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Julie Onofrio

Informed Consent

January 19, 2021 By Julie Onofrio Leave a Comment

Informed consent is one of the most important parts of the therapeutic relationship and building a massage therapy business. You inform clients of what you are going to be doing and why and everything about what you know so they can be informed and clear about what they will be getting. They get to have input into the care that they receive. It also is what will protect you when a client makes a claim against your liability insurance or makes a complaint about you. It is the basis for a safe experience for both the client and the therapist. It is the foundation of the therapeutic relationship and building a successful massage business.

From the minute they start searching for someone to give them a massage, either online or by asking friends and doctors for referrals, a person that will get initial impressions of you which starts the process of the therapeutic relationship.

Clients must be informed of:

  • Who you are and that you will be working with them.
  • Your work hours, fees and policies.
  • The background, history, tradition or evidence of your work.
  • Your training and experience in learning the massage method. How many years of training and experience, classes taken, teachers and reputations, board certifications or certificates (know the difference).
  • The benefits that should come as a result of the work. Know your research.
  • The risks involved in getting the massage.
  • How people may feel before, during and after a massage.
  • What to expect during a massage session with YOU. What areas of the body will you be working on and how. What areas of concern do you and the client have?
  • Describe sessions in a language that is simple and clear, explaining technical terms. What happens from the minute they think about trying you for a massage – the website, scheduling, cancellation policies, appointment times and days, techniques you will use and how feedback will be handled. Assume that people know nothing about massage or the work you do.
  • Clearly state your scope of practice and that you are not able to diagnose anything.
  • Policies and Procedures including cancellation, no show, late arrivals, payment at the time of service, late fees, no payment or delay of payment fees.
  • What is expected from the client – being on time, draping, how to behave (no sexual advances).

Clients must be capable of making a decision for themselves and not be influenced by marketing, hype or rhetoric. A child may need parental consent.

Right of Refusal.

A client has the right to refuse treatment at any time before or during the session. The client should be able to ask questions at any time and stop the session at any time. They should be allowed to give feedback and have it be heard. This is often one of the most difficult things for clients to do when they are undressed and in a vulnerable space.

Informed Consent Forms

Having a client sign a consent for usually should be enough, but many do not fully read those forms.

Informing Clients

Beginning with first contact which is often a Google Business Listing or finding your website or talking to a friend/coworker/family member about you, your messaging needs to be clear and consistent. Your website should tell what solutions you provide as well as have your policies and procedures listed.

As you work with people on the massage table, you can also use this as an opportunity to inform them of everything you are doing especially if they have never had a massage session or had a session with you. Tell them how to lie on the table -under the sheets, face up or down or side, covering up, level of undressing and whatever is needed to help them feel comfortable. Tell them what you are doing before you do it —like I am going to massage the gluts or adductors or pec minor— and I am going to do this and this and you may feel this or this.

Documentation

The intake process and documentation of the session will help protect you in conjunction with the informed consent. If you did not document it, it did not happen.

Filed Under: Blog

Liability Insurance or Professional Association?

January 11, 2021 By Julie Onofrio Leave a Comment

Liability insurance for massage therapists is required in most states. It is a necessary business expense to protect your business and property.

There are many different groups offering massage liability insurance so it is important to compare and contrast the various plans to make sure you get the coverage that is best for you.

The most popular are:

  • Massage Magazine’s Insurance Plus – Massage Magazines Liability insurance plan
  • Hands On Trade. Owned by Judi Calvert who started Massage Magazine with her husband back in the early 90’s
  • American Massage Council –
  • CM & F group –
  • Hiscox – usually higher priced but better coverage.
  • Beauty and Bodywork Insurance
  • Alternative Balance – the only insurance I have seen that covers HIPAA breaches which is really a necessity.

Professional Associations for Liability Insurance.

The American Massage Therapy Association (AMTA) and the Associated Bodywork and Massage Professionals (ABMP) are the two main associations that also offer liability insurance.

