deliberate ten-day break from the Internet and from all the politics of massage while I was enjoying my annual sojourn in Ireland. I didn’t visit any Internet cafes. I didn’t read the paper and I didn’t watch the news. I left my cell phone at home, too. It was quite refreshing and restorative to be unplugged for that period of time, but now it’s back to the grind. From the look of things, it would seem that the powers that be are enforcing a news black-out as well. They have apparently been sworn to secrecy. It looks like a covert operation from the CIA.

The press release from the Leadership Summit, held in Chicago May 1-2, and attended by the leaders of our national organizations, was released May 9. I was expecting a white-washed version of the events, and I was not disappointed.

Out of nowhere, the press release mentions casually: “An ongoing discussion of the Entry-Level Analysis Project (ELAP) occurred and input from the leadership organizations was discussed.”

Wait just a minute… isn’t this the very first public mention of this project? No one outside of the inner circle of secret-keepers knows what the ELAP is, who the driving forces are behind it, and what its real purpose is. They can’t just drop a profession-altering project onto the landscape like it’s a known quantity, wave a little flag that promises us some future opportunity to have input into the project, and then expect us to salute the results whatever they may be.

The Leadership Summit press release mentions that massage therapists are going to get some input into this project—through a “companion” survey to the FSMTB Job Task Analysis. That may sound promising, but let’s remember that FSMTB is an exam provider, and their major focus is on the MBLEx. The Job Task Analysis survey is not necessarily the best way to determine what an entry-level massage therapist needs to know.

The big problem with the use of these and other surveys in our profession is that many therapists received insufficient education in their entry-level massage training programs. It’s unfortunate, but these folks don’t know what they don’t know. Asking this group what constitutes safe and effective massage therapy practice is barking up the wrong tree.

If all you’re looking for is a snapshot of the hours per day one spends doing massage and performing the laundry and other mundane chores that go along with that, it will suffice. But what about seeking opinion and honest-to-goodness input? What about addressing the concerns that the people who will be affected the most by whatever plan comes down the pike? Primarily, that will be small school owners, many of whom are already struggling to survive.

There are still so many things I find disturbing about this whole process, not the least of which is that none of our massage news outlets is saying anything about it. You’d almost think I’m the only one who cares. With the possible exception of a surprise birthday party, I tend to mistrust anything that has to be carried out in secret. So the nice sentiment (which I am glad to see has replaced the “we aren’t seeking input” statement that I found so offensive in the original document) that “A key component to the success of this project will be broad input by the massage profession” notwithstanding, I’ll repeat the call to action from my last blog:

A really good first step would be for ABMP, AMTA and FSMTB to release a full description of the project, including what they plan to do, how it will be done, who sits on the new workgroup, what the timelines are, and what money will be spent. And most importantly, we want to know what they intend to do with the “evidence”. When organizations that represent us are making major decisions that affect us, we deserve to be involved in the process.

In spite of my objections to this whole cloak-and-dagger scene we’re being subjected to, I am comforted by one thought…and that is that the wheels of government turn slowly. Whatever plan the ELAP work group comes up with is just that: a plan. I don’t visualize state lawmakers running to the legislature floor intent on helping them get it off the ground. AMTA is not a regulatory body, and neither is ABMP. For that matter, the FSMTB isn’t either. The individual member boards are regulatory bodies, but the organization in and of itself is not. They don’t have any law-making power.

I don’t know what’s happened to the transparency that we should expect from our organizations, but it seems to have gone to hell in a hand basket. Frankly, I think that would be a good topic for the next leadership summit. The peons like me who pay your membership dues deserve it.

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A Betrayal of Trust

Any time one of the major organizations in the massage field tries to fire up a project that will “advance the profession”, I get awfully suspicious. When a group of them get together to do something on the big scale, I go on full nuclear alert. That’s the case right now with a dubious education standards project introduced by ABMP in September 2011 at the Leadership Summit in St. Louis, which I detailed in my previous post, Behind Closed Doors.

As the title of that blog suggests, 100% of the activity surrounding this project has taken place in secret, with no information about the project being released to the massage therapy community—and no opportunities for review or comment before time, money and human resources are thrown at solving a perceived problem.

AMTA and FSMTB have signed on to this project, which will involve gathering information from the Federation’s upcoming Job Task Analysis survey, to use in a process that will “identify the rudimentary knowledge, skills, and attitudes required to pass a licensing exam and provide basic, but safe, massage in an early massage career.”

