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11 October 2008

NC Board votes to make MBLEx its primary exam

Last night, I received the following update from North Carolina, written by Rick Rosen, which delineates the NC Massage Board's decision to accept only the MBLEx after the end of 2010. Rick was the founding chairman and a past member of the North Carolina Board of Massage & Bodywork Therapy, and was the first Executive Director of the Federation of State Massage Therapy Boards.

The move to the MBLEx can essentially be considered as a natural evolutionary step of the profession. It took regulation of massage by a majority of states to motivate formation of an association of the individual boards and regulating agencies. Once that association formed, it was also expectable that provision of a licensing exam would be brought back under public control and accountability. Occupational licensing, and hence the control of prerequisites to licensing, is inherently the power and responsibility of the states under the U.S. constitution.

 

01 October 2008

Another Year without a Postsecondary School Bureau

On Tuesday, September 30, 2008, Governor Schwarzenegger vetoed Senate Bill 823 which would have reestablished a bureau, under the Department of Consumer Affairs, to oversee operation of private postsecondary and vocational schools.More information is available from the DCA at the website of the former Bureau of Private Postsecondary and Vocational Education (BPPVE), which sunsetted in July 2007 after Governor Schwarzenegger vetoed an extension bill.

SB 823 had also drawn opposition from the California Association of Private Postsecondary Schools (CAPPS) and, according to CAPPS, was also opposed by the Department of Consumer affairs. The bill was 125 pages long, underscoring the complexity of requirements implicit in Schwarzenegger's veto message.

I have repeatedly stated that a reform act must be written clearly, should not be subject to varied interpretations, should treat schools as uniformly as possible, and provide reasonable roles and responsibilities for the Bureau. Our collective objective should be to successfully strike a balance between protecting students, while being firm, yet fair to schools. Unfortunately, this bill does not meet those goals. Instead, this bill would create a statute that would be a challenge to successfully implement. If a statute is not clearly drafted, reasonably enforceable, or easily understandable to students, schools, and regulators, no one is well served.

A Sacramento Bee editorial on 22 June had pointed out some of the problems with the bill. Inflexible bills can be a particular problem for areas of training such as massage and performing arts that often don't result in traditional job placement statistics. One of the sticky points of the current bill was in the Student Tuition Recovery Fund (STRF), essentially a fee levied against each enrolling student as a form of pooled insurance against school closures. Not only was there an explicit assessment, but a provision for special assessments should the pool run low. A string of school failures in one area of training could thus have potentially serious impacts on regulated schools across the board in the form of an unplannable expense.

 

30 September 2008

SB 731 Enacted in California

SB 731 was signed by Governor Schwarzenegger on 27 September, changing the regulation of massage from being local to being a mixture of state and local regulation. SB 731 authorizes creation of a 501(c)(3) non-profit organization to certify massage therapists at the state level. The "organization" remains under legislative review and is subject to the due process and open meeting laws (Bagley-Keene) typical of public agencies. Through 2015, it provides for two-tiers of certification: "massage practitioners" at 250 hours of training and "massage therapists" at 500 hours of training. After 2015, no new 250 hours certificates would be issued, however, previously issued certificates would continue to be renewable. The bill itself, however, sunsets (expires) at the end of 2015, unless renewed, so the expiration of the "massage practitioner" level would only have impact after renewal of the bill and only if the renewal didn't change the language stipulating such expiration.

In the meantime, there is no practical difference between the two tiers. The 250 hour tier stipulates that "Included in the hours shall be instruction addressing anatomy and physiology, contraindications, health and hygiene, and business and ethics, with at least 100 hours of the required minimum 250 hours devoted to these curriculum areas." The 500 hour tier does not add any specific training or outcomes of training. It is thus more of a marketing distinction than any additional stipulation of well-defined training outcomes. Particularly if one is going to eliminate the 250 hour tier, the public should be guaranteed that the 500 hour tier represents a well-defined curriculum teaching a clearly defined body of knowledge and skills with well-specified training outcomes. This lack should be addressed before the legislative renewal of the bill.