AMTA has been the leading advocate for massage therapists in the US since the early 90’s. Each state has their own chapter for organizing and sharing information. AMTA usually has a national convention and many states have state conventions. AMTA is a non-profit membership association that means they puts the money earned back into the organization.

AMTA also owns Massage Today – the once popular online and print newspaper. They also are the main funding source of the Massage Therapy Foundation (research) and also the National Certification Board for Massage and Bodywork. The NCBTMB is also run by past AMTA board members and the executive director also was once the executive director for AMTA. The NCBTMB is having big financial troubles because of the Federation of Massage State Boards taking over the CE classes and becoming the main state testing source. The NCBTMB has created specialty certifications that really should have been board certifications, but they lack the financial resources to create board certifications. Currently, there is a committee working within the NCBTMB to figure out what to do with the Specialty certifications and will hopefully work to move them into true Board Certifications. (Yes quite the mess).

ABMP is a for profit company owned by about 8 different people. The company that owns ABMP is called Professional Assist Corporation, DBA Associated Bodywork & Massage Professionals, and also owns many subsidiaries Associated Skin Care Professionals, Associated Hair Professionals, and Associated Nail Professionals. They have quite a line up of free CE classes for everyone and more for members. They also were first to gather and share info on the Covid-19 issue.

Both have many added benefits like discounts on products and services like many of the individual liability insurances.

Choosing Wisely

With so many options, it divides our profession up which makes it very difficult to move forward on issues like getting license portability between states, consistent scope of practice laws, consistent CE classes that are evidence based, and working to get massage therapy more accepted by health insurance, Medicaid and Medicare.

Neither professional associations really fit the bill for what we need and we are falling behind in moving forward. There is also talk of new associations and even talk of unions forming to fill in the gaps.

Do you want to support growth of the profession or do you just want to be covered by insurance? Who should you choose if you want to support the growth of the profession?

Understanding Liability Insurance

There is a lot to know about liability insurance and it is often difficult to weed through it all to find out what is best for you.

ABMP has a booklet on it that is free. The 411 on Insurance (PDF)

Massage Exam has a comparison chart on massage liability insurance.

The big things to look at are:

  • Do they cover legal defense?
  • Do they cover the spread of infectious diseases like Covid -19?
  • Do they cover you if you have a claim after your policy timeframe ends?
  • What happens if they have one or two big claims that exceeds their shared aggregate amount?
  • Will they cover the tools you use like hot stones, cupping, Fascia blasters, and others?
  • Will they cover you if you are charged with sexual assault?

Filed Under: Blog

Take Back Your Facebook Newsfeed with 5 Easy Tips!

October 4, 2020 By Julie Onofrio Leave a Comment

Facebook is always changing the way they do things and in the past 6 months or so, the biggest issue is that they no longer are showing you what you want to see in your news feed.

1 Recent Posts vs Top Stories

Make sure you are getting the recent posts and not the top stories or that you know which feed you are looking at.

By default, News Feed shows the most popular posts first. To temporarily view stories by most recent:
Click at the top of Facebook. Click See More in the left menu.
Select Most Recent.

Beware! It does not stay on the most recent setting! You have to constantly change it back. I prefer to see most recent.

2 Control your newsfeed preferences :

Your News Feed preferences help you control what you see on your News Feed. To view your News Feed preferences:

  1. Click  in the top right of Facebook.
  2. Select Settings and Privacy > News Feed Preferences.

To adjust your News Feed preferences:

  • Click See First to make posts from people or Pages appear at the top of your News Feed. Learn about see first.
  • Click Unfollow to unfollow a person, Page or group. Learn about unfollowing.
  • Click Reconnect to follow a person, Page or group that you unfollowed in the past. Learn about reconnecting.
  • Click Snooze to restart, stop or add more time to your snoozes. Learn about snoozing.

3. Get Notifications.

And then remember to look at your Notification feed! This one is sort of controversial if you are trying to limit your time on Facebook. The Social Dilemma talked about turning off notifications if they are making you look at your phone/computer at all hours of the day. The notifications though are how you find past posts and comments you made.

