Code of Ethics

Note: Members of the AMTA Ethics Board are a resource for consultation and support for AMTA members and the public who may have questions, concerns or be faced with ethical dilemmas. A list of current Ethics Board Members can be found here. More information for AMTA members from the Ethics Board can be found here. If you have a question, concern, or complaint related to the AMTA Code of Ethics, please contact a member of the Ethics Board using our secure email address: amtaethics@hushmail.com. Please allow at least 72 hours for a reply.

Code of Ethics

Adopted by the Assembly of Delegates November 17, 2018 at the 2018 AMTA National Conference
Effective February 1, 2019

 

Table of Contents
Appendices
  1. Glossary of terms
  2. Ethical Decision-Making Models

Preamble and Purpose

Preamble

The Code of Ethics of the American Music Therapy Association, Inc., summarizes our values as professionals and describes principles and standards for guiding the practice of music therapy in a responsible, fair, and accountable manner. We, the members of the American Music Therapy Association, hold Kindness, Social Responsibility, Dignity and Respect, Equality, Accountability, Excellence, Integrity, and Courage to be Core Values. These values are reflected in five ethical principles which include (1) respecting the dignity and rights of all, (2) acting with compassion, (3) being accountable, (4) demonstrating integrity and veracity, and (5) striving for excellence. These values and principles provide guidelines for ethical decision-making in our daily practice. Standards of behavior guide our conduct as professionals. Ethical practice is more than following a list of rules. It is a commitment to virtuous, caring, courageous thinking that involves self-examination and the well-being of others as our highest intent. We commit ourselves to uphold the value and worth of every person, and to treat all with dignity.

Music therapists who encounter ethical dilemmas are advised to follow a decision-making process available in the literature (Dileo, 2000; Swisher, Arslanian, & Davis 2005, & Markkula Center for Applied Ethics). Music therapists are advised to also consult the Scope of Music Therapy Practice and the AMTA Standards of Clinical Practice for more detailed information to guide clinical decision-making.

It is important for music therapists to recognize our responsibility to adhere to laws, regulations, or policies of organizations and other governing bodies outside the AMTA. In cases where such laws, regulations, or governing body policies conflict with ethical responsibilities, the music therapist will address and seek to resolve this conflict with those in decision-making positions with the best interests of the client foremost in mind. Music therapists are reminded that we practice within the norms and standards of the communities in which we work and that our behavior may influence public attitude toward the profession.

Purpose

This Code of Ethics describes the highest ideals for music therapists as an aspirational guide to professional conduct. It is equally intended to educate and guide music therapists in ethical practice, as well as inform those outside the profession.

Applicability

This Code of Ethics is applicable to all those holding the MT-BC credential or a professional designation from the National Music Therapy Registry (ACMT, CMT, RMT), and professional membership in the American Music Therapy Association. This Code is also applicable to music therapy students and interns under clinical supervision. All music therapy practitioners are expected to uphold the spirit and purpose of the Code, and to practice according to these standards.

Upholding our right to freedom of inquiry and communication, we accept the responsibilities inherent in such freedom: competency, objectivity, consistency, integrity, and continual concern for the best interests of society and our profession. Therefore, we collectively and individually affirm the following declarations of professional conduct.

Core Values

This Code of Ethics is grounded in a set of eight Core Values: 1. Kindness, 2. Social Responsibility, 3. Dignity/Respect, 4. Equality, 5. Accountability, 6. Excellence, 7. Integrity, and 8. Courage. These Core Values provide a foundation to guide music therapists in their practice and interactions. These Core Values should be considered in determining all ethical courses of action. (See glossary for detailed definition of these values)

Principles for Ethical Practice

Principle #1 Respect dignity and rights of all

Music therapists respect the dignity and rights of all people; this informs our relationships with clients, colleagues, students, research subjects, and all people we encounter. By acknowledging the worth of all people, this principle also encourages the music therapist to reflect sensitivity in all interactions.

To operationalize this principle, the music therapist will:

1.1  provide quality client care regardless of the client's race, religion, age, sex, sexual orientation, gender identity or gender expression, ethnic or national origin, disability, health status, socioeconomic status, marital status, or political affiliation.

1.2  identify and recognize their personal biases, avoiding discrimination in relationships with clients, colleagues, and others in all settings.