There is an interesting feature to the "500 hour tier" in that it requires [4601(c)(2)] satisfying one of either the 500 hour curriculum requirement or passage of a "massage and bodywork competency assessment examination that meets generally recognized psychometric principles and standards, and that is approved by the board." On the hour side, schools approved by the state, part of the state higher education system, accredited by a Department of Education approved accreditation agency, or similarly approved by another state are considered to be "approved schools".

For both tiers, SB 731 provides that those certified are exempted from local licensing. For certified sole proprietors and for businesses hiring only certified practitioners or therapists, SB 731 also requires that zoning and building requirements be the same as for other professional and personal service professions. There is no distinction between the two tiers in these matters. Those not certified would still fall under local regulation. The terms of such local regulation for those not certified remains at the discretion of the local cities and counties. SB 731 does not define massage, but exempts those certified from whatever regulation local agencies consider to be "massage regulation". In this, SB 731 is a "title act" that exempts those certified from local "practice acts" and from specialized massage zoning stipulations. Nothing, however, requires local agencies to provide a viable means of practicing outside of certification. That remains a matter of local discretion and the local political process.

Because SB 731 does not define massage, it also does not define a scope of practice for massage. If one is claiming treatment of conditions, one must fall back on SB 577 (Burton; 2001-2002 legislative session) and its stipulation for client education and signed client acknowledgment. SB 731 makes explicit (section 4608) that it does not infringe on the right to practice under SB 577 as chaptered in law under Sections 2053.5 and 2053.6.

Outside of use in the bill itself, SB 731 does not define any specific titles to be used by those certified. It does, however, preempt use of claiming to be a "certified massage practitioner", "certified massage therapist", or similar language that might imply state sanctioned certification. Those using such titles and not becoming certified will have to change their usage. Because certification is handled through a private organization, even though a creature of the state, SB 731 also disallows any claims to be state-certified or state-licensed (i.e. licensed, certified, or registered by an agency of state government), even for those certified by the organization. The forbidden title uses are defined in Sections 4605-4607 to be unfair business practices.

Since the certification agency is a private rather than a state entity. It is not subject to the state hiring freezes and subsequent raids on accumulating funds that have plagued California licensing boards.

Toward Massage Guidelines

Toward the end of August, the inaugural issue of the Massage Therapy Foundation's (MTF) new e-journal came into reality. Welcome the International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice (IJTMB). Not by coincidence but by some hard work by a team of people, the MTF's Best Practices Committee has a report to the profession (under the practice section) on its work on developing a process to create practice guidelines for massage therapy. The paper both provides a literature review and sets the groundwork for the elements important to the creation of usable guidelines. Prominent in those elements are transparency of the creation process and a process of wide review and input.

 

18 May 2008

Massage Therapy Records from the NPDB

The CLEAR blog recently noted that the National Practitioner Data Bank (NPDB) public use data file had been updated to include information through the end of 2007. Since November 1999, the NPDB has included information on actions involving massage therapists under the license code 405. A while back, I'd created the tools for extracting the MT records from the NPDB file and making them web-displayable. So here's the massage therapy records as encoded in the NPDB.

I've no means of verifying that the data are encoded correctly. For example, one record from PA reports an instance of death and encodes the transgression as "failure to order appropriate test". That "ordering tests" is generally outside of the scope of massage therapy flags this one as questionable. While most of the malpractice insurance payments have been small, there have been several sizable ones, confirming the advisability of carrying liability insurance.

Annotated Bibliography for Massage Therapists

Over the last couple of weeks, I've done a couple of rounds of updating the annotated bibliography I maintain. While billed as "for Massage Therapists", it also has a goodly number of entries toward a lifestyle synergistic with what often impels people toward massage, entries on dance, and general anatomy and physiology.

