consultation - ftg 2012

8/10/2019 Consultation - FTG 2012

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CONSULTATION &DOCUMENTS

FTM 5TH EDCHAPTERS 2, 4 & 9

Swedish Massage



Texas DSHS RequirementsDesigning Your Consultation Form

Consultation & Documents



Requirements of TexasDSHS

Written Consultation Form



§140.304. Consultation Document

(a) A licensee shall provide an initial

consultation to each client(s) prior to the

first massage therapy session and obtain

the signature of the client on theconsultation document. The consultation

document shall include:

(1) the type of massage therapy services or

techniques the licensee anticipates using

during the massage therapy session;




(2) the parts of the client's body that will bemassaged or the areas of the client's body thatwill be avoided during the session, includingindications and contraindications;

(3) a statement that the licensee shall notengage in breast massage of female clientswithout the written consent of the client;

(4) a statement that draping will be usedduring the session, unless otherwise agreedto by both the client and the licensee;




(5) a statement that if uncomfortable for

any reason, the client may ask the licensee

to cease the massage and the licensee will

end the massage session; and

(6) the signature of both the client and the

licensee.



§140.304. Consultation

Document

(b) If the client's reason for seeking

massage therapy changes at any time and

any of the information in subsection (a)(1) -

(4) of this section is modified, the licenseemust provide an updated consultation

reflecting any changes and modifications

to the techniques used or the parts of the

client's body to be massaged.




§140.303. General Ethical Requirements

(e) For each client, a licensee shall keep

accurate records of the dates of massage

therapy services, types of massage therapy

and billing information. Such records must

be maintained for a minimum of two years.



Client InformationPertinent Information

Designing Your Consultation

Form



Designing Your Consultation Form

Length: Is more than 1 page

necessary?

Time to complete: will it take morethan 10 minutes?

Readability: Type size large enough?

Organization: Does it flow well or havea logic to the arrangement?



Designing Your Consultation Form

Convenient: Can items that apply be

circled or checked off

Necessary: Do you as a therapist need to

know this?

Flexible: Is there room for them to add

information they feel you need to know?



Client Information

Name & Address

Home, work & cell numbers, email

address

Who is responsible for payment

Emergency contact

Date of birth/age, sex Referring individual



Possible Additional Client

Information

Occupation

Hobbies

Social security numberTexas Drivers License Number

Marital status, number of children

Height & weight Any other information?



Pertinent Information

Date of appointment

Purpose of visit

Discomfort/pain levelsFocus areas

Areas to avoid

Medical history includingmedications, surgeries, past injuries

& major illnesses



FTM pp. 137-141

Fig 4-16 Sample History Form

Fig 4-17 Sample Physical Assessment Form

Sample Forms:



Booking the Appointment

Your Preparations for the Massage

First Appointment

Performing the Massage

After the Massage

Next Appointment

Initial Consultation



PhoneWebsite

Booking the Appointment



Our First Contact with the

Client

Phone

Smile when answer the phone

Professional greeting for voice mails –

return calls within 24 hrs or sooner Purpose of the visit?

Is this his first professional massage?Does she have any previous experienceswith massage?

How did you find out about my services?

Explain your professional services & fees



Our First Contact with the

Client

Explain pertinent policies – can also be

on website

Request that she come 20 minutes early

to complete paperwork for the first

appointment

Can include form on website & request

that it be returned to you prior to the

appointment

Confirm appointment – call, email, text



Your Preparations

General considerations: temperature, fresh air

& ventilation, privacy, accessibility, lighting,

aroma/scents, hygiene, warm hands

Prepare room/office – temperature,cleanliness, water, music

Prepare table – fresh linens, table warmer

turned on, face rest cover Prepare for massage – lubricant, holster,

pillows/bolsters, extra blanket



First Appointment

GreetingProfessional

Friendly

Eye contact Completion of intake form/medical history – allow 10 minutes

You ask the questions to complete the formor

You give them the form to complete



Handshake?



