The Cornerstone Of Care: Cultural Competency for Client Retention

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The Cornerstone Of Care: Cultural Competency for Client Retention Webinar Transcription

Hello everyone. Welcome. Thank you for being here with us today. We would love to know where
you're tuning in from by using the chat. I am in sunny St. Petersburg, Florida.
Welcome in. We're going to go ahead and kick things off. Hi everyone and welcome to the
Massage Magazine Insurance Plus webinar series in session. You might also recognize us as
Massage Magazine or a MIP for short. I'm Shannon and I'm so excited to be your co-host
today as we celebrate Massage Therapist Appreciation Week. If you're new to MIP,
we're an all-inclusive liability insurance provider for Massage Therapists,
body work professionals, Reiki practitioners, and more across the United States. Our mission
is to support you with quality coverage that gives you peace of mind in your practice.
But we don't stop at insurance. We also offer a wide range of exclusive member benefits,
including discounts on industry products, up to 53 CE hours with our partner,
and other amazing continuing education opportunities, as well as a wide range of valuable resources
tailored with the Massage and body work community in mind. To learn more, I'll be
dropping our website link in the chat for easy finding. Quick housekeeping tips. A reminder that
today's webinar will run for one hour and it is being recorded. The recording will be emailed
to everyone by tomorrow. Today's webinar is also expected to be eligible for CEU credit through
the NCB TMB. Approval is currently pending and expected very shortly. Instructions for
earning the CEU will be included in a follow-up email. We encourage you to ask questions,
so feel free to use the chat or Q&A feature and we'll be monitoring both throughout. We'll also
reserve the last 10 minutes for a Q&A session. With that said, let's dive in. The topic of today's
webinar is the cornerstone of care, cultural competency for client retention. Please join me
in welcoming our hosts Kirby Clark Ellis, a licensed massage therapist, instructor,
educator and advocate with over 12 years of clinical experience. A dedicated leader in the field,
Kirby has spent over a decade refining a clinical approach that balances technical mastery with
deep human connection. Welcome Kirby and thank you for tuning in to MIPS in session webinar series.
Thank you so much Shannon and to everyone at Massage Magazine Insurance Plus. I'm going to go ahead
and get us started here, see if I can share my screen and jump right into things. So again,
this is the cornerstone of care, cultural competency for client retention and before we get started,
let's ground ourselves in some shared definitions so that we have a common language to engage in
this conversation with. So alert from keynote, continue to share this keynote window using share
play. So cultural competency is the ability to understand and respect the values and beliefs
across different cultures and respond effectively and appropriately. I'm going to pause my screen
share here for just a second. I'm having a little bit of trouble seeing my full screen.
Sorry everyone about that.
So understanding and respecting values, attitudes and beliefs across different cultures and being
able to respond effectively and appropriately. Cultural competency is the road to inclusivity,
so it helps to establish and build strong relationships among other individuals with varying life
experiences, their perspectives, and it helps to foster diversity and creates an environment
of inclusivity. And this is not just something nice to have either because cultural competency
training is in place at many United States medical schools and hospitals. So it's become a standard
because it directly impacts outcomes, safety, and trust with clients.
So in a diverse society clients bring a wide range of cultural identities beliefs and lived
experiences into our practices. These differences don't have to create barriers but they will require
intentional and ethical care. Ethics matter because professional codes of ethics help to ensure safe,
respectful, and equitable treatment for all clients. Ethics help to guide decision-making
when cultural differences, boundaries, or misunderstandings arise. In short, ethics are what
guide us when we don't have easy answers available. Your role as a practitioner is to create a space
that is safe, inclusive, and most importantly client-centered. So reflect on your personal values
and your biases and how those have the potential to impact care. You should also recognize that gaps
in knowledge or sensitivity can cause unintentional harm or discomfort for clients.
Recognizing that is what's known as cultural humility.
So let's talk about something that's uncomfortable but necessary to acknowledge
biases. We all have them. A bias is easily defined as inclinations for or against something.
Often for or against people, places, groups, but could also be a bias for or against circumstances
or concepts. Bias can be positive or negative and are often shaped by the culture that we share
and our lived experiences. For example, you probably are already feeling a positive or a negative
bias based on my presentation so far. And that's okay because having a bias isn't the issue.
It's acting on it without awareness or intention. Prejudice is easily understood as preconceived
judgments that are not based on either reason or previous lived experience. These often lead to
unfair assumptions about individuals or groups and at its worst prejudice can lead to discrimination.
Bias happens automatically but prejudice and discrimination are choices that we make.
Like microaggressions, which are subtle, often unintentional comments or behaviors
that convey dismissive or devaluing messages to marginalized groups.
These can appear as jokes, assumptions, or harmless remarks but they nevertheless have
the potential to cause harm. Healthcare professionals may overlook microaggressions due to either over
confidence or a lack of self-awareness. Always remember that you can mean well but still cause
harm. The key takeaway here is that awareness is your first step. Ethical client-centered
care is going to require ongoing reflection and intentional behavior moving forward.
So there are two main kinds of bias. There's explicit or sometimes referred to as conscious bias
which is deliberate, aware attitudes, or beliefs that a person has about a specific person or a
group of people. Explicit bias is often overt and recognizable both to the person who is expressing
the bias as well as to others around them. So an example of explicit bias could be the use of slurs,
outright stated preferences, or clear generalizations that they make about others.