 

14 May 2008

What are Licensing Board Funds for Anyway?

Having recently written about licensing board budgets, my eye was caught by a Sacramento Bee article on an item in the California Governor's latest budget proposal — "borrowing" from special funds until 2010-2011 (or later), including the funds of licensing boards. The boards affected include:

• State Board of Barbering and Cosmetology Fund – $10 million
• Psychology Fund – $2.5 million
• Accountancy Fund – $16 million
• Contractors’ License Fund – $13 million
• Contingent Fund of the Medical Board of California – $6 million
• Board of Registered Nursing Fund – $2 million
• Pharmacy Board Contingent Fund – $1 million
• Professional Engineers’ and Land Surveyors’ Fund – $4 million
• Behavioral Science Examiners Fund – $3 million
• Vocational Nursing and Psychiatric Technicians Fund – $1 million
• Occupational Therapy Fund – $3 million

As I mentioned in my recent licensing board budget post, the issue of borrowing from boards was discussed in a 2005 document on cross-cutting issues from the Joint Legislative Committee on Boards, Commissions, and Consumer Protection. As Yogi Berra quipped, "It's deja vu all over again."

For those who really might have preferred a state licensing board to the private, state-overseen, credentialing organization proposed in SB 731, the phrase "Be careful what you wish for, lest it come true" comes to mind. It's all too easy, in these days of state fiscal woe, for such a board to find itself impacted by a state hiring freeze with the state tapping into the resulting accumulation of funds to balance the budget. A private certifying organization — even one specially created by state law, under legislative oversight (as is appropriate to ensure public accountability), and affecting local regulation — lies outside of the state budget and state hiring restrictions.

 

04 May 2008

Credentialing of CAM Practice

In his CAMLaw Blog, Michael Cohen recently posted testimony he gave in 2001 on Training, Education, Credentialing of CAM Practice to the White House Commission on Complementary and Alternative Medicine Policy.

Fraser Institute Report on CAM use in Canada

In 1999, The Fraser Institute published the first ever comprehensive study of Canadians' use of and public attitudes towards complementary and alternative medicine (CAM). Last year, a new study was published to capture any changes that have occurred.

Canadians spent an estimated approximately $7.8 billion out of pocket on alternative medicine in the latter half of 2005 and first half of 2006, which is a significant increase from the nearly $5.4 billion (inflation-adjusted) estimated to have been spent in the latter half of 1996 and first half of 1997. Despite incurring large out of pocket expenses, the majority of Canadians believe that alternative therapies should be paid for privately and not by provincial health plans.

In 2006, more than one-half (54%) of Canadians reported using at least one alternative therapy in the year prior to the survey. Massage therapy, was the most common CAM use in the prior year, having been used by 19% of respondents. Average out of pocket payments for massage therapy over the prior 12 months increased from $211 in 1997 to $365 in 2006. If given $100 for treatment of low-back pain, study respondents would have spent, on average, $31 for surgery, $30 for chiropractic treatment, and $40 for massage and exercise therapies.

Esmail, Nadeem. 2007. Complementary and Alternative Medicine in Canada: Trends in Use and Public Attitudes, 1997–2006. The Fraser Institute. ISSN: 1206–6257

Diversity, Creating a Profession, and Calls for Two Tiers

I find it interesting that I've been seeing calls for two tiers of massage licensing in a diversity of places. Doug Barhorst recently wrote a good piece on the need and benefits of two tiers on his Texas Licensed Massage email list. When I opened my newly arrived copy of Massage Magazine, I found a guest editorial by Phyllis Nasta on “It's Time for Two Tiers of Licensing”. My friend Robert, long hostile to any thought of licensing, has shifted over to separation of licensing, with the lower tier or tiers providing background checks and disciplinary oversight of a more simply oriented provision of commercial touch. That's espoused on his newest blog and another meet-up site called CARPET (California Associated Receivers and Providers of Enlightening Touch). In a survey a couple of years ago, ABMP found considerable support among California massage schools for two-tier licensing. Two-tiers are currently in the proposed CA bill, SB-731, although only on an interim basis. Still, the lower tier wouldn't be eliminated before the measure itself sunsets—there would be five years to work on the legislature. What's common to all of these voices is the feeling that worthwhile services by good-hearted people are being eliminated by the current technically-oriented mindset of massage therapy and its push toward being a health care profession. At its heart, the two-tier movement is a “back to basics” movement—a movement about providing the service of simple touch and connection to those who need it.