4.  Follow Your Groups Feed.

When you click on the group icon at the top of your Facebook account, it takes you to the post that are coming from the groups that you have joined. If you are on your computer, you can see a list of the groups you manage or are in on the left hand side. You can click on any group and see only the posts from that page and scroll to read what you want to read. Click on any group to read the posts from that group.

5.  Like pages as your page!

I have only seen this on my phone so far. There is a way to like or follow pages as your own page and see the feed from only those pages. I don’t see it on my view from my computer.

Responsible Social Media

Responsible social media use has been brought to the forefront with the latest documentary “Social Dilemma”. While it give much to think about, it opens up the discussion and directions for research on how social media is affecting our lives and also the massage profession. The discussions have gotten really ugly at times with the immediacy of posts and comments bringing out the best and worst of us. It has also helped bring information and connection to massage therapists that may not otherwise get that support.

Facebook of course has it’s own view of things and has posted a rebuttal (PDF) to the issues the movie brings up about addiction, advertising, algorithms, data and polarization.

One of the things I would love to see are more groups of massage therapists getting together in person (post covid) or getting together via zoom or other platforms in small groups for discussion and support.

Filed Under: Social Media

Doing what it takes

September 9, 2020 By Julie Onofrio Leave a Comment

Starting and running a massage business is not an easy thing to do. So many start and try but get nowhere. Some blame it on their limiting beliefs or that they don’t have the right mindset. The whole concept of mindset is just one theory. Then there is the positive thinking way—just think positive thoughts and you will get what you want.

I used to follow all that and put hundreds if not thousands into books, classes and learning the ‘law of attraction”. I even put up a website at one point on the law of attraction.

Then about 10 years ago or so, I found the writing and words of Barbara Ehrenreich who talks about how positivity is a joke.

We need to brace ourselves for a struggle against terrifying obstacles, both of our own making and imposed by the natural world. And the first step is to recover from the mass delusion that is positive thinking.”

So what are we to do

The whole you have to change your mindset, you have to be more positive is just another way you are beating yourself up. It is OK to feel bad, to not have a positive mindset, to not have a growth mindset. At the basis of positive mindset and growth mindset theories is usually the beliefs you have about yourself that are mostly unconscious. It is the little voice that is always saying some version of “You are not good enough. You are a monster. You don’t have what it takes.”

Can you ever really get over that, change that and get rid of it once all? Personally, I don’t think so after 64 years, 25 years of therapy, 20 years of supervision, years and years of reading every self help book around. (If self help books worked, we wouldn’t need them anymore.) It will always be with you in some form or another. The thing that we can do is come to know what that ‘not good enough’ voice is running the show and do what needs to be done anyways.

Here’s the key: You can have those beliefs, you can have whatever kind of mindset, you can be positive or negative and guess what— You can still be successful.

What you do need is commitment.

Are you willing to do what it takes to start and run a massage business? That could mean just about anything:

  • Are you willing to work a part time job or even a full time job while you build your business?
  • Are you willing to work long days, weekends, evenings and at other times to accommodate people’s schedules? (yes you might have to in the beginning.)
  • Are you committed to figuring out a marketing method that will work for you to bring you the clients you need? That could be learning to use Facebook, learning to create a website, learning to use Google Business, learning to use Groupon, learning to do free events (yes), learning how to build repeat clients, learning how to get referrals and whatever way or method YOU find or create that works for YOU. (Any one of these things takes 6 months or so to learn or more.)
  • Are you willing to keep trying and learning from each failure? Did you try a Groupon and get exhausted from the number of clients and low pay? Did you try to ask a few people to rebook for next week and it didn’t work so you gave up? Or did you ask every single person until you perfected the art of rebooking clients? Did you try one free event and feel like you got taken advantage of? Or did you try and try again until you perfected the art of turning free events into getting clients?
  • Are you willing to go to the office everyday even if you don’t have clients?
  • Are you committed enough that you have set up daycare, your home life and your schedule to make your business first?
  • Are you willing to show up even in the face of things like deaths in the family, struggles in your personal life,

You probably reacted to some things on the list and were taught otherwise. Don’t do groupons. Don’t go to the office if you don’t have clients. Don’t work all hours of the day. Work only on your ideal client. I don’t know where all that is coming from but it requires that you start understanding that it is a business after all.