Implicit bias, on the other hand, is often automatic, learned associations that operate
without a conscious awareness. It happens without you even thinking about it. And they may contradict
your stated values and show up in other subtle behaviors. For example, you might treat people
differently. You might make assumptions, engage in microaggressions, or patterns in who you choose
to include or exclude. A little note implicit is the preferred term over unconscious because when
you use the word unconscious bias, it gives the impression that the bias can't be recognized
and therefore can't be changed. Key reminders here are that our perceptions are shaped by
our culture and our lived experience. Bias is a function of the brain. It's not a moral failure,
but it does require accountability. Because bias feels automatic, it can often go unnoticed
without being in the practice of reflection. And always remember that intent does not equal
impact. Good intentions don't prevent harm.
So our brains are designed to take shortcuts. Our brains are actually kind of lazy, to be honest.
But the way that our brains take shortcuts is necessary and it happens incredibly fast.
So stereotypes are widely held over-simplivized beliefs about a group of people. They are a result
of how the brain naturally categorizes and predicts. A stereotyping can be helpful for brain
efficiency, but it's risky when it's applied without critical thinking to individuals.
So why this happens? Brain science tells us that the brain is energy intensive and it relies on
shortcuts in order to conserve metabolic resources. So it uses pattern recognition and past experiences
to quickly interpret new information and new data it's being fed. So instead of asking,
what is this, the brain often asks, instead, what is this most similar to that I've experienced or
seen before? This helps to speed up decision-making, but it can often lead to inaccurate assumptions.
So the risk involved is that when left unchecked, stereotypes can shape expectations, behavior,
and decision-making, which can lead to discrimination, which is the unjust or unequal treatment of
individuals based on their identity or group identity. Some professional takeaways here are
that stereotypes may be automatic, but how you respond to them is a choice. So pause and assess,
ask yourself, am I treating this client as an individual? In massage therapy, harm can occur
through communication just as easily as it can occur through unskilled touch. Finally, ethical
care requires awareness, reflection, and intentional action. The work ahead is a marathon,
not a sprint. So the brain learns, we know through that humans tend to over weigh negative
experiences while under weighing positive ones. This can reinforce fear, those assumptions, and
biases if the patterns are not left unexamined. So the goal isn't perfection, it's growth.
You will make mistakes, and what matters is your willingness to be able to reflect,
learn, and adjust. Stay open to feedback and take accountability for impact, not just what
your intention was. Ongoing awareness is key to advancing inclusion and equity,
clients' rights, and professional boundaries. Clients have the right to respect, dignity,
and safe care. Boundaries protect both the client and the therapist. Be mindful always of the power
differential in the therapeutic relationship, and setting clear boundaries and having policies
will help support you in addressing discrimination and inappropriate behavior when it shows up in
your treatment room. Let's zoom out for a moment here. The bodywork industry, as of 2020, was valued
at approximately $542 billion. The global wellness economy, which includes massage and bodywork,
is currently valued at around $5 trillion. But representation and massage is not as reflective of
the population that we serve. In the United States, the massage workforce is predominantly
white and smaller representation of other races break down like this.
The profession is also largely female identified. These estimates are based on industry reports
such as the AMTA and the Global Wellness Institute. Exact figures can vary by year and by source.
However, the U.S. population is more racially diverse than what the U.S. massage workforce is.
Massage therapy and healthcare, more broadly, has not historically been fully inclusive.
Workforce demographics can influence access, representation, and client comfort. Avoiding
conversations about diversity and bias can only reinforce disparities and
further limit who feels welcome in our care. So engage in these realities openly and thoughtfully
and expand awareness to help serve more diverse communities with equity and respect.
So research published in the IJ-TMB in 2020 identified that racial and gender disparities in massage
therapy utilization. So that means racial and ethnic minorities are less likely to receive massage.
And the profession is often culturally associated with white women as both practitioners and clients.
And clients. So industry perception matters here. Common imagery such as spa settings and luxury
environments reinforce the idea that massage therapy is a luxury service for affluent white
clients rather than accessible healthcare intended for all. These perceptions influence who feels
welcome, who will seek care, and ultimately who will choose to enter the profession themselves.
The impact is clear. Reduced exposure leads to lower familiarity and trust with massage,
which leads to fewer individuals from underrepresented groups pursuing massage as either
clients or as future practitioners themselves. This contributes to ongoing disparities in both
access and workforce diversity. So some reflective questions that I urge you to when you review
this material take some time to really sit with and think about are how do you demonstrate
awareness of your client's cultural identities in your practice and how might your space,
your messaging, or your branding be experienced by these underrepresented communities.
So why does this matter in the first place? There are six key concepts that I want to
introduce you to. Gaps and care exist, so many minority communities have limited access to services
that reflect their cultural needs and their experiences. Diversity, however, will improve outcomes.
A more diverse workforce will only increase client satisfaction and foster a more inclusive
profession. Representation matters. We know that clients will seek providers who look like them.
They often report greater trust, engagement, which leads to improved health outcomes.
There is a pipeline impact as well. Representation in our profession will encourage more diverse
individuals to pursue massage therapy careers. This is also evidence-informed direction.