Interestingly, a two-tier way of thought is also a result of trying to improve the positioning of massage therapy as a health care profession. In a recent white paper, Rick Rosen presents his views On Becoming a Profession.

Despite the fact that it has become commonplace to refer to this occupational domain as “the massage therapy profession”, it lacks a number of essential elements that are considered to be hallmarks of a full-fledged profession. These include: a well-defined body of knowledge; educational standards; teacher training requirements; common terminology; standards of practice; and a regulatory system that affords public protection and allows inter-state mobility for practitioners. While some of these elements exist on a limited scale, there is little consistency among them.

I agree with Rick on a number of issues, although I have much less faith in the process of accreditation in achieving cost-effective training quality. In general, I've spent too many years employed as a physicist at a national laboratory to not have become skeptical of the efficiency of large bureaucracies. Yesterday's posting delved sufficiently into accreditation, however, and I won't expand on that further.

I do strongly agree with Rick that massage therapy, as currently regulated, lacks a single, coherent knowledge base typical of a health profession. The regulation of massage was not approached to create a health care profession, but to cast a wide regulatory net over the commercial provision of touch services. Looking back to 2000, there was a Massage Magazine articles on The Regulatory Net Part One: The Catch-All Effect of Massage Laws. The effect of this history is that regulatory laws are vague on knowledge and outcomes. Required hours of training may create an entry hurdle, but they don't define a cohesive profession. Many caught within the current net also have little interest or willingness to be herded together.

Resolving the issue requires distinguishing between massage therapy as a health care profession and massage provided as a more general, less defined (or definable) service. Not making the distincition still makes it, but simply by eliminating those not interested in the “professional progression”. In essence, making the distinction is what the title act for massage therapy accomplishes in British Columbia. Massage therapy, as included in the health professions, is regulated, yet it includes no restricted acts. In is unlikely in the U.S., however, that commercial provision of touch will not be regulated at some level of government. The only way of resolving the issue is to split the practices. For basic touch, define what training in knowledge and skills is essential, then provide disciplinary oversight. If you can't define a specific knowledge or skill requirement, it isn't essential. For massage as health care, start work on defining the outcomes of training; the sum total of what the health care massage therapist should be able to do and the auxiliary conditions and contexts under which they should be able to do it. The knowledge and skill training will follow from the outcomes. Among the resources, include books such as Working Minds A Practitioner's Guide to Cognitive Task Analysis by Beth Crandall, Gary Klein and Robert R. Hoffman.

 

03 May 2008

Education, Training, and the Conundrum of Accreditation

Unless the universities begin preparing students to participate in the “Great Conversation that began with the dawn of history and continues at the present day,” the outlook for Western civilization is indeed grim. — Robert Maynard Hutchins (Time, Monday, Sep. 21, 1953)

Maynard Hutchins' reference to the “Great Conversation” is a reference to the classical ideal of a liberal education that was forwarded by himself and Mortimer Adler. Adler's comment was:

What binds the authors together in an intellectual community is the great conversation in which they are engaged. In the works that come later in the sequence of years, we find authors listening to what their predecessors have had to say about this idea or that, this topic or that. They not only harken to the thought of their predecessors, they also respond to it by commenting on it in a variety of ways.

Hutchins, as noted in the review in Time, added a stronger statement on the purpose of education.