First Appointment

Determine ifindications orcontraindicationsexist

Observation of posture,gait, & generaldemeanorCommunication &

listening skillsObserve client’s non-

verbal language

Notice any touching ofbody parts during thediscussion – can be



Sample Questions - Chief Concern or

Priorities

What is your major concern today? Any other areasof concern or pain?

What type of massage do you prefer? Relaxation,deep tissue, other?

What results do you want from your massagesession? What would you like to achieve with ourwork?

Is there an area where you would like extra time

spent? Any area where you seem to hold a lot oftension?

How do you use your body during the day?

Examples: how much time spent per day standing,

sitting, chasing small children, carrying heavy items,etc?



Sample Questions - Soft Tissue

Conditions

Do you follow a regular exercise program? What kind?

Do you use alcohol, coffee or tea? Is your use heavy,moderate or light?

What are your frequent activities? Occupation?

What are your sleep habits? Hours & quality of sleepmost nights, difficulties? What is your sleep position? Isyour mattress comfortable?

What is your diet like?

Do you use orthotics such as heel lifts, sole lifts, archsupports, or inner soles?

How many glasses of water per day?

Current level of stress in your life? Currently in a periodof prolonged stress?



Sample Questions - Stress

In which part of your body do you feel stress mostoften? Head, neck, shoulder, back, digestive,extremities, or other?

What portion of each day is set aside forrelaxation? What kind?

Do you use anything specifically for stressreduction? Examples: prayer, meditation, guided

imagery, exercise, energetic therapies, or other. Have you ever had a massage before? What is

your previous experience with professionalmassage?

Do you have a music or aroma preference?

S l Q ti



Sample Questions -

Symptoms

What is your primary symptom? Any othersignificant symptoms? Examples: headaches,fatigue, depression, pins and needles, painful joints, loss of balance, stiffness, loss of strength,edema, constipation, diarrhea, heartburn, etc.

If pain, what is the pain like?

How severe or uncomfortable is the symptom for

you? What is the location of your symptom? How much

of your body is affected?

What is the onset? When did your problem

begin? When did you first notice it? What brought

S l Q ti



Sample Questions -

Symptoms

What makes it worse? How long does it last?

Is the symptom getting progressively worse?

Is it constant or intermittent (comes and goes)?

Is there a pattern? Describe one episode – number of times per hour,

day, week, or month

What activities help or make the symptom worse?

What activities have you had to alter, decrease orstop? Examples: housekeeping, self-care, childcare, work, sleep



Sample Questions - Mobility & Ability to

Perform Various Activities

What have you done to get relief? What homeremedies have you used to get relief?

What body positions are most comfortable? Do

you use over the counter medications? Whichones? In general, what makes the pain better?

Have you been or are you under a physician’scare for this symptom? Has there been a

diagnosis? Do you have a recommendation or aprescription for massage?

What does this problem mean to you?(Opportunity for client to express any feelings or

emotions surrounding the problem.)



First Appointment

Determine client’s goal for the

massage

What must be done to achieve it?

Is the client’s goal reasonable?

Jointly determine plan for the massage

– allow 10-15 minutes

Determine pressure preferences, focus

areas, areas to avoid

Determine modalities to be used



First Appointment

Informed consent and her signature(pp. 46-47;p. 50 Box 2-10) Get agreement from your client regarding what

modalities and techniques you will be using.Stress that if she doesn’t like something you do duringthe massage to let you know so that you can modify itor stop doing it.

If you need to work close to the breasts, groin or

gluteals, explain why and how you will drape the area. Consider having a written explanation of the services

you offer, along with a listing of their benefits and risks,if any. Give this to every new client. Ensure they havetime to read it & ask questions before you start

working with them.



Informed Consent Form



An informed consent contains information

from which the client

A. Can judge the practitioner

B. Can state the rights to reschedule thetreatment

C. Are advised of undesirable effects from

the massage D. Have decision-making rights



An informed consent contains information

from which the client

D. Have decision-making rights



Informed consent can be ___ at any time.

A. Modified

B. Ignored

C. Withdrawn

D. Both A and C



Informed consent can be ___ at any time.

