Statement of Coalition of National Massage Therapy Organizations

 
“We believe that the efforts of work group members have resulted in an extraordinary, ground-­breaking body of work. Their Blueprint, and the underlying process described in the report, gains strength from its intellectual integrity and independence.”

The “Coalition of National Massage Therapy Organizations” comprises seven organizations listed at the end of this statement. Our organizations play different roles, each contributing to the betterment of the massage therapy profession while also educating the public about benefits of professional massage therapy. We share a national focus: each of the seven organizations has members or constituents throughout the United States. Each of us seeks a thriving massage therapy profession that enhances the health and well-­being of clients throughout the United States. We also share a desire to help our profession beyond serving each organization’s self-­interest.

Our Coalition initially convened in 2011 to identify and address opportunities to advance the massage therapy profession. Two senior leaders from each organization participated in that initial meeting and three subsequent meetings.

Consistency and Portability

In a healthy profession, effective improvement requires candor in acknowledging current imperfections. When our group of organizations initially assembled, we began by naming and prioritizing profession challenges that required attention. Emerging at the top of the list were two concerns:

• inconsistent quality, depth and focus of entry-­level massage therapy education; and
• lack of licensure portability (professional mobility).

Why these two? Numerous participants referenced observed knowledge and skill deficits among many recent school graduates and expressed concern that a resulting potential increase in inconsistent quality massage experiences could dull public enthusiasm for seeking massage therapy. Uncertainty about education quality and how to evaluate transcripts from unfamiliar schools, combined with inconsistent entry-­level examinations utilized by different states, impairs state massage board confidence about approving licenses for practitioners moving to a new residence state.

Identifying Entry-­Level Skills and Knowledge

A preliminary proposal advanced at that meeting was refined by participating organizations over the following six months. The objective: identify and gain agreement on what should be core elements of entry-­level massage therapy instructional programs – the knowledge and skills an entrant to the profession should possess to be ready to work safely and competently with clients.

The proposal recommended formation of a seven-­person work group composed of  massage content experts and two individuals holding credentials in education and instructional design. Each Coalition member had an opportunity to recommend participants and to listen and offer comments during the March 2012 selection process.  The aim was to bring together a group possessing objectivity and judgment alongside specific classroom instruction, curriculum development, instructional design, and assessment expertise. A clear instruction to the group was to approach their work with impartiality and integrity, to arrive at sound, research-­informed conclusions unconstrained by precedent or political acceptability.

The project was initially estimated to require slightly over one year. As it evolved, participants quickly realized that more time would be required to do the job thoroughly. In the end, it proved to be a 21-­month endeavor.

It is our belief that the resulting work product, combined with engagement and courage by leaders throughout the profession, can assist substantially over the next several years in alleviating both entry-­level education quality and professional mobility concerns.

The project was titled Entry-­Level Analysis Project (ELAP). If that title fails to sing, it does accurately identify the project focus. The ELAP process illuminated some predictable strengths in massage education, but also some wide-­ranging knowledge and skill gaps. We can’t be certain how these skill gaps formed, but we can speculate that educational programs leave out certain subjects, address others in inadequate depth, fail to reinforce particular desirable behaviors, or dilute essential learning with too much focus on other topics.

With such gaps and inconsistencies, exacerbated by frequently vague state education requirements and equally vague education content descriptions on school transcripts, further compounded by diverse profession entry testing options, it is no wonder that some state licensing boards are cautious about licensure portability.

Such education inconsistency frankly also causes some other health care professions to look at massage therapy with a skeptical eye, and to be hesitant about referring patients to massage therapists. Getting to a place where every newly trained massage therapist has completed education in agreed-­upon core knowledge and skill development, thereby being positioned to be able to reliably deliver a quality basic massage, can potentially increase confidence among other health care providers. Our profession thrives when primary care providers recognize the power of evidence-­informed massage therapy for the treatment of pain, stress, and other common problems.

The ELAP Work Group

The Core: Entry-­Level Massage Education Blueprint is the product of the seven work group members – Pat Archer, Clint Chandler, Rick Garbowski, Tom Lochhaas, Jim O’Hara, Cynthia Ribeiro, and Anne Williams. While other individuals potentially could also have been constructive work group contributors, we are confident the final group of seven chosen individuals has superbly represented the interests of the massage profession.