Education should be neither a means toward earning a living nor of promoting social reform. Education should be liberal, its object “to prepare the young to educate themselves throughout their lives.” With such an education, a man can take part in the continuing Great Conversation, and himself seek the answer to the overwhelming question: “What is the nature and destiny of man?”

This view of education, a view that separates education from the more pragmatic and immediate goals of training, is, I suspect, why the process of accreditation is what it is and why it has in recent times found itself caught on the shoals of controversy. Accreditation has its roots in the “Great Conversation” and those schools that supported it.

Accreditation has always been about the larger educational processes of creating the stability and environment to sustain and foster the academic world view. It was not created to ensure the quality of any specific section of training, but to sustain the quality of discussion as a whole. Academic discussion, however, is more often about knowing and discussion than about the mundane features of skills and doing, a feature noted by Paula Alsher in a article on Validating Knowledge Through Testing and Assessment for the Center for Effective Performance.

Because the roots of learning in the business world are found in the academic model, it’s not surprising that testing and assessment also typically follow that model. … At the end of the training, learners are tested on their ability to recall the content. True-false or multiple-choice questions are used to test the learners’ knowledge. If learners are able to answer questions more or less correctly, they are deemed “trained” and job-ready. But when those same learners go back to their jobs, managers quickly discover that they are not fully ready to perform, despite the knowledge they might have attained in training.

What started out, however, as a means for the academic world to maintain its academic integrity, to determine who was or was not part of the academic club, became more complicated when the federal government adopted accreditation in the 1950's as a gatekeeping function for federal financial aid. The move was not a bad one in itself; an institution that conforms to the larger picture of education is unlikely to be one lacking in educational value and simply wasting federal funds. The conundrum, however, is that this association opened the door to viewing accreditation as the benchmark of quality in training, something quite apart from its origins. That thought, however, moves us into the current realms of discussion and controversy surrounding accreditation. To exemplify the seriousness of this discussion, consider a statement from a January 2007 report from the Association of College Trustees and Alumni (ACTA) titled “Why Accreditation Doesn't Work and What Policymakers Can Do About It”.

Nothing in the accreditation process concretely measures student learning, instructional quality, or academic standards. Nothing measures whether students have made intellectual progress since high school or have attained a level of basic knowledge and competence that would be expected of college graduates. If the accrediting process were applied to automobile inspection, cars would “pass” as long as they had tires, doors, and an engine—without anyone ever turning the key to see if the car actually operated.

This report was a follow up (and the answer) to a prior ACTA report, “Can College Accreditation Live Up to Its Promise?” A reply to both reports was offered up by the Council for Higher Education Accreditation (CHEA) under the title “Here we go Again …Sin, Salvation, and Accreditation.”

CHEA also has a number of its own reports covering issues of reforming accreditation—making it more accountable to consumers and more focused on student outcomes. Notable among them are “Accreditation and Accountability: A CHEA Special Report” and “Accreditation and Student Learning Outcomes: A Proposed Point of Departure”.

All of the above is also occurring within the context of the report from the Secretary of Education's Commission on the Future of Higher Education. The Issue Papers section contains a number of papers on accreditation and its much needed reform.

Finally, there were two comparisons between accreditation and state-approval of schools done in California in 2004. When he was Chair of the California Assembly Business & Professions Committee, Lou Correa requested a report from the California Research Bureau. The California Postsecondary Education Commission also wrote a similar contrast report.

Ultimately, the quality of a program that is oriented toward training rather than broad education derives from the stipulation of clear outcomes and assessment that they actually occur from training. At least at the present time, it appears that accreditation is far too diffuse a mechanism and in far too much flux of its own to further these goals is an efficient, cost effective manner.

At the same time, there are efforts underway in learning and competency information management from a diverse consortium of defense, business, and education stakeholders that may reshape training as much as the Internet has reshaped communication. In fact, the consortium is much like that which created the Internet itself, as a means of having a distributed (and thus attack resistant) communication network. That, however, is another story for another, near-future MPS post.

