Contributed by Jolie Haun PhD, EdS, LMT; Derek Austin, PT, DPT, MS, BCTMB, CSCS; S. Pualani Gillespie, LMT, MS, RN, BCTMB

Professional accountability is the backbone of advancing a field of practice for professionals. In the field of health and wellness, complementary and alternative medicine (CAM) disciplines have made great strides in validating the profession's accountability through regulatory mechanisms such as formalized accredited education, licensure and laws of practice. Brett and colleagues published a 2013 review in Explore focusing on an in depth examination of competencies for public health and interprofessional education for four CAM disciplines including naturopathic medicine, chiropractic health care, acupuncture and oriental medicine and massage therapy. This month's review presented by the writing group at the Massage Therapy Foundation takes a closer look at this review to highlight the educational accreditation standards for massage therapy.

Brett and colleagues identify public health and other competencies as a core contributor to maximizing service to patients and the public through cooperative collaboration among health care professions. Educational accreditation standards are the framework for delivering competencies and are the foundation for interprofessional education. Brett and colleagues suggest requiring competencies through accreditation standards ensures massage therapists are trained to practice in clinical care settings. To orchestrate this effort, the American Massage Therapy Association (AMTA) created the Commission on Massage Therapy Accreditation (COMTA) in 1989. COMTA is the only accrediting agency recognized by the U.S. Department of Education (USDE) to offer programmatic accreditation for massage therapy schools. Programmatic accreditation gives COMTA the authority to require participating schools to teach and assess specific competencies.

The following list is identified as the foundational competencies from which public health competencies can be developed:

• Identify and practice appropriate methods of sanitation and personal hygiene in the performance of massage and bodywork sessions.
• Describe and demonstrate standard precautions.
• Demonstrate techniques that are appropriate for each body area, including endangerment sites.
• Vary the choice and application of techniques as appropriate to the client's needs, including those of special populations.

COMTA also requires competencies focused on skills required for the massage therapist to responsibly refer clients to other health care professionals and to develop and maintain healthy relationships with those professionals:

• Identify strategies for effective communication with other professionals regarding client care and referrals.
• Describe the process used to identify the scope of practice of allied health professions.
• Describe the appropriate use of medical release and consent forms.
• Discuss the process for establishing and maintaining professional relationships in the workplace.
• Discuss strategies for establishing and maintaining professional relations with peers and with other professionals.
• Identify strategies for conflict resolution with other professionals, including the need for documentation.

Brett and colleagues noted two examples of interprofessional training and education that is promoting the field and massage therapy professionals entering the workforce. They first identify the Pillsbury House Integrated Health Clinic, a social service organization that provides services to the underprivileged and underserved population. CAM practitioners and students deliver care in this clinic in an integrative approach, while providing learning opportunities for students.

The second example presented by the authors is the training provided by the Hospital-Based Massage Therapy (HBMT) courses, which focus on the unique practice setting of the hospital for massage therapists. HBMT courses teach interprofessional skills related to communication, documentation and clinical aspects that are needed to succeed when providing massage therapy services in the hospital environment. These interprofessional educational programs exemplify the opportunities to allow students to gain professional competencies while serving patients and promoting public health.

Though COMTA accreditation supports advancement of the field and assures competency of massage therapy school graduates, to date COMTA only accredits 88 massage schools and programs, representing less than 10% of all massage therapy schools. Furthermore, the authors indicate a major challenge to implementing the accreditation standards is that though COMTA schools are required to show evidence of education and assessment designed to help students achieve each of the competencies, schools are able to interpret the level at which the competency is taught and assessed which introduces significant variation in the approach taken by individual schools. As such, COMTA competencies reflect a relatively "low-bar" standard. Institutional accreditation is currently available however these agencies are viewed as, "a less onerous route to accredited status and access to federal title IV funding," however the field of massage is moving away from programmatic accredited institutions to implementing a state level license. Despite the evident benefit of increasing the standard of competencies for the field of massage therapy, currently there are no plans to change the interprofessional education or public-health related competencies.

Implications

As professionals in the field of massage therapy continue to conduct research in diverse patient populations, the use of massage in clinical settings will continue to increase. As such, the need for implementing COMTA accreditation will become more apparent and ultimately a necessity for massage therapy schools. Perhaps increased standards at the state level or advanced credentialing in the field could also help massage therapists learn the skills needed to work with clients across various healthcare settings. Some American massage therapists may be surprised to learn of Canadian massage therapists obtaining 2,000 or more hours of massage education at a minimum. Some American curriculums may simply be too short to cover both clinical skills and needed public health competencies.

Brett and colleagues suggest in their review that, due to the vast acceptance of massage therapy in health related and non-health related settings, massage therapists are in a position to have a real impact on public health through participation in interprofessional clinical settings. The authors ask the question, "How can a profession which is practiced on the beach or in a hotel spa have a meaningful impact on public health?" The popularity of massage alone makes it a powerful tool for promoting public health. Massage therapists should accept the need for entry-level practitioners to learn certain interprofessional competencies.

The authors contend, in order for massage therapists to maximize their impact on public health, "They will need to embrace their responsibility as true healthcare providers and not retreat to the shelter of the limited scope of technicians." Considering that COMTA competencies are developed by professionals within the field of massage therapy, it seems that meeting these competencies could be the best, first step toward embracing that responsibility.

Supporting the advancement of the field of massage therapy is a primary mission of the Massage Therapy Foundation. You too can support this mission by donating to the Foundation: www.massagetherapyfoundation.org.

Reference

• Brett J, Brimhall J, Healey D, Pfeifer J, Prenguber M. Competencies for public health and interprofessional education in accreditation standards of complementary and alternative medicine disciplines. Explore. 2013; 9(5):314-20. doi: 10.1016/j.explore.2013.06.001.