The work group was asked to consider a multitude of previously completed massage and bodywork studies and reports, but to aim at constructing from the ground up what they believe should be the fundamental building blocks within every entry-­level massage therapy instructional program. Existing studies did contain useful nuggets, however, what is known about learning and delivery means has changed in the interim and, equally important, the kinds of learners populating massage classrooms have changed.

Work group members also reached out to all interested members of the profession for input. They commissioned fresh research to learn practitioner, instructor and employer perspectives. Then, about two-­thirds of the way through the project, they provided an opportunity for public comment about which learning objectives and activities should be embraced within core education. That public commentary significantly informed the final product. Where the work group judgment differed from majority perspectives, the work group has clearly articulated those differences and provided a compelling rationale for their choices in the Project Report document.

Integrating all this input into the group’s work proved a massive undertaking.

Coalition Support

The group’s work was funded by several of the Coalition organizations, but the work group worked independently and arrived at its conclusions independently, with no steering from Coalition organizations. The final report contains a highly comprehensive, detailed education blueprint that provides guidance on essential knowledge and skill components and the depth to which they should be taught. With so much detail, opportunities for divergent views certainly arise. Representatives from our seven organizations indeed may differ on several particulars. As such, neither the Coalition nor its constituent organizations, endorse every specific recommended sub-­topic, activity, or proposed weighting in the report

Those differences aside, we all heartily support the message of The Core: Entry-­Level Massage Education Blueprint and its companion document The Core: Entry-­Level Analysis Project Report. We believe the work group processes have been thorough, inclusive, intellectually honest, and defensible. Their instructional design approaches are solidly grounded. Their development of a tailored, innovative learning taxonomy is potentially an important gift to vocational education.

The work group agreed to clear parameters to guide their work. Following initial Coalition guidance, they put aside attachment to any particular philosophies or products to focus on outputs that reflected data findings, feedback from the profession, and the best interests of massage clients.

The Coalition specifically supports important work group choices to include in basic instruction for all massage therapists not only assessment protocols, but also the development of skills necessary to “choose appropriate massage and bodywork application methods to benefit [each] client’s unique health picture.”

The Coalition also commends the work group for its inclusive bridging approach, in response to profession feedback on the initial draft, to long-standing profession differences about techniques, approaches and language with reference to application methods. Rather than choose between Western and Eastern approaches and vocabulary, or among diverse styles and forms, the work group usefully has organized its recommended content around approaching “application methods and techniques based on ways in which the hands and other anatomical tools … manipulate … soft tissue structures.”

We believe that the efforts of work group members have resulted in an extraordinary, ground-­breaking body of work. Their Blueprint, and the underlying process described in the report, gains strength from its intellectual integrity and independence.

Core Outcomes and Instructional Hours Recommendations

One key focus of the project is to recommend the minimum number of instructional hours schools and proficient educators need to prepare their students for entry into the profession. Instead of attaching a relatively arbitrary number of hours to subjects and topics, the work group approached this task by using data and feedback to define core content first – differentiating foundational learning from advanced theory and practice. It was only in the final month of its endeavors, when the blueprint was complete, that the work group tabulated hours for subjects, topics, and sub-topics by translating learning objectives into recognizable classroom learning experiences as a means to determine timeframes.

That said, the work group’s eventual recommendation that approximately 625 classroom hours of capable instruction would be required for students to acquire just core skills and abilities is invigorating. For context, a majority of states with massage regulation (28 of the 45 states including D.C.) now require 500 total education hours; another 7 require between 570 and 600 hours, and 10 require more than 625 hours. Still, the typical distance to be bridged may not be so daunting: a 2012 survey of massage programs revealed that average program length was 697 hours.

The hour estimate is what it is – an honest, objective best estimate by seven instructional design and curriculum experts who thoroughly examined the profession’s body of past work in this realm. The elements making up The Core were built piece by piece. The 625 hour total represents simply the summing of the instructional hours associated with each of the pieces.

We encourage interested parties to focus less upon the total hours and more on recommended subject matter and subtopics. Indeed, many massage therapy instructional programs already provide more than 625 total education hours. The Coalition recommends that, in addition to meeting the total education hours mandated by individual states, every  massage school curriculum include Core report recommended subjects, topics and weighting.

This report will require each of the constituent organizations to assess our perspectives on the subject of appropriate education hours. What we do clearly agree upon is that the work group endeavors represent real progress in that its findings are based upon substantive assessment. That is far superior to arbitrary bases and biases that all too frequently have animated past decisions by licensing boards, cities, accrediting bodies, professional associations and others.