 

01 May 2008

How much does a California Regulatory Board cost per Licensee?

A combination of the Governor's budget for the regulatory boards within the CA Department of Consumer Affairs and the recent DCA Annual Report paint an interesting picture of regulatory board costs. The budget gives the total expenditures and the annual report lists the number of licensees for the individual boards.

As background, boards are generally self-financed by licensing and other fees. Some boards may also get revenue from other services provided to the public or licensees. However, spending the money they receive from such fees still requires legislative approval. State boards also are subject to state staff hiring freezes, so they can, at times, collect funds but be unable to hire needed staff to spend them. A 2005 Joint Legislative Committee report discussed issues related to accumulating funds and state budget balancing.

The following table lists a number of the professional boards, their total expenditures for the 2007-2008 fiscal year in thousand of dollars (k$), the number of licensees, the expenditure per licensee in dollars, and a fit to the dollars per licensee (see below). None of the boards above had an expenditure budget less than $1 million annually.

Board Name	Expenditures (k$)	Licensees	$ / Lic	Fit of $ / Lic
California Board of Accountancy	12,410	45,004	$276	$75
California Architects Board	4,230	21,998	192	96
Board of Behavioral Science	5,821	64,665	90	69
Board of Barbering & Cosmetology	17,653	476,352	37	57
Dental Board of California	12,901	42,660	302	76
Board for Geologists & Geophysicists	1,311	7,602	172	173
Medical Board of California	52,699	139,299	378	61
Acupuncture Board	2,653	8,502	312	161
Physical Therapy Board	2,457	25,298	97	91
Physician Assistant Committee	1,184	6,595	180	191
California Board of Podiatric Medicine	1,355	2,579	525	404
Board of Psychology	3,432	17,500	196	106
Respiratory Care Board	2,903	16,511	176	110
California Board of Occupational Therapy	1,046	9,682	108	148
State Board of Optometry	1,205	9,692	124	148
Osteopathic Medical Board of California	1,276	5,171	247	229
California State Board of Pharmacy	9,729	103,408	94	64
Board for Prof. Engineers & Land Surveyors	9,179	114,299	80	63
Board of Registered Nursing	24,092	425,115	57	57
Veterinary Medical Board	2,266	16,976	133	108
Board of Vocational Nursing & …	8,542	85,198	100	66

In the following graph, board expenditures per licensee are plotted with blue symbols. An approximate fit to the less expensive boards is shown in gold symbols. The fit is based on a fixed board cost of $900,000 and an additional cost per licensee of about $55. As a reminder, these data represent annual expenditures, not expenditure per license renewal period. The higher cost boards include the medical board, dental board, and board of accountancy. The differences in cost appear to follow staff size relative to the number of licensees. For example, the medical board, pharmacy board, and board for professional engineers & land surveyors all have somewhat over 100,000 licensees. They have staff sizes of 265, 51, and 53, respectively. The latter two boards have comparable staff sizes and comparable expenditures. Staff needs would vary with the need for onsite inspections and the complexity of disciplinary investigations and prosecutions.

The physical therapy board, the occupational therapy board, and the registered nursing board all lie along the fitted curve. The fitted curve thus likely gives a reasonable estimate for the annual expenditures to be expected of a massage board, unless the need for onsite inspections by board staff was significantly higher for massage. While a private certification agency under legislative supervision is contemplated for California under SB 731, it is likely that it would require similar expenditures to a board. One major difference would be that it would not be subject to state hiring freezes.

The greater cost per licensee for smaller professions (<10,000) motivates why legislatures would consider placing regulation, if needed, under an existing board or administrative bureau rather than creating a new board.

 

23 January 2008

Massage Kiosks, Costs, and Profitability

Last Sunday's San Francisco Chronicle ran a story on the massage kiosk (Zubio) effort being floated by David Palmer and Sam Keller. The article notes the difficulties of finding space and achieving profitability in a commercial environment. Palmer has long been an advocate of bringing massage into people's work lives rather than forcing people to come to massage.

