Authorized Activities and Restrictions within Professional Practice: Updated November 7, 2024
PREFACE
Definition
A scope of practice highlights the professional activities permissible by respective legislation and/or education skills and training certifications. It provides an external boundary within which graduates of the profession work. An individual therapist’s scope of practice may vary somewhat from others within the profession, as professional development may provide them with advanced skills in specific areas of practice. However, the scope of practice of an individual therapist may not exceed the scope of practice of the profession.
Introduction
This Scope of Practice document is developed for Spa Therapists with the basic level of training and certification. It is to be used in conjunction with the CMMOTA Standards of Practice for Massage Therapists and/or Spa Therapists and the CMMOTA Code of Ethics for quality assurance in the practice of Massage Therapy. CMMOTA recognizes the overlapping roles between Spa Therapists and Complementary Health Practitioners and therefore has included a list of activities restricted under the various pieces of legislation which govern health professions in the jurisdictions which CMMOTA Spa Therapists are authorized to practice.
This scope of practice statement creates public awareness in the choice of a suitable provider for their treatment needs. It also assists Spa Therapists to distinguish between modalities that lie within their scope of practice and those which do not.
This document does not apply to Massage Therapist members, whose Scope of Practice is a separate association document, and covers practice within unregulated parts of Canada by those Massage Therapist members registered with CMMOTA.
This document does not apply to Registered Massage Therapists (RMT), whose Scope of Practice is established and governed by their respective legislated professional College within a regulated Province or Territory of Canada.
Purpose
The purpose of this Scope of Practice document is to:
Provide a summary of authorized professional activities for Canadian Massage and Manual Osteopathic Therapist Association (CMMOTA) members registered as Spa Therapists with the Association;
Provide new and prospective graduates of Massage Therapy programs entry-to-practice margins with the Spa Therapist space;
Set a framework upon which CMMOTA Spa Therapist members can maintain their identity as professionals;
Encourage sound-logic and evidence-based approaches to guide care provided by a CMMOTA Spa Therapist member;
Provide CMMOTA Spa Therapist members a benchmark to maintain good standing with the Association;
Provide CMMOTA a parameter by which to initiate a complaints investigation process and implement a disciplinary action where applicable.
Acknowledgements
Special thanks to the Federation of Massage Therapy Regulatory Authorities of Canada for the 2016 Entry‐to‐Practice Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists which defines the practice competencies which the Association expects of CMMOTA Spa Therapists at their entrance into practice.
Liability Statement
In addition to this document, Spa Therapist Members are accountable to work in a manner that is consistent to all applicable pieces of Federal, Provincial and Municipal legislation, Association Bylaws, Association Policies and Procedures, Standards of Practice and Code of Ethics documents.
GLOSSARY
Capable Scope: the sum knowledge surrounding the treatment or potential treatments for which the therapist has received sufficient training in to allow them to practice the techniques necessary for safe and effective treatment of a physical condition of a client and has adequate professional liability insurance coverage for the same.
Client: The person receiving treatment from a qualified Spa Therapist.
Massage Therapist: An individual that has graduated from an approved and licensed program and has become a Full Massage Therapist member or is in the second year of an approved and licensed program and has become an Associate Massage Therapist member, or is in approved and licensed program and has become a Student Massage Therapist member of the Canadian Massage and Manual Osteopathic Therapist Association (CMMOTA).
Massage Treatment: This is the therapeutic intervention provided by a qualified Full Massage Therapist, or a Massage Therapist in training (Associate Massage Therapist or Student Massage Therapist).
Registered Massage Therapist: An individual that is a member in good standing of the legislated regulatory College which includes the profession of massage therapists as registrants within a Regulated Province or Territory in Canada.
Restricted Activity: An action that is legally impermissible and/or unethical and/or immoral and/or unauthorized for the Spa Therapist to perform on a client due to inadequate authorization/training/skills/education/certification.