Research from related health professions shows us these patterns consistently.
So offering a strong foundation for growth and future study in massage therapy.
And finally, this all leads to better client care. Cultural humility will build trust,
increase comfort, and help uncover concerns that might otherwise go unspoken.
This isn't just ethical, but it's also practical. The premise of health equity is that all people,
regardless of their background and circumstance, deserve the best quality care in order to live
their fullest potential for well-being and good health. Trust drives retention.
Diverse teams increase client confidence and trust. When clients don't feel represented or
understood, they're more likely to leave your business. Better thinking equals better solutions.
So when you bring diverse voices into the profession, it introduces broader perspectives,
which leads to more creative problem solving and better decision making.
You can't meet every client need without every voice being included.
So inclusive decision making is essential to understanding and serving a wide range of client
experiences. And consumers are paying attention. A majority of consumers say the diversity and
inclusion influences their purchasing decisions, especially in younger generations. 60% of consumers
overall feel that diversity and inclusion are important. 72% of people aged 41 to 56 feel this way,
and 76% of younger adults do as well. The business impact is measurable. Research across other
industries show that diversity is associated with increased innovation, productivity, and financial
performance. Projections indicate that the United States is on track to become a majority minority
between the 2030s and 2040s. So making cultural responsiveness, it's not only an ethical imperative,
it's also a business imperative. Loyalty and relationships matter. Underserved minority
communities often show strong brand loyalty when they feel seen, respected, and well-served.
And inclusion must be authentic. Stated commitments to diversity without meaningful action
will erode trust over time. Sustainable impact requires ongoing, visible inclusion efforts,
not just messaging. When we talk about cultural competence, we're also talking about access and
equity. This isn't merely theoretical, this affects real people. So 45 years ago in 1981,
two professors on public health, Prichansky and Thomas conceived what they called the five
A's of access to care. They are availability, so think is the right care offered in sufficient
supply? Are there enough providers in the area? Are needed specialties or modalities available
and do appointment openings exist within a reasonable time frame? The second A is accessibility,
so think can a client physically reach the care they need? Is their distance to the provider
or geographical location? Are there transportation options or are there barriers to transportation?
Are mobility considerations such as those presented by disability or chronic pain present?
And do parking, public transit, and billing access affect their health care accessibility?
The third A is accommodation, think how well is care organized to fit the client's needs?
Think scheduling systems, online ease of use, hours of operation, our evenings or weekends available,
language access, our interpreters are translated forms available for clients,
flexibility for cancellations, walk-ins or urgent needs. The fourth A is affordability,
think is the cost manageable relative to what the client's resources are? Service pricing and
transparency, nobody likes hidden fees. Insurance coverage or reimbursement options are those available,
and what about sliding scale or payment plans? Also consider the indirect costs, time off of work,
time to find and provide child care. And the fifth A is acceptability, think does the client
and the provider both feel comfortable with each other? Cultural competency and respect is key here.
Also think about client preferences including gender, communication styles, and values.
And finally trust in the provider and the profession as a whole, perceived safety, dignity, and inclusion.
It's important to remember that these five factors form a chain that's no stronger than its weakest link,
so improving just one of these factors won't significantly improve access if the other four
factors are not also addressed. So the next several slides will give us context and again a common
language to engage in a conversation about race and ethnicity and beyond. So race is a classification
system that was constructed to distinguish between groups of people based on physical characteristics
that are deemed important by a society. And when I say deemed important, for example,
we categorize race by skin color rather than other physical characteristics like eye or hair
color for example. It's important to remember that human share approximately 99.9% of DNA
regardless of our race. So physical traits like skin color exist biologically, but the racial
categories that we created are socially defined. It's important to understand that race was often
used historically to justify unequal treatment and the exploitation of certain groups. Famously
for example, Italian immigrants were not always socially considered white in the United States.
They often face discrimination, segregation, and even violence despite legally being counted
as white on US censuses. Ethnicity on the other hand is a term that is used to describe shared
culture, shared practices, values, beliefs, language, and ancestry all factor into what
we talk about when we're talking about ethnicity. So for example, Judaism doesn't fit perfectly
as a religion, race, or ethnicity, or even a nationality. It's a religion, but not all Jewish
people are religious. It's passed down from parents to children and can bear recognizable
genetic characteristics, but Jewish people comes from all kinds of racial backgrounds.
So for that reason, anthropologists often describe Judaism as an ethno religion.
Jewish people can belong to any race, but many share a partial ancestry.
Another example of ethnicity are Japanese and Vietnamese people. They're both considered Asian,
which is a race, but they represent different ethnic groups that have their own distinct languages,
cultures, and histories. Other examples include Hispanic, which is a term that describes people
whose heritage originates from Spanish-speaking countries, and Latino, Latina, and Latinx
are terms that refer to someone whose heritage originates from Latin America,
including the United Mexican States, Latin Central and South America, and much of the Caribbean.
It's important to know the difference here. So not all Hispanics are Latino,
and not all Latinos are Hispanic. So for example, being from Spain would make one Hispanic because
they are from a Spanish-speaking country, but not Latino because they're not from Latin America.
While being Brazilian would make one Latino because they're from South America,
but not Hispanic because Brazilians actually speak Portuguese and not Spanish.