That doesn’t sound like a such bad thing—in and of itself—but the group intends to use this data to create an “evidence-based minimum educational requirement” for state licensing. This would be used as a rationale for changing state laws, and would likely be used to drive the curriculum standards for entry-level massage programs—basically telling schools what to do.

Goodness knows, there is a lot of inconsistency in massage education and regulation, but there is no problem in our profession that justifies one or a group of our so-called “stakeholder organizations” seizing the ball and marching down the field without our input or permission. I don’t give a rat’s you-know-what if they claim to be doing this in our best interests; this power play is a gigantic betrayal of trust. And I might add that I am personally in favor of the evidence-based practice of massage, but I don’t think one tiny group of people should get to decide what that is.

I’ve not yet been able to confirm the status of NCBTMB, Massage Therapy Foundation, AFMTE or COMTA as it relates to this project (mum’s the word all around). These four organizations, along with ABMP, AMTA and FSMTB just gathered on May 1-2 for another Leadership Summit—this time in Chicago. I’m taking bets that they will issue another sanitized press release that gives us regular folks in the bleachers little substance about what really happened in this meeting that has the potential to alter the very nature of our profession.

The only other info I’ve been able to glean is that ABMP, AMTA and FSMTB hand-picked a new workgroup of massage educators and other “experts” in instructional design and curriculum development to start this project on May 3-4, right after the completion of the Summit. Are you kidding me? Where was the public notice of this opportunity to serve on a panel that will influence the future of massage therapy? Who gave these organizations the authority to do this on our behalf?

No one. They took it on themselves, and that’s what stinks to high heaven.

In stark contrast, the Massage Therapy Body of Knowledge project had both fans and detractors, but it was carried out with a reasonable amount of transparency. The majority of the dissent on the project concerned the inclusion of energy work in the document and dissatisfaction with the way objections were handled—or not handled—in favor of evidence-based practices. The five organizations that comprised the MTBOK Stewards (ABMP, AMTA, FSMTB, MTF, NCBTMB) did a good job of not interfering with the project once it was launched.

Right now, we have a genuine crisis on our hands. The problem is that hardly anyone knows about it. This blog only goes so far. I never set myself up to be the New York Times of the massage field, but it seems like the major massage publications are afraid to get their teeth into the real breaking news that affects the practitioners, teachers, CE providers and schools that make this profession possible.

Friends, it’s up to YOU to let these organizations know that it’s not OK for them to act in your interest without your permission. As long as these “leaders” think they can get away with it, they will. Trust has been blown out of the water, and it will take a concerted effort to rebuild it.

A really good first step would be for ABMP, AMTA and FSMTB to release a full description of the project, including what they plan to do, how it will be done, who sits on the new workgroup, what the timelines are, and what money will be spent. And most importantly, we want to know what they intend to do with the “evidence”. When organizations that represent us are making major decisions that affect us, we deserve to be involved in the process.

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Behind Closed Doors

From the title, you might think this blog is about The Client List, the trashy new show on the Lifetime Channel that gives massage therapy a black eye. No such luck; the event I am referring to is the upcoming Leadership Summit #2, set to take place next week in Chicago.

The first Leadership Summit (to clarify: there were summits in 2003-04 before AFMTE and FSMTB existed) took place last September in St. Louis, with the executive directors and chairs of ABMP, AFMTE, AMTA, the Massage Therapy Foundation, FSMTB, COMTA, and NCBTMB in attendance. It was a historic event in that it was the first time all seven of these organizations had come together in the best interests of the profession. The purpose, according to the press release announcing the meeting, “was to hold a beginning conversation about major structural issues and impediments to profession progress. The desire is to have candid exchange about core challenges, quality concerns, consumer expectations and organizational roles.”

Apparently, one of the hot topics at this week’s meeting is going to be the number of required entry-level education hours. Although this was not on the agreed-upon agenda at the first meeting, it was introduced anyway by ABMP Chairman Bob Benson, complete with a thorough proposal prepared by Anne Williams, Director of Education at ABMP. Basically, the proposal was for a task force to be formed immediately, and using Job Task Analyses that have been conducted by the NCBTMB and the FSMTB, to nail down a definite number of hours that should be required for entry-level education. This was contrary to the facilitator’s recommendation—and the group’s agreement— that they would spend the initial meeting identifying problems, and would address possible solutions for these problems at meetings to follow.

In the interest of the leaders being comfortable in speaking freely, these are closed meetings—no press and no other staff members in attendance—an executive session, so to speak. Certainly not without precedent; boards have executive sessions all the time—usually to discuss personnel matters or other things that would violate someone’s privacy if they were discussed in public.