D. Both A and C



A care plan is

A. A list of contraindications

B. A list of mutually agreeable goals and

course of treatment decided upon betweenclient and therapist

C. An assessment

D. Session notes



A care plan is

B. A list of mutually agreeable goals and

course of treatment decided upon betweenclient and therapist



First Appointment

Explain massage procedure

Facilities – where change clothes, restroom

Explain draping procedures

Level of undress for massageHow to get on & off table

How to position themselves on table

Use of pillows and bolsters forpositioning/support

Purpose & choice of lubricant – anyallergies?

Temperature preferences & use of blanket/s




Modify pressure, plan & modalities as

needed

Explain why the modification is needed and

get her approval. Tell her that if she doesn’t

like the modification, you will stop doing it.

Client Feedback During



Client Feedback During

Massage

Slower, deeper

breathing Relaxing of muscles

Verbal feedback

Snoring!

Fidgeting

Tensing muscles Facial flinching

Making a fist

Holding his/herbreath

Ways indicate enjoyment Ways indicate discomfort




Ask questions about anything you

encounter such as scars, etc. not already

on intake sheet.

Document changes while waiting for client

to dress



After the Massage

Ask her about her perceptions of changes in

focus areas – what worked & what didn’t

Ask if there was anything that he would have

liked you to have done differently

Give your suggestions for changes in next

massage based on your observations



After the Massage

Provide suggestions about

Drinking water

Stretches to be done at home

Frequency of massage

Referrals to other professionals if needed

Schedule the next massage

Walk her out of your office Complete your session notes

Client feedback form



Which is a skill for developing an optimal

client relationship?

A. Acceptance

B. Ignoring

C. Listening

D. Humoring



Which is a skill for developing an optimal

client relationship?

C. Listening



What is the first step in beginning massage

treatment?

A. Apply lubricant

B. Effleurage

C. Determine indications/contraindications

D. Diagnose the patient



Follow-up after the Massage

Within next 2 days, contact client by phone,

email, or text to ask about changes in focus

areas

Document your discussion in session notes



Next Appointment

Prior to client’s arrival – reread session notes

Discussion:

How did she do in between appointments

regarding previous goal/focus area? Any changes in goal, focus areas, & areas to

avoid?

Any new indications or contraindications?

Revise intake form to reflect any changes

Jointly determine plan for today’s massage – informed consent



Planning single and multiple sessions

A. Is not easy to accomplish initially

B. Depends on client history and interview

C. Depends on the emotional status of the

client

D. Can only be effective after 6 visits



Planning single and multiple sessions

B. Depends on client history and interview



Massage Documents

Diagrams p. 138

Fig 4-18 Sample Treatment Plan p. 140

HIPAA Act - pp. 51-2 Box 2-11

Self-report forms

Diagrams – indicate where pain/discomfort felt

Document symptom occurrence & severity



Body Diagrams & Pain Scales

A way for clients to

indicate focusareas and areas to

avoid

Can indicate pain

levels of differentareas of body

A way for clients to

document their levelof pain

Body Diagrams Pain Scales



Body Diagrams



Pain Scale



Release of Information

Completed by the client to allow you to share

information with his/her health care provider

Includes your name and the client’s name

Includes name of person information will bereleased to and a time frame if necessary

Only exception to first completing a release

of information form is to respond to a court

order



Release of Information



FTM pp. 292-3

Client Feedback



Sample Client Feedback Questions

Ask client to rate questions on scale of 1-5

where 1 is poor and 5 is excellent.

The overall atmosphere, cleanliness, and

quality of the facility was professional andrelaxing.

My massage therapist was friendly,

knowledgeable, and professional.

My therapist started and finished the session

on time.




My therapist consulted with me about the type of

massage I wanted to receive, the degree of

pressure I enjoy, and the areas of the body I wanted

focused work. We had an agreed upon plan for the

session before the start of the massage.

The therapist followed the session plan we agreed

on and I received the massage I requested.

My therapist asked about the degree of pressure ofstrokes and adjusted the pressure appropriately

when asked.