Another example to people from the same ethnicity can be from entirely different races.
For example, Cameron Diaz and Celia Cruz both have human heritage, making them Latina or Hispanic,
but Cameron Diaz is typically categorized as white, while Celia Cruz is often categorized as black.
So if that's race and ethnicity, when we're talking about racism,
it includes beliefs, thoughts, and actions that are based on the idea that one race
is superior to another. Recall that this can show up in explicit or implicit forms.
Institutional or systemic racism are patterns within policy institutions and social structures
that produce advantages for some racial groups while disadvantaging others,
even without explicit individual prejudice involved. This was highlighted by civil rights activists
Stokely Carmichael and Charles V. Hamilton. Because institutional racism
operates through systems rather than individuals, it can be less visible and harder to recognize
and therefore more challenging. It can be most prevalent in health and wellness professions
because it is not the result of one individual's actions or the racial animus.
Historically, POC or people of color were consciously omitted from policies,
laws, and systems in order to oppress them. Examples of this include Jim Crow laws and
redlining in the United States. Civil rights legislations like the Civil Rights Act of 1964
sought to address these inequities, though disparities persist in many areas today,
and voting rights are also being challenged and rolled back recently.
Even individuals who did not create these systems may still experience their effects
or their benefits depending on how institutions distribute opportunity and resources.
Researchers have also examined how medical research and professional standards
historically reflected dominant culture norms, sometimes leading to gaps in representation
and health outcomes across racial groups. So the concept of good health has often been
determined by white, European, cisgendered, and able-bodied standards.
So some more opportunities for you to contemplate later. How might health care have looked for
enslaved or impoverished people? How does access, affordability, and representation
still shape that care today? What impact might police violence have on mental and physical health
of clients of color? How might it feel to not see providers who look like you in massage and body
working? And what does representation signal about the clients belonging and their safety?
How have dress codes and professionalism standards historically excluded certain cultural
expressions? Why are certain forms of language or slang labeled as unprofessional? And who defines
what is professional? In some cultures, rest comes only after all work has been done completely.
So what happens when work is never considered finished? And how can massage therapy be refrained
as health care, not a luxury? Luckily, there are some opportunities for growth and some steps that
we can take. Start with auditing your practice. Could your intake, pricing, or policies unintentionally
be excluding clients? Is your location accessible? Think transportation hours and costs? Does your
space reflect diverse representation in your marketing, artwork, and even your staff if you have it?
Are referrals, scheduling, and payment options easy and flexible? Also engage your community.
Show up in culturally specific spaces such as festivals, events, and local organizations.
Offer chair massage, of course, education, and outreach. Advertise in multiple languages
and in diverse media outlets. Collaborate and advocate. Partner with organizations who are
already doing the work of equity. Support them with your time, your platform, and if you can,
your funding. Build relationships with health care providers in order to integrate massage
further into care. Examine your tools even. Are your products and materials inclusive of all skin
tones and all body types? And use your influence. Start conversations within your own communities.
When those with privilege speak up, it can shift norms and expectations. So advocate for equity,
not just as an individual, but systemically. Another opportunity is consider supporting the
Black Massage Therapy Conference. Their next one is scheduled for October of 27 in Phoenix, Arizona.
When we talk about inclusion, LGBT clients are also a part of that discussion. So here's a simplified
exploration of the different groups that make up the LGBTQIA acronym. Lesbian is a term that is
often used to describe women or female-aligned people who are attracted to and have relationships with
other women or female-aligned people. Gay is sometimes used as an umbrella term for all sexual and
gender minorities, but is most used to describe men or male-aligned people who are attracted to
and have relationships with other men or male-aligned people. Bisexual and pansexual are often confused
for each other or used interchangeably. Bisexual is something of an umbrella term for someone
attracted to and having relationships with two or more genders. And pansexual is a term that is
used to describe someone who is attracted to someone regardless of their sex or gender.
Transgender is a term that is used to describe anyone who doesn't identify with the sex and or
the gender they were assigned at birth. This is often abbreviated to A-M-A-B for assigned
male at birth or A-F-A-B for assigned female at birth. And this is regardless of status of
their transition. A transgender person who is living their life as a woman is known as a trans woman
and a transgender person living their life as a man is known as a trans man. On the other hand,
cisgender is a term that is used to describe anyone whose gender identity does match the sex
and or gender that they were assigned at birth. Queer questioning. Queer is something of an umbrella
term that is used for sexual and gender minorities. However, it can sometimes be viewed as a slur
when it's used by people who are outside of this community. Queer can also describe someone whose
identity is either fluid or can include multiple identities. And questioning is a term that is
used to describe anyone who is in the process of exploring or questioning their sexuality
and or gender identity. Intersex is the correct term that is used to describe someone who was born
with several absent or ambiguous sexual characteristics. And the U.S. intersects population is around
2% that's similar to the amount of people who have green eyes. Finally, asexual or allies. Asexual
is a term that is used to describe someone who does not experience sexual attraction to either
any or all genders. An ally is a term that is used to describe a person that is outside of a minority
community but who acts against oppression in the belief that eliminating oppression will benefit
members of vulnerable groups as well as the advantage groups. To talk about pronouns,
these are words that take the place of proper nouns. Everyone uses pronouns and all pronouns are valid.