“What is the one thing that would upset me if, at the end of my life, I do not attempt, do, or complete?”

Filed Under: Blog

Start a Pregnancy Massage Business

August 21, 2020 By Julie Onofrio Leave a Comment

Giving massage to pregnant women, from conception to birth and postpartum is one of many business models for massage therapists. If you are going to focus on that, you will need to have extra training in pregnancy massage as well as clinical massage to be able to work with women through various stages of pregnancy and work with the various conditions that they may be faced with.

You can take classes as well as read books and articles online to be informed.

Massage may be given in any stage of pregnancy contrary to some information being taught or having been previously taught in massage school.

  1. Website. Starting and running a pregnancy massage related business will require you to create a very content rich website talking about every stage and the massage applications. Your website needs to show that YOU are the expert in this area in your neighborhood. You will want to focus on the results you get when working with pregnant women. Talk about the various possible conditions that may arise like back pain, hip pain, carpal tunnel syndrome and other common conditions. Read more on everything you need to know about creating a website that works.
  2. Rebooking clients. This one is easy with pregnant women. The next 9 months will be filled with challenges both mental and physical. Getting regular weekly or monthly massage can help support a mother to be through this time. Get the results that your client wants and they will easily rebook.
  3. Getting Referrals. You may want to take the next step and connect with expecting mothers. Look for local Facebook groups with the focus of having babies. Look for doctors near you that specialize in labor and delivery. That is really best done by working on a pregnant woman and having her talk to her doctor about you and tell what a great job you are doing to open the door instead of just cold calling.
  4. Ethical Practice. One of the challenges you may be faced with is the mother/client asking you questions about the pregnancy and delivery process that are really out of your scope of practice even though you may have extra knowledge on the various stages and procedures. It is important to clarify that they need to work with their doctor on everything. You may want to work with a supervisor yourself to keep yourself clear and get the support you need. You can learn about the advice giving issues.
  5. Self Care. Taking care of yourself so that you can be present with expecting mothers is essential.
  6. Is pregnancy massage covered by health insurance? For the most part, pregnancy massage is wellness or relaxation massage that is not covered by insurance. If there are problems like back and hip pain or carpal tunnel, insurances would be more likely to cover it. Most states do not allow for health insurance to cover massage of any type although many plans are now covering things in various states. There is also a grassroots movement to make it happen. See more on the Healthcare Integration page or Learn to bill Insurance for Massage.

You

Filed Under: Blog

Lessons from COVID-19

August 12, 2020 By Julie Onofrio Leave a Comment

As we work our way through this unprecedented pandemic, what are we learning about the massage therapy profession? I am sure there will be more things as this virus spreads on and on.

  • Massage schools were already struggling to attract new students before the pandemic. Schools have moved to some online classes. Could massage school be made less expensive by teaching more classes online?
  • The pandemic also brought up the issues of race and how BIPOC are discriminated against in the massage profession. We don’t have any clear statistics on the number of BIPOC who are massage therapists? How many BIPOC also receive massage regularly? Many can’t afford massage therapy and the answer to that is to get massage therapy covered by health insurance or open clinics to serve this population for free or low cost.
  • It isn’t only BIPOC who can’t afford massage. Other low income people/families are down to survival mode just wondering where their next meal is coming from. What’s the answer? Low income clinics to provide free massage and healthcare? Getting massage covered by health insurance?
  • Our professional associations were very late to the game and made a very disappointing show of advocacy and support. AMTA Chapters were working with governors and legislators to try to clarify mandates and essential worker status. Remember all of the chapter leaders are volunteers who may or may not be experts on working with legislators and just help when they have time. Many chapters found things like legislators and governors calling massage therapists masseuses which is really showing us where we have failed in communicating who we are and what we do. ABMP was the first to step up about a month after the pandemic started here in WA. I worked to provide as much information as I could as we went through each step of figuring out what the heck was going on. See the section on COVID-19 although mostly outdated now except Wear the Masks.