Scope: The assessment, treatment and prevention of soft tissue physical dysfunction, injury, and pain, using skills and techniques acquired through the entry -level modalities in which the Spa Therapist is trained and certified to competently perform after graduation, or advanced modalities in which the Spa Therapist has received advanced training that has been recognized as sufficient training to practice the advanced modality by their professional liability insurance provider
Spa Therapist: An individual that has graduated from an approved and licensed program in Massage Therapy recognized by CMMOTA and has become a registered Spa Therapist member of the Canadian Massage and Manual Osteopathic Therapist Association (CMMOTA).
Spa Therapy Treatment: This is the treatment intervention provided by a qualified Spa Therapist using one or more of the modalities in which they have received qualified education, and for which they have adequate professional liability insurance coverage.
Summary of Scope of Practice
From a physiological perspective, this is what is permissible for CMMOTA Spa Therapist members:
• Any Spa Therapy Modalities as outlined in Appendix 42: Modalities List for Spa Therapists for which the therapist has receive adequate recognized training in and has professional liability insurance coverage in place to practice.
• Client education for self or home care. For example:
Suggesting that an office worker with low back pain get up and move around periodically throughout their workday; or
Suggesting self-care techniques which may help stretch or strengthen areas of concern; or
Educating clients about factors influencing their pain, for better client understanding and further taking steps toward self-care.
Summary of Restricted Activities
This scope of practice restricts CMMOTA Spa Therapist members from performing the following activities:
1. Prescribing/administering medications.
2. Providing diagnoses.
3. Puncture of the dermis.
4. Performing all forms of psychotherapy, mental health counselling, or spiritual counselling.
5. Resetting or attempting to treat a broken bone or joint.
6. Performing any other restricted activities as defined in applicable provincial legislation in the jurisdiction in which the therapist practices. (see end note 1)
7. Performing modalities NOT approved or defined as Spa Therapy in accordance with Appendix 42: Modalities List for Spa Therapists and billing them as Spa Therapy Treatment.
8. Performing modalities included in Appendix 42: Modalities List for Spa Therapists without having adequate training recognized and insured through their professional liability coverage provider.
9. Providing advice on areas outside of the scope of spa therapy including but not limited to client’s mental, social, financial, or nutritional health except ONLY in the form of a referral and ONLY when requested by the client.
10. Inserting body parts or equipment into the anus, vagina, or urethra.
11. Massage of the nipple, areola, penis, testicles, vulva, or perinium.
12. Initiation or pursuit of personal romantic relationship(s) with client(s) within twelve months of the last treatment with the therapist.
13. Conducting research related to the profession. This includes but is not limited to any technique, or the effects of the use of a technique or treatment protocol.
14. Providing instruction or training supervision, either within a massage therapy program, or any continuing education for the profession.
SCOPE OF PRACTICE
1. Client Interaction
Scope
The Spa Therapist:
• Communicates professionally with the client
• Applies principles of beneficence and non-maleficence when working with clients
• Respects the client’s right to refuse treatment
• Treats all clients fairly and impartially
• Maintains privacy and confidentiality of client information in accordance with provincial and federal legislation
• Provides the client with all the options pertaining to the treatment session, including the potential benefits and side effects
• Invites the client to attend treatment sessions
• Creates an environment where confidentiality can be maintained for the client to fully disclose their health history
• Seeks informed consent from the client before performing any activity within this scope of practice document
• Seeks written informed consent for treatment of any sensitive areas (as defined in the CMMOTA Treatment of Sensitive Areas Policy) before preforming any activity within this scope of practice document
• When required by law, reports to relevant authority, or encourages reporting, when there is evidence and admission of abuse on a client in accordance with CMMOTA’s Duty to Report Policy.
• Reasonably charges the client for services rendered
• Retains the right to refuse to provide treatment if safety of the client and/or the therapist is perceived to be compromised
• Discloses to the client their level of training/certification and licensure
• Prohibits Animals from entering a treatment space except where the animal is a certified or licensed service animal.