Most common ones are he, him, and his are pronouns that are commonly used for male or
masculine identified people. Examples include he arrived late for his appointment and I couldn't
fully accommodate him. She, her, and hers pronouns are commonly used for female or feminine identified
people. For example, her appointment was for one hour but she wanted to know if hers could be a 90
instead. They, them, and theirs pronouns are commonly used for non-binary or gender queer people.
These are used respectfully when you don't know a person's gender or pronouns
and have always been used in a singular form to refer to just one person. Examples include
they wanted a facial after their massage but were all booked up. What should I tell them?
Remember that you never know a person's gender or their pronouns until you either asked or you're
told explicitly. There are also other pronouns that are known as neopronouns that are less common
in use but are nevertheless every bit is valid and should be respected. Some best practices with
pronouns include asking someone if they don't voluntary share them. It can be harmful to make
assumptions and alternatively you should be in the habit of providing your own first to make it
clear you don't make assumptions. When talking about someone to a family member,
friend, or colleague it's important to continue to respectfully use the correct pronouns.
If someone corrects you for misgendering them or another person avoid getting defensive or making
a big deal about it. You can just politely apologize and move on. Keep in mind that correcting
pronouns is not an attack on you but it's a reminder of that person's identity. Mistakes are normal
you're deconditioning a social norm and that takes time and like most skills you won't immediately be
perfect but practice always helps. You should never ever refer to someone as their incorrect
pronouns with malicious or rude intention even if you don't like that as a person. And finally
keep looking for ways to educate yourself and other cisgendered heterosexual people around you.
I would also include those who are not cisgendered or heterosexual. Educate everyone.
To talk a little bit about transgendered massage clients, gender transition is not about changing
who you are but it's about aligning your outward expression with one's gender identity. Transition
is not a one size fits all. It can be broken down into three major categories. Legal so think
documents like birth certificates, IDs. It can be a social transition so when a person changes their
name socially, introduces themselves with different pronouns or they start to wear different clothing
or make different appearances to their physical appearance. And finally medical which can include
the use of hormones or the use of surgeries. Should be noted that not all trans people who undergo
all or any forms of transitions, however their transition and their identity is still valid and
should be respected. Massage can be a way to support transgender clients through body awareness,
comfort, and promoting a sense of safety, offering affirming and respectful touch. Massage consideration
for the transitioning client may include client preferences around language, draping,
and body regions of focus, scar tissue, nerve sensitivity and numbness, swelling for post-operative
clients, limited range of motion, positioning considerations, and pain. Language matters so
get in the habit of referring to people at least in your mind with they them and their pronouns
until you're made aware of the pronouns that they do use. Avoid assuming gender based on appearance
or voice alone. Instead of using gendered honorifics like sir or ma'am, just get in the habit of
dropping them off completely. So instead of how can I help you sir, try how can I be of assistance?
When you don't know, instead of assuming someone's gender pronouns use they them and theirs or find
a way to refer to them in other ways. So instead of she is in the waiting room, try they are in
the waiting room, or the client is in the waiting room. Instead of assuming a person has a mom and
a dad, try using gender neutral terms instead. Instead of what are your mom and dad's names,
you could ask what are your parents or your guardians names. Instead of assuming that a person
is married to a person of the opposite sex, again try using gender neutral terms. Instead of do you
have a wife, you could try instead do you have a partner, spouse, or significant other. Small
language shifts can significantly increase client comfort, trust, and safety. Often it's not about
saying something perfectly, it's about demonstrating that you care and that you're trying.
Another opportunity to contemplate. Historically what might health care felt like for closeted
are openly queer individuals. How has the response to HIV and AIDS crisis from the 80s to now
shaped the trust that is experienced in health care today? How do homelessness, job insecurity,
and discrimination impact physical and mental health? How would you respond if a client requested prenatal
massage after they previously presented to you as male? Do your forms language and training support
this? Does your marketing use heteronormative language for example his and her services? What
assumptions might that signal to clients? How have the transgender community especially trans
people of color been overlooked even within LGBTQ plus spaces? And finally most transgender
people often share stories of driving far out of their way just to find businesses with single
stall bathrooms or gender neutral ones. What impact could a non-gendered restroom have
to make sure that all feel welcomed? There's opportunities for growth here too. So introduce
yourself with your pronouns, you can add them to your email, social media, and business cards,
and be in the habit of using the gender neutral language you've already talked about. Consider
that your client may be estranged from their birth family so traditional small talk about family
might make them uncomfortable. Use inclusive advertisements, posters, pamphlets, signage
that might include rainbow signage or enamel pins that demonstrate that you're invested in safety.
Ensure non-discrimination policies for staff as well as the clients related to sexuality,
gender identity, or expression. Emphasize to clients that their privacy will be respected
and that their information is protected. Have gender neutral restrooms available.
Support and collaborate with organizations that advocate for LGBTQ issues. Attend pride events
that are often held in June or October. Again, you can offer chair massage, set up a booth,
educate, and encourage the local LGBT community about massage therapy.
Include a space on your intake form for clients to provide the pronouns that they use,
and if you're in a shared practice, document that for colleagues.
Ensure transgender clients are equally covered by company health insurance. If cis-gendered
employees have access to hormone therapy, then trans people should also have access
for medically prescribed treatments. Anything less than that is discrimination, plain and simple.