Just an idea…What if we figured out how to set up community based health centers like this: Federally Qualified Health Centers are community-based health care providers that receive funds from the Health Services & Resources Administration (HRSA) Health Center Program to provide primary care services in underserved areas. According to the HRSA, 1 in 12 people across the United States rely on FQHCs for care including 3.5 publicly housed patients, 1.4 million homeless patients, 1 million agricultural workers, and more than 355,000 veterans. FQHCs must meet a stringent set of requirements, including providing care on a sliding fee scale based on patient’s ability to pay and operating under a governing board that includes patients. More information about FQHCs can be found here .

  • The debate over wearing facemasks has gotten to the point of being ridiculous. Some want their freedom and still think this is a hoax. Part of being a professional and a health care professional is doing what is right. If your state, city, county or business are mandating wearing masks and YOU are not, your liability insurance may not cover you if you are breaking the mandates. Not wearing a mask says quite simply you don’t care. Wearing a mask says, we are all in this together and I honor others. Wearing a mask is a sign of solidarity and support. (It is a national problem too and not just something within the massage profession but it goes to show how divided the US is and the massage profession.)
  • The pandemic has also brought an increase in the use of Opioids causing another pandemic of sorts. Massage therapy was being called on from every angle to be a part of the answer to the Opioid epidemic but we don’t have enough advocacy from our associations and leaders in the massage profession. Here is a long list of the events where we are being cited as a possible answer to the Opioid epidemic. The latest was something from the Massage Therapy Foundation President, Doug Nelson who was recently a panelist at the Alliance to Advance Comprehensive Integrative Pain Management (AACIPM) virtual symposium which is great but only a drop in an ocean. There are many many things we need to be doing. Here is a list of some of my ideas based on what I saw happen here in WA State where we have been able to bill health insurance for over 20 years.
  • The pandemic has also shown massage therapists and everyone really that no income source is reliable which is why I recommend having other sources of income. What I do is create websites and share information. Here is a list of ideas I have that may fit your skills and knowledge and ideas on how to make money with a website.
  • It is going to get worse before it gets better. The economy is tanking and it is just the beginning. Restaurants, gyms, sporting events, conventions, travel will never be the same. In the last 30 years, I have survived the downturn in the economy by being able to bill insurance – car accident, workers comp and health insurance. It is a process to learn what cases to take and which to avoid and it will take time to learn that yourself. Meanwhile people who are coming in with their insurance paying come in weekly or twice a week even and it usually takes a few months or more depending on their injuries to get better. Learning to bill insurance can help make a difference when trying to survive during a depression.
  • There is a high demand for massage therapists in clinics, spas, and franchises. Many massage therapists are not going back to work or waiting it out more. You now have even more ability to negotiate pay and benefits. Demand more for your risk.
  • Have you taken any CE classes? I have taken a few online. Two different classes said they were 3CE credits. I took one in 20 minutes and one in 40 minutes. Are CE system is really messed up to say the least. The CE Conundrum continues.
  • Stress is at an all time high and more than ever we need to have massage therapists working but the risk of working may outweigh the benefits. Each therapist has to decide that for themselves. The pandemic has certainly brought out the best and the worst of us as seen in the many Facebook forums and posts. Be kind.

What other lessons are we seeing as a result of COVID-19 and also the race issues that have been brought to light and what needs to be done? What can we do as a profession and as an individual practicing massage?

See my first post on Lessons from COVID-19 with more of a general overview.

Filed Under: Blog, Covid-19

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