1.3  respect, acknowledge, and protect the rights of all clients, including the rights to safety, treatment, respect, dignity, and self-determination, as well as the rights to choose a provider, to exercise legal and civil rights, and to participate in treatment decisions.

1.4  respect the client's right of ownership to creative products as a result of participation in music therapy.

1.5  obtain informed consent from the client or legal guardian. In cases in which the client is unable to provide consent, assent will nonetheless be sought.

1.6  respect and protect the client's confidentiality at all times and following any applicable institutional or legal rules and regulations. The music therapist will inform the client of all limitations to confidentiality prior to the beginning of treatment.

1.7  protect the rights of clients, students and research participants under applicable policies, laws and regulations. Music therapists will ensure students, researchers, volunteers, and employees abide by privacy laws and exceptions as currently defined in Pub.L. 104-191 - Health Insurance Portability and Accountability Act and Pub. L. 93-380 - Family Educational Rights and Privacy Act, and Title IX- Education Amendments Act.

1.8  acquire knowledge and information about the specific cultural group(s) with whom they work, seeking supervision and education as needed.

1.9  avoid entering into dual relationships when doing so would violate professional boundaries or clinical objectivity.

1.10  avoid accepting gifts or other considerations that could influence or give an appearance of influencing professional judgment.

1.11  avoid engaging in sexual or romantic relationships with clients, their family members, caregivers, students, trainees, research participants, or employees.

1.12  work collaboratively with peers using open direct communication to resolve differences of opinion or to recognize others' perceptions.

1.13  respect the professional services offered by colleagues in music therapy and other disciplines and endeavor to communicate openly when a change in provider occurs or is pending.

Principle #2 Act with compassion

As music therapists we are often confronted with much suffering and feel the need to assist in the alleviation of discomfort. By manifesting patience, wisdom, and genuine desire to help meet the needs of our clients, we offer compassion to those we serve. In addition, it is important for music therapists to extend compassion to themselves when confronted with their own human limitations.

To operationalize this principle, the music therapist will:

2.1  act with the best interest of clients in mind at all times.

2.2  actively listen to their clients and affirm and validate their experiences.

2.3  be aware and accepting of client's individual factors and cultural differences in the treatment process.

2.4  empower clients to make desired changes in their lives.

2.5  act with compassion and genuine interest when dealing with peers.

2.6  seek peer/professional supervision to assist with reflection and practice improvement.

2.7  practice self-kindness and mindfulness and extend compassion to self if faced with feelings of inadequacy or failure.

Principle #3 Be accountable

The act of being accountable encompasses the obligation to report, explain, and be answerable for resulting consequences. Accountability is valued as a means to establish trust and strengthen professional and client-based relationships. The music therapist will be honest, fair, accurate, respectful, timely, and maintain privacy in all interactions.

To operationalize this principle, the music therapist will:

3.1  fulfill their legal and professional obligations to the profession with respect to any applicable local, state, and federal laws and regulations, and employer policies.

3.2  accurately inform potential and current clients of credentials and fulfill educational requirements for maintenance and renewal.

3.3  work in a manner to reflect truthful and fair business practices that benefit clients, society, and the profession.

3.4  seek remuneration that is fair and reasonable.

3.5  conduct, document, and report professional, academic, and research activities in an accurate and timely manner, and in accordance with applicable regulations and best practices.

3.6  identify and fully disclose errors, adverse, or sentinel events that compromise the safety of clients and others, to all appropriate persons.

3.7  differentiate personal views from those of the profession, the employer or agency.

3.8  report any illegal actions to authorities.

3.9  give credit and recognition when using the ideas and work of others.

3.10  provide comprehensive, accurate, and objective information about expectations for treatment outcomes.

3.11  offer services commensurate with training and corresponding scope(s) of practice(s), recognizing personal limitations.

3.12  exercise caution and professional judgment in all electronic, written, verbal, and inferred communications being especially aware of electronic messages and potential public access.

3.13  be familiar with the Code of Ethics, abide by its principles and report witnessed violations to the Ethics Board, refraining from frivolous or punitive reporting. When a question arises regarding behaviors and ethics, the member is encouraged to consult with the Ethics Board.

3.14  cooperate and participate in ethics board inquiries and processes when requested to do so.