To talk about religious sensitivity, religious and cultural limitations aren't as obvious as
physical traits of someone's body, the language they speak, or how they dress. Religious limitations
are often more subtle. These religious considerations shape comfort with touch, how clients feel about
modesty, how they can interact with genders, and the body in very subtle but significant ways.
So address the client's view of massage therapy. Explain the benefits of massage and draw distinctions
of what massage therapy is not. Give the client a chance to reveal their religious or cultural
limitations in order to help build trust. The 2020 U.S. Census recorded religion as 42% Protestant,
21% Catholic, 18% unaffiliated, 6% and 5% agnostic and atheist respectively,
2% as Mormon and Jewish separately, and then separately 1% of identified as Muslim, Hindu,
or Buddhist. Given this background of diverse religions and cultural traditions,
it's important to be sensitive and attempt to understand how massage is viewed by and can fit
into different faiths. Luckily, there are also opportunities for growth here too.
So avoid assumptions is first off. Beliefs about touch, healing, and the body can vary widely
across faiths. Start with curiosity. Ask questions like, what is your experience with massage?
Try to find respectful common ground while also honoring their differences. Avoid one-size-fits-all
care here. Use open-ended client-centered questions. Examples include, are there any cultural or
religious considerations I should be aware of that would make you more comfortable? Clearly
explain what massage therapy is, professional, therapeutic, consent-based, and what it is not
to address misconceptions. Offer choices and draping options, same-gender practitioners,
whenever possible, including reaching out to your referral partners, and possible body regions
to avoid. Create space for disclosure. Trust increases when clients feel safe naming their
boundaries. Examples might include, is there anything I can do to better respect your beliefs or to
increase your comfort? But maintain professional boundaries. Do not assume that you share beliefs
with someone and don't initiate proselytizing your own religious views or values. If religion
does come up, center the client, listen with respect, avoid dismissiveness, and support
don't challenge their worldview. Finally, foster dialogue that is inclusive for clients,
colleagues, and others when you have to be in shared spaces.
Keep the focus on respect. It doesn't have to be about agreement or alignment of faith or worldviews.
Another thing to think about are the aesthetics in your clinical spaces. So it's common for
massage environments to include spiritual or religious imagery, symbols associated with
Buddhism such as the Buddhist statue, lotus flowers and chakras, or Christianity crosses
Bible verses. The question isn't about which tradition is being highlighted, it's about how
it might impact your clients. So pause and evaluate. Does your space reflect a specific belief system?
And if so, how might that feel to someone who doesn't share that belief system?
Could visible religious or spiritual messaging influence a client's sense of safety or belonging?
Are you creating a universally welcoming environment or one that signals a particular worldview?
The best practices include prioritizing a neutral client-centered space that welcomes people of
all faiths or people of no faith. Be intentional. If you include personal or spiritual elements,
consider their visibility and the potential impact they could have.
Finally, let inclusivity guide your design choices just as it should guide your communication and your
care. Disability is incredibly diverse and so are the client needs here.
Disability is a condition that may affect a person's mobility, their sensory experience,
their cognition, or their emotional functioning, and how they navigate their daily life.
Types of disability include physical, so think mobility limitations, amputations,
chronic pain or chronic illness, vision, or hearing impairments. Cognitive or neurodivergent
disabilities think autism, ADHD, learning differences, and brain injuries. Mental or emotional disabilities
could include depression, anxiety, PTSD, dyslexia, or other mental health conditions.
And these disabilities may be congenital, meaning that they're present at birth,
or they could be acquired, such as through injury, illness, or aging. Some disabilities require
the support of some form of accommodation, assistance, or supports. Disability experiences
vary widely, even within the same diagnosis. Isolation and loneliness can affect those with
disabilities. Depression can be especially common companion that is associated with acquired disabilities
as they adjust and cope. So some potential massage benefits, of course, include supporting
pain and stress reduction, relaxation, and improving range of motion. Helping to address
compensation patterns for mobility aids or altered movement can enhance body awareness and their
self-image, provide safe, compassionate touch, which may reduce feelings of isolation or loneliness,
even if it's just temporary. It offers comfort for clients with a history of invasive or
traumatic medical experiences. Collaborate and communicate. When appropriate, coordinate with
clients, caregivers, or their other healthcare providers. Use clear, flexible communication
with clients, so pick up on verbal, nonverbal cues, and again be mindful of your check-ins.
For clients that have communication differences, observe their body language and their tolerance
closely. Always prioritize client comfort, consent, and their feedback. Mobility considerations
include conditions that may impact mobility, such as spinal cord injuries, stroke, multiple
sclerosis, muscular dystrophy, cerebral palsy, traumatic brain injury, paralysis, and limb loss.
And finally, aging and chronic conditions may also affect mobility and require accommodation.
The Americans with Disability Act, often referred to as ADA, came out in 1990 and it provides guidelines
for public accommodations for those with disabilities. It includes specific requirements for business
entry, as well as throughout public facilities. So accessibility isn't optional. It's a part of
ethical professional care. Ensure that your space supports safe navigation and safe transfer.