Education Costs: Career Impacts

One other constituency – prospective massage school students – will be impacted should The Core gain the breadth of influence we seek. As previously noted, most states now require a minimum of 500 hours of massage instruction to qualify for a license. Adoption of The Core would entail a 25% increase in minimum required instructional hours, which will likely translate into more tuition dollars for students.

It is important to note that today 40% -­ 50% of massage school graduates exit the field within 24 months after graduation. Many factors contribute to this result, including unrealistic expectations about the physical demands of massage work, compensation realities, and evolving life circumstances for 20-­somethings. Implementing The Core won’t cause all attrition from the field to cease, but, by providing a sound knowledge and skill foundation, a more functional curriculum should materially help to lessen the proportion of massage school graduates having to write off the cost of their massage education just a year or two out from graduation. We believe that use of The Core has the potential to lengthen and strengthen the careers of new massage school graduates; that is a cost benefit that will outweigh any increase in tuition from a 500-­hour program.

The Importance of Diversity

It is vital to understand what The Core is not – it is not a complete massage school curriculum. The contents of this report are seen as the core – the foundational knowledge and skills every beginning massage therapist should possess – that should be part of every entry-­level massage instructional program, but not the entirety. The massage and bodywork profession benefits from diversity in program points of emphasis and features. Diversity and innovation are profession strengths. While we believe that a student completing an instructional program containing just the recommended core elements would be ready to begin practice, we encourage individual schools to add program elements that reflect each school’s expertise and philosophy, or to provide greater instructional depth in selected subject areas.

Indeed, the recommended hours allocated to the practice of essential massage and bodywork application methods are independent of any specific modality. The work group listened to profession feedback that insisted that one form of hands-­on work is not superior to others. Instead, the defining feature of massage and bodywork is therapeutic, structured touch, regardless of the system through which it is applied. This is a significant departure from previous thinking in our profession, one that builds on valuable diversity and exploration in education.

What’s Next?

The Coalition believes use of The Core will elevate instruction, because it presents clear learning objectives and guidelines. Relatively inexperienced instructors will especially benefit from an improved road map. However, it is important to understand that the ELAP blueprint and the hours allocated to topics define minimum classroom hours. The blueprint places an emphasis on practical, real-­world learning appropriate for adult education. It assumes that teachers are competent, that learners have average learning ability, that only the defined content is taught, and that class time is well structured and used efficiently.

Clearly, with these caveats, instructor training needs greater focus. Next steps in our profession should focus on helping massage content experts transition into classrooms with effective strategies to support adult learning

Our desire is that The Core: Entry-­Level Massage Education Blueprint will have a positive, transforming impact on the massage therapy profession. Our organizations do not have the power to force the re-­modeling of massage therapy instructional programs, but we believe that a movement toward adopting the ELAP standards would be beneficial for both massage therapists and massage therapy consumers.

We aspire to have this report influence several profession audiences:

• the Federation of State Massage Therapy Boards, which can use The Core as it builds guidelines for a model practice act;
• state licensing boards, which can use The Core in setting education requirements for licensees;
• the Alliance for Massage Therapy Education, which can refer to The Core in creating teacher-­training standards and curricula;
• the National Certification Board for Therapeutic Massage & Bodywork, which can   use The Core as it identifies beginning vs. advanced knowledge and skills for its Board Certification credential;
• professional membership organizations, which can use The Core in shaping membership criteria;
• the Commission on Massage Therapy Accreditation, which can use the Core in evaluating massage and bodywork curricula for programmatic accreditation;
• other accrediting organizations, which can use The Core in shaping their accreditation criteria;
• school owners, administrators and faculty, who can use The Core to strengthen or validate curricula and to adopt consistent learning outcomes;
• and, potential massage therapy students, as they consider where to enroll.

The Core may also influence publishers and writers in the development of new textbooks and teaching materials; continuing education providers who can develop offerings that build onto Core principles; employers, who will be able to rely on graduates of programs that use The Core to have dependable skills; health care providers, who want to make referrals to consistently well-educated massage therapists, and finally the end-­users: massage therapy consumers, who will more reliably be able to get the therapeutic massage they are looking for.

The single most powerful lever for change would be a decision by every state massage therapy licensing board to require license applicants to have completed an education program that includes The Core. Pragmatically, such a requirement could neither be retroactive nor immediate. Time would be required for schools to implement the new recommendations, for teaching materials to be developed and for creation of a method to identify which programs have implemented The Core.