Principle #4. Demonstrate integrity and veracity

Demonstrating integrity and veracity challenges each individual to act with truthfulness and accuracy in all communications. These qualities compel us to be incorruptible and devoted to truth in all professional relationships and interactions. Additionally, adherence to the principle of veracity requires thoughtful analysis of how full disclosure of information may affect outcomes. If there are circumstances in which a music therapist must weigh the consequences when two or more values are in conflict, it is incumbent upon the music therapist to seek peer supervision or counsel from other resources.

To operationalize this principle, the music therapist will:

4.1  demonstrate truthfulness while using discernment and judgement while contemplating potential outcomes.

4.2  use resources available to them to enhance and better their practice (e.g., peer/professional supervision).

4.3  use caution when predicting the potential outcomes of services offered.

4.4  truthfully and accurately document outcomes of treatment.

4.5  fully disclose any financial interest in products or services that they recommend to clients.

4.6  make referrals to other professionals to address client needs beyond the scope of music therapy practice or beyond the therapist's professional competence.

4.7  provide accurate information to clients entering into a therapeutic or research relationship, and obtain informed consent from the client or research participant.

4.8  ensure that billing and business practices are accurate and reflect the nature and extent of the services provided.

Principle #5. Strive for excellence

The music therapist seeks to continually improve skills and knowledge, evaluating the strength and applicability of evidence into all areas of professional practice and behavior. Striving for excellence in music therapy encompasses all aspects of music therapy: education, training, supervision, clinical practice, business and research. Striving for excellence does not imply perfection, but the ongoing commitment to expand our knowledge and skills in all areas.

To operationalize this principle, the music therapist will:

5.1  achieve and maintain professional competence through learning and personal growth, and encourage colleagues to do the same.

5.2  strive to be self-aware and to continually improve skills and knowledge by integrating the best available evidence and findings from research to maintain best practices.

5.3  use caution, critical thinking, and strong consideration of the best available evidence when incorporating new and evolving interventions and technologies into their practice, education, or supervision.

5.4  will serve as a positive role model for students and interns regarding professional behavior, most especially regarding ethical behavior; assuring that students learn about and operate under the guidelines of this Code.

5.5  educators and clinical training directors ensure that students and interns meet or exceed the AMTA professional competencies before recommending entrance into the profession.

Music therapists are reminded that a Code of Ethics cannot describe every possible situation but offers the music therapist guidelines for ethical decision-making and professional conduct. Music therapists are encouraged to seek supervision or assistance as needed.

References:

American Occupational Therapy Association. (2015). Occupational therapy code of ethics (2015). American Journal of Occupational Therapy, <59(Suppl. 3).

American Physical Therapy Association (2009). Code of Ethics for the Physical Therapist, Alexandria, VA: APTA.

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010 and January 1,2017). Retrieved from http://www.apa.org/ethics/code/index.aspx

American Art Therapy Association, (2013) Ethical principles for art therapists American art therapy association, Inc. (2011, revised December 2013). Retrieved from https://arttherapy.org/wp-content/uploads/2017/06/Ethical-Principles-for-Art-Therapists.pdf

Art Therapies Credential Board (2016). Code of Ethics, Conduct, and Disciplinary Procedures. Retrieved from https://www.atcb.org/resource/pdf/2016-ATCB-Code-of-Ethics-Conduct-DisciplinaryProcedures.pdf

Behnke, S. (2004). APA's new Ethics Code from a practitioner's perspective. Ethics Rounds, 35(4). Retrieved from http://www.apa.org/monitor/apr04/ethics.aspx

Dileo, C. (2000). Ethical Thinking in Music Therapy, Cherry Hill, NJ: Jeffrey Books.

Fellman, S.J. (2018). Will your code of ethics get your association in trouble? Online webinar, GKG Law, June 28, 2018

Fisher (2003) Decoding the ethics code: a practical guide for psychologists. London: Sage Publications

Josephson Institute of Ethics, The Seven-step path to better decisions. Making Ethical Decisions. Retrieved from http://josephsoninstitute.org/med-4sevensteppath/

Ling, T.J., & Hauck, J.M. (2017). The ETHICS model: Comprehensive, ethical decision making. VITAS online retrieved from https://www.counseling.org/knowledge-center/vistas/by-year2/vistas-2017/docs/default-source/vi stas/the-ethics-model

Members of the 2018 Ethics Board

  • Carol L. Shultis, Co-chair
  • Janice Schreibman, Co-chair
  • Barbara Bastable
  • Debra Dacus
  • Jennifer DeBedout
  • Jamie George
  • Kevin Hahn
  • Jennifer Sokira

Note. This document replaces the AMTA Code of Ethics (2014), revised 2018, previously published at https://www.musictherapy.org/about/ethics/. This Code of Ethics effective February 1, 2019.