Thank doorways, hallways, table height, and restroom access. When clinic access is limited,
consider in-home or medical settings, such as hospital or hospice settings, or other accessible
locations. Be prepared to adapt. Sessions may occur on a table, a massage table that is a bed or in a
wheelchair. Ask before assisting. Would you like any help getting on or off the table? Follow the
client's guidance and stay within your scope, your own ability, and your safety limits. Use tools
that improve access and comfort, such as bolsters, positioning supports, and consider investing in
hydraulic or electric tables if you can. When you meet someone with a disability, before you ask
them anything about their abilities or their limitations, it's best practice to share something
about yourself and talk about how you might perform that specific action. Some limiting mindsets,
referring to disabled people as inspirational for doing everyday activities, can unintentionally
reinforce bias. It might suggest that you don't expect disabled people to participate in ordinary
life, that you hold lower standards or assumptions about their capabilities,
you view disability as inherently tragic or limiting in all contexts, you value disabled people
primarily for how they can inspire others rather than as whole individuals. So shift your mindset,
recognize disabled people as multi-dimensional and not defined by their disability. Focus on
respect, autonomy, and lived experience, not inspiration. Let the client define what is meaningful
or challenging in their own lives. Some person-first language, so some words to avoid instead of
disabled person, try person with a disability. Instead of low functioning, say greater support
aids. Instead of normal or healthy person, you can say person without a disability. Instead of
nonverbal, you could say communicates without using words. Instead of he has a problem with,
you can instead say he needs or he uses. Instead of saying she's learning disabled,
you might say she has a learning disability. And instead of using the wrestler, slow,
simple, ironic, defective, or special person, you can otherwise use person with an intellectual,
cognitive, developmental, or disability. Opportunities for growth when working with
people with disabilities. Ask, don't assume what accommodations or modifications would make this
session most comfortable for you. Be prepared to adapt, positioning, pressure, pacing, communication
style, and even the length of session. Respect the client's autonomy. Clients are the experts
on their own bodies. Access and inclusion matters. Consider physical access, so think entryways,
tables, and restrooms, and sensory environment such as lighting, noise, and touch preferences.
Use person-first language like we just talked about based on the client's preference.
Provide a space that supports dignity, agency, and connection instead of pity.
This is some inclusion general guidelines. So build trust through client-centered care. Listen deeply,
validate client concerns, and remain aware of your own biases. Always seeing care through the client's
perspective. Protect dignity and privacy. Ask only what is clinically relevant. A client's right to privacy
outweighs curiosity. Evaluate underrepresented voices. Support and promote professionals from
diverse backgrounds. Cross-education, leadership, and practice settings. Invest in learning and
partnerships. So engage in ongoing cultural humility training and collaborate with organizations
that are committed to equity and social justice. I cannot speak enough about articles that MMIP
have published that were helpful in creating this course, as well as the terrific work that
Heelwell is doing. Strengthen workforce diversity. Recruit intentionality. Intentionally that is.
Create welcoming environments and provide mentorship and support for retention. Expand access through
education. Increase outreach to underserved communities about the benefits of massage and career
pathways. Align your values with your actions. Ensure that your business practices, partnerships,
and financial contributions reflect a genuine commitment to equity. Keep it practical
and sustainable. Inclusive practice doesn't require politicization or major expenses. Small,
consistent actions can also create meaningful change. Little bit about boundaries and shared
commitment. Address harm consistently. Racism and tolerance should be treated with the same seriousness
sexual misconduct and your policy should clearly reflect this idea. Establish shared expectations
upfront. Use your intake forms or other agreements to outline standards of respectful behavior.
A safe space is open to all people but not to all language or all behavior. Normalize this boundary.
Just as we clarify that massage therapy is non-sexual, we can clearly state that discriminatory
language or behavior will not be tolerated in our spaces. Do you have a clause or a space on
your intake forms where clients acknowledge these understandings and expectations? It can be as simple
as adding one to two lines in your intake forms. Prioritize equity over retention. Maintaining a safe
inclusive environment is more important than keeping or accommodating an inappropriate client.
Respond in the moment. If a boundary is crossed, address it directly but professionally.
Name the behavior as inappropriate. Set a clear expectation for moving forward.
Reinforce your commitment to a respectful space. And follow through when needed. If behavior
continues, remind the client that you reserve the right to in sessions and discontinue services.
Inclusion doesn't mean that we have to tolerate or accept harm.
Safe spaces rely on clear boundaries and shared responsibility. So silence sends a message. When
you freeze, ignore, or just let something slide, that can be interpreted as permission or worse,
agreement. Interrupting matters. Even calm, brief disagreements can disrupt harmful behavior
and set a clear standard for your space. Prepare so that you don't freeze. Practice responses.
Examples like role playing can help you build confidence and reduce in the moment hesitations.
Call people in, not just calling people out. So address behavior without shaming the person.
This keeps the door open for further understanding and the potential for change.
Use neutral clarifying language. Can you help me understand what you mean and then
repeat what the client said? I want to make sure that I'm hearing you correctly and again repeat
what you heard the clients say. That kind of language isn't something that we use here.