Arizona May Consolidate Health Care Boards

A story in the Arizona Republic reports that Arizona Governor Janet Napolitano is pushing to consolidate a number of health care and personal service regulatory boards under a single administrative umbrella. Napolitano is supporting a series of bills in the Legislature to eliminate nine inactive boards and consolidate more than 30 others. The result might be along the lines of the Texas Department of State Health Services (DSHS) or New York State's Office of the Professions (OP). Such consolidation rarely makes individual professions happy, but it does provide a means of regulating for the public benefit and lowers administrative costs. Having such consolidations doesn't imply that domain experts can't be consulted as needed by the regulatory agency.

Another take on Colorado's Massage Regulation

An article from Colorado Spring's KOAA TV notes that El Paso County is frustrated with the state neither licensing massage practice nor allowing the county to do so. Such input may put more pressure on DORA, which recently recommended against state licensing. This is another reminder that much of the push for state licensing has little to do with the actual practice of massage and more with oversight of commercial touch.

The article links to a nonprofit working against human trafficking started by a massage school. The nonprofit, in turn, links to a number of other NGO's involved in such work against trafficking. In some ways, however, prostitution and trafficking are not synonymous, as brought out in a recent Economist article on a conference on Selling Sex (19-25 Jan 2008 issue) and by a Canadian article on decriminalizing sex work and activism by sex workers. I've also run across a European article extensively reviewing both demand and economic forces enabling trafficking. The latter article is especially significant in discussing that for some, the economic hope and life possibilities are so poor that being trafficked looks better than staying home. It's also worth noting, that whatever the cultural myths, trafficking and prostitution both require relatively local demand. This demand is coming from within the same culture trying to suppress its visible effects — a clear indication of a significant, undealt with social schism. In any case, there is much that can be worked on at an earlier stage than law enforcement. As an example, I'll point to my Ramblemuse Touchpoints blog on Three Cups of Tea linking to Greg Mortenson's work in creating schools in remote areas of Pakistan. A little hope and opportunity could greatly reduce the supply side of trafficking. It would seemingly take a lot more early training in empathy and social connection to reduce the demand side.

The regulatory association between massage practice and sex work is one that massage practitioners consider to be about on the same level as most people consider spam — something that they would be happy to see go away and never come back. Moving regulation from the local to the state level hasn't done away with that tacit association. The structure is still about control of commercial touch rather than about defining explicit outcomes for competence. The advantage is not in structure, but in uniformity of entry requirements and in escaping the unwillingness of a relatively few local agencies to recognize that massage therapy is a well-established profession in its own right. A recent foray into Google Books turned up book references to “Swedish Massage” dating back into the late 19th century.

 

01 January 2008

MPS Entries for 2007 Archived

The MPS entries for 2007 have been moved into their own archive file. There's also a link to the old index page from the archive index page on the navigation bar to your left.

If you came here via a link or search to the old index entries, there may be a date hash of the form "#pyymmdda" following the "index.html" at the end of the URL in your browser's address bar. When you get to the archived file, go to that date to see the entry you were seeking. You can even copy the "#pyymmdda" hash here, and paste it on the new page, then hit the enter key to go there. Here's a JavaScript based link that does all of that for you.

 

It is through each of our individual efforts that together we work to keep or get our profession and practices independent of unnecessary and/or onerous regulation. It is the responsibility of the state to protect the public from harm. It is the job of the profession itself, independent of the state, to develop norms of practice for particular client populations and contexts.

Liberty means responsibility.  That is why most men dread it. — George Bernard Shaw, Man and Superman, "Maxims: Liberty and Equality", 1905

 

 

Copyright by Keith Eric Grant — The Ramblemuse^SM — Last revised Thu 16 Oct 2008

Masthead and border based on the photo Knight by Elvinstar.