Copyright, American Music Therapy Association, 2018.

Appendix I - Glossary of terms

Definitions of Terms Used within the Code of Ethics

Core Values

Core Values are the fundamental beliefs of a person or organization. These guiding principles dictate behavior and can help people understand the difference between right and wrong. Core Values also help companies to determine if they are on the right path and fulfilling their goals by creating an unwavering guide. There are many different types of Core Values in the world, depending upon the context.

Kindness - 1: the quality or state of being kind //treating people with kindness and respect 2: a kind deed : FAVOR//They did me a great kindness.

Dignity - 1: formal reserve or seriousness of manner, appearance, or language 2: the quality or state of being worthy, honored, or esteemed 3a: high rank, office, or position b: a legal title of nobility or honor

Respect -la: to consider worthy of high regard : ESTEEM b: to refrain from interfering with please respect their privacy 2: to have reference to : CONCERN

Equality - : "the state of being equal." It's one of the ideals of a democratic society, and so the fight to attain different kinds of equality, like racial equality, gender equality, or equality of opportunity between rich and poor, is often associated with progress toward that ideal of everyone being truly equal.

Accountability - : the quality or state of being accountable especially : an obligation or willingness to accept responsibility or to account for one's actions

Excellence - 1: the quality of being excellent 2: an excellent or valuable quality : VIRTUE

Integrity -1: firm adherence to a code of especially moral or artistic values : INCORRUPTIBILITY 2: an unimpaired condition : SOUNDNESS 3: the quality or state of being complete or undivided : COMPLETENESS

Courage - : mental or moral strength to venture, persevere, and withstand danger, fear, or difficulty

Principles

la: a comprehensive and fundamental law, doctrine, or assumption b(l): a rule or code of conduct (2): habitual devotion to right principles

Respect and dignity for the rights of all - acknowledge the worth of all people and reflect sensitivity in all interactions

Acting with compassion - manifestation of patience, wisdom, and genuine desire to help meet the needs of others and self

Being accountable - encompasses the obligation to report, explain, and be answerable for resulting consequences

Demonstrating integrity and veracity - to act with truthfulness and accuracy in all communications.

Dual Relationship - occurs when a therapist has a second, significantly different relationship with his or her client in addition to the traditional client-therapist one, either concurrently or subsequently. This may be a professional relationship, such as playing the part of both counselor and teacher. Or, it may be of a nonprofessional nature, as in the case of a therapist who is also a friend or intimate partner of the person seeking therapy.

Members of AMTA who hold the credential MT-BC - The credential Music Therapist Board Certified (MT-BC) is granted by the Certification Board for Music Therapists (CBMT) to identify music therapists who have demonstrated the knowledge, skills and abilities necessary to practice music therapy at the current level of the profession. The purpose of board certification in music therapy is to provide an objective national standard that can be used as a measure of professionalism by interested agencies, groups, and individuals.

Music therapy students and interns - individuals working towards the MT-BC credential in an AMTA-approved college or university, national roster internship or university affiliated internship.

Professional Designations defined -

  • RMT: Members of AMTA who hold National Music Therapy Registry title Registered Music Therapist*
  • CMT: Members of AMTA who hold National Music Therapy Registry title Certified Music Therapist designation*
  • ACMT: Members of AMTA who hold Advanced Certified Music Therapist designation*

* Until such time as these designations expire 12/31/19

NMTR: The National Music Therapy Registry (NMTR) serves qualified music therapy professionals with the following designations: RMT (Registered Music Therapist), CMT (Certified Music Therapist), ACMT (Advanced Certified Music Therapist). While new RMT, CMT, and ACMT designations are no longer awarded, individuals who have received and continue to maintain these designations have met accepted educational and clinical training standards and are qualified to practice music therapy. https://www.musictherapy.org/about/find/

Professional Boundaries - provide the framework for healthy relationships between healthcare providers individuals being served.