Don't assume intent but address impact. So start this communication with curiosity but be clear
about your boundaries and expectations. Stay professional and grounded. You can set firm limits
without judgment, clarity and consistency or what create change. And with that, I will try to stop
my share and go into Q&A sessions. Awesome. Thank you so much Kirby. Thank you. How do we do
right up to the end? Yeah, it's no worries at all. Really great information that you had to pack
into one presentation. So I really appreciate that. The feedback that we've been getting
from our participants has been amazing. Very appreciative of all this amazing knowledge that
is just so important and valuable. So thank you again Kirby for your time and for modifying
the presentation to make it a little bit shorter because it's just some just a wealth of knowledge
and things that everybody I think should be aware of whether you're a massage therapist
or just a person. So I know I gained a lot of really valuable insights that I can take with me
into my own personal world and apply it to others as well. So thank you so much. Really, really amazing.
So cool. We are getting a lot of thank yous. We are doing a Q&A. So if there are any questions,
please feel free to drop them in the chat. I did get a question. I think that they wanted,
Theresa said this is an amazing presentation seriously. But am I the only one waiting
for an answer to that prenatal massage question? How would you go about that?
Hmm. I don't have a clear cut answer right here. One resource that I will point you to that I think
would be helpful is, oh gosh, what are they called? There's a Facebook group. I think they're called
safe on my table or safe at my table that I would highly recommend. If that question hasn't been,
I would be surprised if that question has not been specifically addressed by people who have a
much higher understanding of that situation than I do. If that hasn't been answered already,
I'm sure that people will have great resources in that group there for you.
Awesome. And then I am getting some questions about the recording.
Just want to reiterate again, and thank you, Anna, in the chat for answering the question of,
is this recorded, the CU credit, all that good stuff. Thank you for the backup.
Another reminder that this is recorded and it will be included in the post webinar follow-up email
along with the link to the presentation slides itself. So there will be a dedicated webinar
page with slides. So the links will all be included in that email. And then as far as the
CEU credit goes, we're just waiting on final approval from NCBTMB. So that should be coming
through very, very soon. So there will probably be just a separate follow-up email to all of you
with all of the instructions on how to claim that CEU credit. So it will be very simple and
outlined and all the details will be there for you. So you will be receiving that in addition to
the post webinar follow-up email. Cool. It looks like we have one question that came through. Are
there a tactful resources to share with the community to help with all of this? Where I live
and work currently, this may not be known or understood. Yeah, definitely. Again, the number one place
that I'm going to point people is to the incredible work that Healwell is doing in massage therapy.
Their bread and butter is hospital-based work, but they have, I mean, like changing societal norms is
one of their driving forces. And they also have pretty affordable online CE courses that cover
these topics. Again, it's where I didn't have all of this information just at my fingertips too.
It's stuff that I've learned, Massage Magazine Insurance Plus. They have articles that have
been written before. AMTA and ABMP both have online courses as well in diversity, inclusion equity,
cultural competency that I would recommend. And I haven't checked, but I think I have
my full course in this topic with this information and a little bit more in depth.
I think I have a recording of that available on my YouTube, but I wouldn't swear to it. I need to
double check and get it uploaded if not. But those are the first things that come to mind for me.
Awesome. And then I'm going to drop these links in the chat, the Society of Massage Artives and
the kcemassage.com. So in case anyone wants to look into your new project, and additionally,
your website, I drop that in the chat. And it will be included in the follow-up email as well.
Yes, and I'd love to connect with people. If you didn't get, if you couldn't ask a question here,
because you felt a little shy, I totally understand that. I have that every once in a while myself,
and it's a heavy topic. So if you have follow-up questions and want to get in touch with me
directly, I'm happy to field questions or try to find you a resource that will help you out
some more than I can. Awesome. And then we did have a question from Ashley. As for advertising,
how would you make sure you are inclusive to all demographics? As for pride flag on brochures,
as far as racial or cultural inclusion, I don't know where to begin as I live in a predominantly
white Christian area. I'm not sure if I'm asking this in a great way. You are. I understand.
At least you're asking it is, I would also say, give yourself a break. That is a huge burden to
task yourself with, to advertise to everyone. But yeah, I think some of the things that you,
the question mentioned, rainbow signage, pride flags is helpful. But again, finding those,
you know, whenever I talk about advertising in minority based publications, the first thing,
you know, I don't know, it's probably pretty costly, but like the first thing that comes to
my mind is something like Ebony magazine. I know there've got to be other more local or regional
publications that you could reach out to and try to figure something out that way.
Primarily, I think finding those publications that are reaching those demographics is going to be
a better step to take than trying to advertise to everyone. I would, I would niche it down that way,
I think. Awesome. Great. Well, I think that this will conclude our webinar for today.
I like to keep like end things with some comments from the chat. I wanted to mention this one from
Anna. This is absolutely beautiful. Thank you so much. Great way to start massage therapist
appreciation week. Just a lot of really great feedback. Thank you Kirby knocking it out of the
park Kirby. Thank you so much. Love it. I love this amazing feedback. So with that being said,
Kirby, thank you again for your time. Thank you everyone for joining. So be on the lookout for
those two separate emails, the post webinar follow up with the recording and the slide details as
well. And then we will be following up with how to get your CEU credit. So thank you so much. So
first webinar for massage therapist appreciation week. And we're very, very grateful for Kirby's time
today and for everyone joining. So thank you so much. Thanks everyone. Thank you massage
magazine insurance plus and happy massage therapy appreciation with their business. We appreciate
all you guys. Thank you so much. Bye.