That’s not exactly the case here; and while I am thrilled that our leaders—some of whom are from competing organizations—are sitting down at the table together, my concern is that a small group of people has the power to decide (or worse, just think they have the power to decide), what is best for the profession on the whole, without getting input from the people it affects—you and me. Practitioners, school owners, teachers, CE providers, the regulatory community, all have a vested interest in the future of our profession, and I don’t think that should be decided by an exclusive group behind closed doors.

Unfortunately, that is just what the ABMP proposal states in no uncertain terms. Verbatim, Williams’ proposal stated: There is no step in this proposal to obtain input from the broader massage profession or from other health-care or bodywork organizations during this project. The reason is simple—the work group is simply performing a work task in writing learning outcomes and objectives for job tasks defined by surveys already conducted by FSMTB and NCBTMB. It doesn’t matter what stakeholders, or other groups think should be taught or shouldn’t be taught. The work group would be responding to what therapists report they do, on a day-to-day basis, in their massage-related environments as part of their jobs.

The sentence that disturbs me there is “It doesn’t matter what stakeholders, or other groups think should be taught or shouldn’t be taught.” Any time you start to think it doesn’t matter what stakeholders think, there’s a problem, in my humble opinion, no matter what the issue. Stakeholders are the ones it will affect, and to think their opinion isn’t important is just beyond the pale.

At the recent ABMP School Issues Forum in Austin, Texas, Bob Benson stated to those in attendance that there was 100% consensus in support of this standards-setting proposal from the organizations that attended the Leadership Summit. That’s not exactly so. COMTA, FSMTB, and AFMTE all expressed concerns after the proposal was introduced in September; they are not petty concerns, and they do not appear in any way to be based on politics or turf wars.
This is bad business for two primary reasons: First, any project that has the potential to affect the entire massage therapy profession should not be designed, approved, and launched in secret. Changing the baseline numbers of entry-level education required for state licensure is a huge thing, as it will affect schools, regulators, and future students.

By contrast, the MTBOK project modeled appropriate transparency, and the massage community had adequate opportunities for input along the way.

Second, it is more important right now that our primary stakeholder organizations learn to work together in an atmosphere of trust and cooperation—than to plunge headlong into a major problem-solving project when consensus has NOT been reached. The end does not justify the means. Some of my own issues are that the MTBOK and the competency-based curriculum standards set forth by COMTA aren’t even being given consideration. This proposal also overlooks the fact that the AFMTE is currently working on a National Teacher Standards Education Project. A huge amount of work has gone into creating both the MTBOK and the COMTA standards; a huge amount of work from some of the best educators in the business is going into the AFMTE project, and for these to be cast aside when they have direct relevance to this proposal is irresponsible to say the least.

During our troublesome economy of the past few years—and it doesn’t appear to be over yet—school owners have been seriously affected already, and having a nation-wide upheaval based on an “official” number of required hours is not the be-all end-all solution to licensing portability. It will just serve to put an additional burden into the mix at the present time. The lack of portability may be an irritant to our field, but it is not causing harm to the public.

The AMTA Board of Directors voted last October to support the project in its present form. As ABMP and AMTA are the two largest professional membership associations, they carry a big stick. That doesn’t mean their agendas should be force-fed to the profession, and I hope that they will reconsider both the timeline, and the very valid concerns raised by the other organizations before barging ahead with this project. I am certainly not saying that it never needs to happen. I am just saying it doesn’t need to happen on speed-dial until all of these issues have been ironed out. I hate to see good intentions canceled out by unchecked enthusiasm for rushing something to market; I hate to see valid concerns from the other organizations swept under the carpet; and I hate to see the opinion that what the stakeholders think doesn’t matter.

When you’re meeting behind closed doors, it’s easy to forget who the stakeholders are. I’m one of them. I’m a member of both AMTA and ABMP, a founding member of the AFMTE, a past delegate to the FSMTB, a Nationally Certified Massage Therapist & Bodyworker, an Approved Provider under the NCBTMB, and a current site reviewer for COMTA, so I do indeed have a vested interest. I don’t appreciate our national organizations acting as if my opinion and that of the other thousands of massage therapists, school owners, and others who enable your very existence on this planet don’t matter.

At this week’s Summit, the representatives of these seven organizations have an opportunity to address this issue that has divided the group, and to get their process back on track. I hope that they also remember the responsibility that they have to their own members, and to the profession as a whole. To use ABMP’s own slogan here, we “Expect More” from our leaders.