Restricted Activities
The Spa Therapist shall not:
1. Refer to themselves as any other protected title under any provincial or federal legislation in the jurisdiction in which they are practicing; or
2. Encourage, initiate, or maintain a sexually intimate relationship with an existing client; except when legally married or in a common law relationship; or
3. Encourage, initiate, or maintain a sexually intimate relationship with a former client within a twelve-month period following the end of the therapeutic relationship; or
4. Encourage, initiate, or maintain behavior of non-therapeutic nature; or
5. Misrepresent their qualifications to members of the public.
Termination or Refusal of Treatment
The Spa Therapist may refuse or terminate treatment where:
1. The therapist believes that the condition of the client requires treatment that is beyond the therapist’s capable scope; or
2. The Safety of the client is perceived to be compromised; or
3. The Safety of the therapist is perceived to be compromised; or
4. Sexual harassment has been perceived to occur before or during a treatment session; or
5. The client refuses to follow proper draping procedures; or
6. The client refuses to pay for treatment or for previously missed or cancelled appointments.
Where treatment has been refused or terminated the therapist must document within the client’s treatment chart the date of the refusal of treatment, the reason, or reasons why the treatment was stopped or refused in detail.
Where there have been serious breaches of professional boundaries by a client, which include sexual harassment in the form of inappropriate physical contact or sexually suggestive behaviour or sexually suggest remarks or requests for sexual services, the therapist is encouraged to document such within the treatment chart, and to report the incident to their supervisor, employer, clinic owner, the Association, and the respective police authority within the jurisdiction where the incident took place.
2. Technical Skills
Scope
The Spa Therapist,
• Performs physical assessments and re-evaluations on clients as per the CMMOTA Standards of Practice for Massage Therapists and Spa Therapists document
• Partners with the client to develop an appropriate treatment plan
• Implements treatment techniques as outlined in the CMMOTA Standards of Practice for Massage Therapists and Spa Therapists document and the Inter-Jurisdictional Practice Competencies and Performance Indicator for Entry-to-Practice Massage Therapists and as outlined in Appendix 42: Modalities List for Spa Therapists for which the therapist has adequate recognized training in and carries adequate professional liability insurance coverage for.
• Effectively manages time in the workplace
• Provides a progress report when requested
• Refers the client out to more experienced professionals when the complexity of the client care exceeds their expertise or when there is a high risk of a negative outcome in response to a therapeutic intervention or whenever is suitable
Restricted Activities
The Spa Therapist shall not:
1. Perform any activity restricted in any Health Professions Act or other applicable legislation which governs the jurisdiction in which they are practicing;
2. Perform treatment on a client without seeking and obtaining informed consent;
3. Perform treatment on a sensitive area on a client without seeking and obtaining informed written consent;
4. Perform a therapeutic intervention to intentionally harm the client;
5. Perform High Velocity Low Amplitude Thrusts on a client;
6. Diagnose a condition presented by a client and/or suggesting that a therapeutic intervention can provide a cure for a disease or syndrome;
7. Issue a requisition to a client for a diagnostic test;
8. Perform a technique on a client without having the skill, education, training and certification;
9. Perform a technique on a client without having adequate professional liability insurance coverage for use of the technique;
10. Puncture the dermis of the client in the course of treatment;
11. Perform intra-anal, intra-penile and/or intra-vaginal treatments on a client;
12. Perform massage of the nipple, areola, penis, testicles, vulva, or perinium.
3. Leadership and Resource Management
Scope
The Spa Therapist:
• Performs cost-benefit analyses of their business and service to clients
• Applies quality assurance and quality control measures in the provision of services to the client
• Monitors resource provision to clients
• Fairly allocates resources such as time, finances and intellectual wealth to clients and staff
• Prioritizes and budgets for task completion
Restricted Activities
The Spa Therapist shall:
1. Comply with any Provincial and Federal Government legislations, Human Rights Commissions and Labor laws regarding health and safety and employment standards;
2. Provide a workplace free of verbal or conduct harassment or discrimination due to disability, sexual orientation, gender, race, religion, country of origin, ethnic descent, family, appearance, color, age, criminal history, medical history, marital status etc.
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End Notes
1. References (Restricted Activities)
British Columbia – https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/professional-regulation/interpretive_bulletin.pdf
Ontario – Regulated Health Professions Act; Section 27 – https://www.ontario.ca/laws/statute/91r18#BK12
Prince Edward Island – Regulated Health Professions Act: Section 86 – https://www.princeedwardisland.ca/sites/default/files/legislation/r-10-1-regulated_health_professions_act.pdf
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