Standards - an idea or thing used as a measure, norm, or model in comparative evaluations.

Striving for excellence - ongoing commitment to expand our knowledge and skills in all areas

Tribunal - A tribunal is a special court or committee that is appointed to deal with particular problems.

Substantiated - Provide evidence to support or prove the truth of.

Unsubstantiated - not established as valid or genuine

Public Laws

Pub.L. 104-191 - Health Insurance Portability and Accountability Act - includes important information about confidentiality of patient information and required protections https://www.hhs.gov/hipaa/for-professionals/index.html

Pub. L. 93-380 - Family Educational Rights and Privacy Act - includes important information about requirements for maintaining and accessing educational records. https://www2.ed.gov/policy/gen/guid/fpco/ferpa/leg-historv.html

Sherman Act (1937) - Antitrust Law "The Sherman Act outlaws "every contract, combination, or conspiracy in restraint of trade," and any "monopolization, attempted monopolization, or conspiracy or combination to monopolize... Long ago, the Supreme Court decided that the Sherman Act does not prohibit every restraint of trade, only those that are unreasonable. For instance, in some sense, an agreement between two individuals to form a partnership restrains trade, but may not do so unreasonably, and thus may be lawful under the antitrust laws. On the other hand, certain acts are considered so harmful to competition that they are almost always illegal. These include plain arrangements among competing individuals or businesses to fix prices, divide markets, or rig bids. These acts are "per se" violations of the Sherman Act; in other words, no defense or justification is allowed." https://www.ftc.gov/tips-advice/competition-guidance/guide-antitrust-laws/antitrust-laws

Title IX - The U.S. Department of Education's Office for Civil Rights (OCR) enforces, among other statutes, Title IX of the Education Amendments of 1972. Title IX protects people from discrimination based on sex in education programs or activities that receive Federal financial assistance. Title IX states that:

No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.

https://www2.ed.gov/about/offices/list/ocr/docs/tix_dis.html

Sources

Accountability, Courage, Core Value, Dignity, Equality, Excellence, Integrity, Kindness, Principle — Definitions from (n.d.) In Merriam-Webster Dictionary online. Retrieved from https://www.merriam-webster.com/dictionary/kindness

Dual relationship (2015, August 6). In Goodtherapy.org online. Retrieved from https://www.goodtherapy.org/blog/psychpedia/dual-relationship-definition

Equality definition from https://www.vocabularv.com/dictionarv/equality

MT-BC (2011). MT-BC Fact Sheet. Retrieved from http://www.cbmt.org/fact-sheets/mt-bc-fact-sheet/

Professional Boundaries (2017, Dec. 12). Professional Boundaries in Mental Health Care. Retrieved from http://www.belmont.edu/nursing/pdf/Clinical/2017-professional-boundaries.pdf

Standards - https://www.dictionary.com

Substantiated https://en.oxforddictionaries.com/definition/substantiate

Tribunal - https://www.collinsdictionary.com/us/dictionarv/english/tribunal

Unsubstantiated - https://www.collinsdictionary.com/us/dictionary/english/unsubstantiated

Appendix II - Ethical Decision Making Models

Ethical Decision Making

When we increase our awareness of the components of ethical behavior, it is easy to see ethical concerns in many places in our lives. Because ethical issues can arise in both our professional and personal lives, it is helpful to have resources to help navigate these issues. There are many models for ethical decision making available in the literature. In music therapy, Dileo (2000) outlined a 12-step model that is a compilation of several other approaches to addressing ethical dilemmas. This model gives a detailed, step-by-step process for clarifying, exploring and resolving ethical problems. For details, please consult Dileo, C. (2000). Ethical Decision Making in Music Therapy. Cherry Hill, NJ: Jeffrey Books.