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MOCC Proposal: Dis-Organized Chaos

I’ve been criticizing the Maintenance of Core Competency (MOCC) proposal from the Federation of State Massage Therapy Boards since the moment it landed on my radar, and I haven’t changed my mind. I think it’s a terrible plan that doesn’t serve any good purpose other than increasing the coffers of the FSMTB. In its present form, it appears to be a blatant move to put the NCBTMB out of business.

What has been interesting to me is to see the way this thing has unfolded. Right off the bat, I had some criticism of the Task Force assembled by FSMTB that supposedly got this thing together. I say supposedly, because when I saw who was on it, my first thought was “No, they couldn’t possibly have supported that.”

So here we have Immediate Past President of AMTA, Glenath Moyle, whom I know personally and like a great deal. In spite of Moyle’s presence on the Task Force, the national office of AMTA only took a few days to come out with a statement shooting more than 20 holes in the MOCC proposal. In spite of the fact that the FSMTB chose Task Force members who were supposedly representatives of their respective organizations, that apparently didn’t work too well in this case.

AMTA has never allowed an individual officer to speak for the entire organization without their board’s approval; their blanket slam of the proposal seems to indicate that they never saw the proposal prior to publication, much less given the opportunity to sign off on it. I wholeheartedly support AMTA’s condemnation of this far-fetched plan, but I didn’t like to see Ms. Moyle in a position of looking like she had egg on her face. That could have been prevented if this process had been carried out in a more transparent manner.

Then we have Pete Whitridge and Cherie Sohnen-Moe, President and Board Member, respectively, of the Alliance for Massage Therapy Education. Since both of these leaders are well-known continuing education providers, and represent an organization that is largely composed of CE providers and massage schools that sponsor CE, I was shocked at their support of this plan. I felt at the time, and still feel, that if the membership of the AFMTE had been polled about this plan, the consensus would be a big fat NO.

The theory that this plan will not take away business from CE providers is BS of the highest order. Since the proposal calls for newly-created education modules that the FSMTB will put on their website to be the ONLY course work required for state license renewal – with all other CE related to “professional development” becoming optional – it doesn’t take a rocket scientist to figure that out.

The AFMTE issued a statement last week,that frankly, I feel should have been included in the proposal itself. I might have felt better about the whole thing if this was part of the original proposal. The AFMTE has suggested that they support the FSMTB contracting with the NCBTMB to administer the process of approving CE courses and providers, as that is beyond the resources and scope of most state massage therapy boards. The NCBTMB was excluded from the MOCC Task Force, which is petty politics to me. This plan affects them in a major way and they should have been included. They have expressed their willingness to work with the FSMTB, and frankly it’s the Federation that has prevented it from happening.

That doesn’t look good to me. When the NCBTMB convened a meeting of diverse stakeholders last year for the purpose of getting input into revamping their programs, they invited the FSMTB to participate. Their exclusion from the MOCC process is, I’m sure, based on the Federation’s party line, “the NCBTMB isn’t regulatory.” Big freaking deal. That is true, but they exist and for 20 years have administered the only national approval process for CE providers. AMTA, ABMP and AFMTE are not regulatory organizations and they were invited to serve on this Task Force. There were people on the Task Force from states that don’t even have any CE requirements to begin with. That dog don’t hunt, as we say in the South.

As the NCBTMB has announced their intent to sunset the existing National Certification program in favor of a post-graduate Board Certification credential, it is obvious that they are phasing themselves out of the entry-level market. At this point, they are not letting go of offering their National Certification Exams for state licensure purposes. However, that use of the cert exams is on a steady path of decline, as the MBLEx is now being used by the overwhelming majority of massage school grads. I think with some negotiation with the FSMTB, they would let it go altogether. The thing is, cooperation is only possible when both parties come to the table. The FSMTB isn’t playing nice.

There will need to be some skilled facilitation to get these organizations to look beyond their own interests, and to work together to achieve broad-based solutions. We need a single national approval program for continuing education, and our field will truly advance when there is just one entry-level exam for state licensure (instead of the current crop of five).

Every professional organization should take a lesson from some of the past troubles at the NCBTMB: all it takes is to get one or two people with a personal agenda in a position of power, and the fallout is detrimental to the organization and the profession on the whole. Board members have the responsibility of checks and balances. To those who sit on their hands and blindly follow the leader, I say get up or get off.