The massage strokes felt firm, flowing, and

appropriate to the needs of my body.

Draping, positioning, lighting, music, and my

overall warmth and comfort were attended to. My payment was processed in a timely

manner and I was given the opportunity to

book a future appointment at the end of the

session.

My overall experience was excellent and I

would come back.



Session Notes

S i N t



Session Notes

Progress Reports:

Used to report back to the referring physician

SOAP Notes:

PP. 138-142

Fig 4-19 Sample SOAP Notes p. 141

SOAP N t



SOAP Notes

SOAP

S = Subjective

O = Objective

A = Assessment/Analysis/Application

P = Plan

Most popular charting system for health

care professionals

SOAP F



SOAP Forms

Box 4-6 SOAP and Massage p.



Box 4 6 SOAP and Massage p.

142

E l f SOAP i M



Example of SOAP in Massage

Box 4-6 p. 142

S: hand placement, pain level

O: elevated shoulders, ROM of neck, pain

when touched, upper trapezius feels warm Approach: focus and strokes used

A: level of pain reduction, ROM of neck,

palpation results, effective strokes, cold feet P: exercises, next appointment, expected

number of sessions, talk with personal

physician re massage



A client comes in and reports that herlower back has been hurting ever since she

mowed her yard yesterday. In which

section of the SOAP notes is thisinformation recorded?

A. S

B. O

C. A

D. P



A client comes in and reports that herlower back has been hurting ever since she

mowed her yard yesterday. In which

section of the SOAP notes is thisinformation recorded?

A. S



Communication between therapist andclient during a massage session should be

kept

A. To a minimum



The confidential information about theclient can include:

A. Information during a session

B. Observations made by a therapist abouta physical or emotional condition

C. Health history

D. All of the above



The confidential information about theclient can include:

D. All of the above



Subjective information is obtained by

A. Assessing the way the client walks

B. Palpation

C. Assessing the way the client stands

D. Listening



Subjective information is obtained by

D. Listening



IN CLASS ACTIVITY

SOAP Notes Activity



SOAP Notes Activity

Read case study of Mona’s condition and

her massage

Record information in appropriate

categories of S, O, A & P.



Answer Key

SOAP Activity

Subjective



Subjective

Symptoms

Diagnosed with frozen right shoulder

Currently receiving physical therapy for shoulder

Has shoulder pain, tension in neck & shoulders &numbness in 3rd & 4th fingers of right hand

Has limited use of her right arm

Can’t do things like hook/unhook her bra

Subjective



Subjective

Client goals:

She wants massage to assist in her recovery

She wants a full body massage with focus on

neck & shoulders. She wants firm pressure but is more sensitive in

her right arm & shoulder.

Objective



Objective

Observation:

Her right shoulder appears to be slightly

protracted in sitting posture

While palpating her neck & shoulders, musclesfeel tight

Objective



Objective

Treatment goals Will confirm possible right shoulder protraction

Will focus on right Pectoralis major & minor to relieveshoulder protraction

Will use Swedish massage & trigger points to workright trapezius & underlying muscles to addressnumbness due to possible nerve compression

Will use reflexology to treat shoulder points on rightfoot

Mona will do any movements required of right arm

Full body massage with firm pressure with a focus onher neck & shoulders

Applications



Applications

Massage Treatment Given

Confirmed protraction of right shoulder

Provided Swedish massage & trigger point work

to neck & shouldersUsed reflexology on shoulder points

Received normal massage on rest of body

Required more time to roll over due to her need to

protect the right shoulder

Applications



Applications

Changes due to massage:

States that her neck & shoulder feel less tense

States that numbness has ‘disappeared’

Planning



Planning

Homework Mona to ask her physical therapist about home use of hot/cold

packs

Mona already has daily home exercises from her physicaltherapist

Plan for next session Mona will return in 1 week for another massage

Will ask for input re tension & numbness in neck & shoulders

Will repeat Swedish & trigger point techniques as well asreflexology on shoulder points

Will evaluate the possibility of side-lying position for protractedshoulder

Long-term goals: