Considerations for Moving Forward as COVID-19 "Stay at Home" Orders are Lifted
June 29, 2020 08:26 AM
AMTA COVID-19 Task Force
The AMTA offers the following considerations to assist music therapists in making decisions as locations across the country transition to more open conditions. Please keep in mind that it is important to take into consideration state, local, territorial, or tribal health and safety laws, rules, and regulations when addressing the unique circumstances and needs of your local community.
Infection Control Precautions
Standard Precautions should be used for all service user care. These precautions are based on risk assessment and use both common sense practices and personal protective equipment. Standard precautions are designed to protect providers from infection and prevent the spread of infection from service user to service user. Examples of appropriate precautions include but are not limited to (a) hand hygiene, (b) proper cleaning of instruments and equipment between each service user/ group, (c) cough etiquette/hygiene, and (d) use of personal protective equipment (Centers for Disease Control , 2016).
Continue to use PPE in accordance with area (state/ local/ facility) guidelines. If you work outside a facility that sets guidelines, consider using protocols set by reputable health care organizations in your area as models for setting your own policies.
Use of face coverings is recommended for all public spaces. Note that plastic face shields are not an adequate substitute for cloth or medical-grade face masks.
When possible, limit materials and/or instruments used in sessions to those that can be disinfected effectively. Consider use of instruments like those in the Remo Green and Clean line which can be disinfected with hospital grade disinfectant (Evans, 2020).
Mobile technology (e.g., tablets, etc.), when used with products that can be safely and easily disinfected (e.g., Otter products, Ziplock cover on iPads, etc.), may be a viable alternative to traditional instruments that cannot be safely disinfected. Consider use of technology to replace instruments that would be difficult to disinfect.
Limit contact of potentially contaminated work items outside of work when possible. For example, the use of dedicated scrubs and work shoes—which can be removed before interacting with family members—could help prevent or reduce risk of cross contamination.
Consider air flow in your clinical space/room and how that may impact spread of the virus.
For more information on Standard Precautions and PPE see:
Standard Precautions: https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html
Mask Use: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
Mask Use: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
Note: Please continue to check the CDC website for up-to-date recommendations. For more info, see https://www.cdc.gov/coronavirus/2019-nCoV/index.html
Practice Considerations
Make sure your HIPAA policies are up to date. Consider implementing an addendum to disclosures and patient consent forms that advises service users that collection of contact information may be disclosed to public health authorities in the event of a reported positive case of COVID-19 for purposes of contact tracing and public safety.
Review the available research and local policies and/or consult with facility administration to determine when and where in-person services should be reinstated. Consider prioritizing service users who do not respond to or benefit from teleservices during the first phase of returning to in-person interactions. Be prepared to propose a decision/triage process to managers and administrators if needed to help identify who should return to in-person services.
When returning to in-person interactions, continue to follow area (state/ local/ facility) safety guidelines such as temperature checks, symptom checks/screening, use of barriers, use of PPE, distancing, etc. If you work outside a facility that sets guidelines, consider using protocols set by reputable health care organizations in your area as models for setting your own policies.
Recognize that some service users may be unable to follow personal protective measures (Centers for Disease Control , 2020). Proactively determine how you will proceed with these service users.
Recognize that use of PPE could increase distress in service users with some level of cognitive impairment (NHS, 2020).
Stressors related to the COVID-19 pandemic may put both service users and music therapists at increased risk for experiencing emotional distress. It is important to monitor the psychosocial effects of the pandemic on ourselves and our service users, and promote or implement healthy stress management and coping strategies—including seeking professional mental health assistance—when needed (Pfeffer Baum & North, 2020).
When possible, conduct all aspects of music therapy services that can be done remotely (e.g., documentation, chart review, etc.) in non-patient contact locations.
Adjust your location/proximity to service users as needed to reduce potential spread when speaking loudly, singing, or using wind (blown) instruments. If needed, feasible, and appropriate for the clinical situation, consider use of pre-recorded songs and double the song quietly or lip sync to minimize risk of droplet spread.
Practice decisions will continue to be complex, and decisions about what is safe and feasible may vary based on setting, population, location, and other factors. Please continue to consult the AMTA Code of Ethics (2019) and Ethical Decision Making Models shared at https://www.musictherapy.org/about/ethics/ as needed to inform your clinical decision making processes.
Teleservices Considerations
Be cognizant of HIPAA, FERPA, and other regulations and maintain compliance with these guidelines. Be aware that these guidelines may continue to change in terms of what is allowable as we transition to different stages of the pandemic. Keep in mind that during a pandemic there may be periods where stricter lockdown is reinstated, depending on the region. Additional guidance is provided by the U.S. Health & Human Services (2020) found at https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
Consider licensing and regulation factors when providing services via technology across state lines.
Consider copyright issues, licensing, and/or other permissions related to use of music and images when providing teleservices (as well as in person services). For more info on copyright see https://www.musictherapy.org/assets/1/7/Advisory_Copyright_from_the_AMTA_COVID19_Task_Force_06_20_20.pdf
Consider discussing and including music-based instruction for safety protocols (like use of masks) with service users during the final telehealth sessions before returning to in-person interactions. Personal Health Considerations
Both you and your service users may be experiencing fear, grief, and anxiety because of the pandemic. Because everyone reacts differently to stress, it is important to know your limits as an individual and integrate self-care strategies as needed so that you can take care of yourself and your community.
Be conscious of vocal health and the potential impact that things like singing and speaking through masks on a regular basis can have on your health.
Consider things like the use of recordings of your own voice to provide vocal rest.
If you are in an at-risk group, determine what will be necessary for you to safely practice as we move forward in the pandemic.
If possible, address concerns with administrators and/or consult legal counsel for options.
References
American Music Therapy Association (2019). American Music Therapy Association Code of Ethics. https://www.musictherapy.org/about/ethics/
Centers for Disease Control (2016, January 26). Standard precautions for all patient care.
https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html
Centers for Disease Control (2020, May 19). Additional COVID-19 guidance for caregivers of people living with dementia in community settings. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/caregivers-dementia.html
Evans, T. (2020, February 24). Remo Green and CleanTM: Designed for music therapy. West Music. https://content.westmusic.com/remo-green-and-clean-designed-for-music-therapy/
NHS Lothian (2020, March). Impact of PPE on individuals with dementia. https://www.nhsaaa.net/media/8922/8-impact-of-ppe-on-individuals-with-dementia.pdf
Pfefferbaum, B., & North, C. S. (2020). Mental Health and the Covid-19 Pandemic. New England Journal of Medicine. https://doi.org/10.1056/NEJMp2008017
U.S. Department of Health & Human Services (2020, March 30). Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
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