Ethical Decision-Making Model (Dileo, 2000)
  1. Identify the problem, issues and practices involved.
  2. Assess the obligations owed and to whom.
  3. Assess your personal/emotional response.
  4. Consult core ethical principles, ethical standards and codes, relevant laws, and institutional policies.
  5.  Consider the context and setting.
  6.  Identify your own beliefs and values and their role in this situation, as well as those of the client.
  7. Consult with colleagues, supervisors and all possible resources.
  8. Consider how the ideal, virtuous therapist might respond.
  9. Generate possible solutions, utilizing the input of the client when feasible.
  10. Evaluate each proposed solution in terms of possible consequences and make a decision.
  11. Implement the decision.
  12. Evaluate the decision.

Used with permission, Jeffrey Books

 
The RIPS Model

Our colleagues in physical therapy have been using a four-step decision-making process as their guide for addressing ethical concerns. The authors suggest a four step decision-making process using: (1) recognize and define the ethical issues, (2) reflect, (3) decide the right thing to do, and (4) implement, evaluate, and reassess. The first step uses the RIPS model outlined in the table below. The details of this model can be found in the American Physical Therapy Association publication of the Section on Health Policy and Administration article. (Swisher, L.L., Arslanian, L.E., & Davis, CM. (2005). The Realm-Individual Process-Situation (RIPS) Model of ethical decision-making, HPA Resource, 5 (3): 1-8.)

Components of the RIPS Model
Realm 2-3 Individual Process 4-5 Situation 1-6

Individual

Organizational/Institutional

Societal

 

 

Moral sensitivity

Moral judgment

Moral motivation

Moral courage

 

Issue or problem

Dilemma

Distress

Temptation

Silence

 
  1. Purtilo RB. Ethical Dimensions in the Health Professions. 4th ed. Philadelphia, PA: Elsevier;2005.
  2. Glaser JW. Three realms of ethics: An integrative map of ethics for the future. In Purtilo RB, Jensen GM, and Royeen CB, eds. Educating for Moral Action: A Sourcebook in Health and Rehabilitation Ethics. Philadelphia, PA: FA Davis, 2005; 169-184.
  3. Glaser J W. Three Realms of Ethics: Individual Institutional Societal: Theoretical Model and Case Studies. Lanham. MD: Rowman and Littlefield: 1994.
  4. Rest JR, Narvaez D, eds. Moral Development in the Professions: Psychology and Applied Ethics. Hillsdale, New Jersey: Lawrence Erlbaum Associates, Publishers; 1994.
  5. Rest JR, Narvaez D, Bebeau MJ, and Thoma SJ. Postconventional Moral Thinking: A Neo- Kohlbergian Approach. Mahwah, NJ: Lawrence Erlbaum Associates; 1999.
  6. Kidder RM. How Good People Make Tough Choices: Resolving the Dilemmas of Ethical Living. New York, NY. Fireside, 1995.

Making An Ethical Decision

Recognize an Ethical Issue
  1. Could this decision or situation be damaging to someone or to some group? Does this decision involve a choice between a good and bad alternative, or perhaps between two "goods" or between two "bads"?
  2. Is this issue about more than what is legal or what is most efficient? If so, how?
Get the Facts
  1.  What are the relevant facts of the case? What facts are not known? Can I learn more about the situation? Do I know enough to make a decision?
  2. What individuals and groups have an important stake in the outcome? Are some concerns more important? Why?
  3. What are the options for acting? Have all the relevant persons and groups been consulted? Have I identified creative options?
Evaluate Alternative Actions
  1. Evaluate the options by asking the following questions:
  • Which option will produce the most good and do the least harm? (The Utilitarian Approach)
  • Which option best respects the rights of all who have a stake? (The Rights Approach)
  • Which option treats people equally or proportionally? (The Justice Approach)
  • Which option best serves the community as a whole, not just some members? (The Common Good Approach)
  • Which option leads me to act as the sort of person I want to be? (The Virtue Approach)
Make a Decision and Test It
  1. Considering all these approaches, which option best addresses the situation?
  2. If I told someone I respect—or told a television audience—which option I have chosen, what would they say?
Act and Reflect on the Outcome
  1. How can my decision be implemented with the greatest care and attention to the concerns of all stakeholders?
  2. How did my decision turn out and what have I learned from this specific situation?

Ethical Decision Making Model - Markkula Center for Applied Ethics, Santa Clara University, Retrieved from https://www.scu.edu/media/ethics-center/resources/making.pdf

 

Current as of 2/19

The American Music Therapy Association Code of Ethics document is © 2015,
Registration Number TX 8-178-447