COVID-19 Task Force August 2021 Update

COVID-19 Changing Conditions: August 2021

Making Decisions About Services During COVID

We, as music therapists, are called to provide safe and quality care for our clients. We are also responsible to protect clients’ families, staff, colleagues, and students. As COVID-19 pandemic conditions continue to change, it is vital that we continue to monitor--and adhere to--health, safety, and infection control practices. Galietti and colleagues (Galietti et al., 2021) have outlined five factors that healthcare providers should consider when making service-related decisions during the pandemic. The five factors, which are listed below, can guide our clinical decision making as we continue to adjust to changing pandemic conditions. 

• Determine if in-person services are necessary. Focus on protecting the health of clients, staff, yourself, and your family.
• Review physical/mental health risks related to in-person services. Determine if/when the risks outweigh the benefits. It may be necessary to make case-by-case decisions.
• Establish rules for in-person visits. Clearly define infection control protocols. Implement informed consent for all participating in in- person services and consult your liability insurer when/if necessary.
• Implement steps to reduce COVID transmission in your practice. This can include things like implementing scheduling strategies to reduce exposure, use of hand hygiene, and protocols to follow if exposed to COVID.
• Implement policies that protect employees. Consult an employment lawyer and/or coordinate with state and local officials for information specific to your area.

We recognize that conditions and protocols vary across the country, and monitoring changes can feel overwhelming. Yet, we are still bound to ensure client and others’ safety consistent with the AMTA Standards of Practice, AMTA/CBMT Scope of Practice, CBMT Board Certification Domains, and the AMTA Code of Ethics. The AMTA COVID-19 Task Force advises and recommends that all music therapists follow best practices and put safety first. More information can be found at COVID-19: When is it okay to provide more in-person services? Please note: This article was posted in April of 2021, so specifics may no longer be accurate. Please consult the links provided elsewhere in this document for more recent information.

Mask Updates

COVID-19 Task Force Presents: Reminders and Update on Masks

Infection Control Guidance Updates

• For information on changing infection control precautions from the CDC related to K-12 institutions, see Guidance for COVID-19 Prevention in K-12 Schools and Safe Schools During the Pandemic.
• For updates on the NFHS aerosol study ,including updated guidelines for fall music activities, see NFHS COVID-19 Study.
• For updates on COVID-related information in higher education institutions, see Live Updates: Latest News on Coronavirus and Higher Education, Live Coronavirus Updates, or Guidance for Institutions of Higher Education (IHEs).

Singing Specific Guidance

Music Therapists use singing as part of a treatment plan to (a) promote healthy development, (b) reduce the impacts of stressors and trauma, (c) rehabilitate speech, and (d) address other client needs. Music therapists can be "safer singing" champions by understanding the intent and implementation of infection precautions and being experts in adapting singing behaviors to context.

While research into singing and aerosolization is emerging, initial research suggests that at 50-60dBA, there is no difference in aerosolization between singing, speaking, and breathing (Gregson et al., 2021). However, it is still important to promote best-practice and risk mitigation approaches to singing with vulnerable populations.

Current guidance suggests use of the following strategies when music therapists and clients are engaged in singing during sessions:

• Fully vaccinated
• Wearing a mask
• Observing physical distancing
• Singing at quieter volumes (50-60dBA)
• Working in spaces that are well-ventilated or with proper filtration or air exchange
• Limiting sessions with singing to 30m

In settings where clients have access to technology, consider if they may benefit from telepractice music therapy interventions using singing techniques. Consider using emerging virtual software applications that can lead to benefits for groups engaged in singing. For additional information on safe music presentation strategies, see the latest update from the NFHS aerosol study.

While children 12 and older are eligible for vaccination, those younger than 12 currently are not, and mutations of the COVID-19 virus, such as the Delta variant, may pose a greater risk to unvaccinated populations including children. Music therapists must prioritize safety and health of the populations through risk mitigation and adapted practice.  Continue to care for those you serve, your community and yourself with compassion.

Reference

Gregson, F. K., Watson, N. A., Orton, C. M., Haddrell, A. E., McCarthy, L. P., Finnie, T. J., Gent, N., Donaldson, G. C., Shah, P. L., Calder, J. D., Bzdek, B. R., Costello, D., & Reid, J. P. (2021). Comparing aerosol concentrations and particle size distributions generated by singing, speaking, and breathing. Aerosol Science and Technology, 1-15.

Telepractice Changes

While many music therapists have returned to in-person work, others may still be providing telepractice services or preparing to return to virtual services as conditions change in their communities. Consider the following updates as you practice virtually:

Changes in Payor Requirements

Be aware that some payor sources (e.g., insurance companies, state agencies) who have permitted telehealth during the pandemic may be changing their policies. Know what remote services are reimbursable.

HIPAA Compliance Issues

Since the beginning of the pandemic, the Office for Civil Rights has been exercising discretion in enforcement, effectively easing requirements for HIPAA compliance to increase access to various platforms for the purpose of telehealth. This notice remains in effect; however, music therapists are encouraged to reevaluate the systems they are using for telehealth, as more HIPAA-compliant platforms are available now than were available in the early days of the pandemic.

Practicing Across State Lines

Music therapists must be qualified to practice in the state where the client is physically located. While the MT-BC credential demonstrates that qualification nationwide, some states have additional requirements for licensure or registration. Check the CBMT website for an up-to-date list of state requirements.

School Updates

School’s a little different this year… (7/28/21)

As students of all ages return to school, music therapists must understand, adopt, and communicate in ways that promote health and safety issues as well as the ways preventive measures such as wearing a mask can help protect vulnerable populations (unvaccinated, vaccinated but immune compromised, aged, or with underlying health conditions).

 As schools anticipate in-person reopening while the Delta variant surges in many areas, it will be helpful for music therapists to consider public health recommendations and risk mitigation strategies to create the safest settings possible for students.

Latest recommendations for schools

The CDC recommends all persons over the age of 2 wear masks, regardless of vaccination status, (8/4/21). The American Academy of Pediatrics has recommended universal masking in schools (7/19/21) (regardless of vaccination status) to protect vulnerable populations who are not yet eligible for the vaccination.

Communicating Through Music

As a new school year begins, consider sharing songs written by music therapists that communicate risk mitigating social behaviors such as social distancing and mask wearing, or normalize the school experience for students in-person or remaining remote.

“Think of your COVID-19 vaccination like a very good raincoat.”

To recalibrate your understanding of risk related to vaccination, masking and the Delta variant of COVID-19, listen to Terry Gross’ recent interview with Dr. Leana Wen.

Mental Health and Well-Being Needs

Students, faculty, staff, and families all undoubtedly have a range of emotions as the school year begins again. Our healthcare workforce has also continued to be intensely affected by the COVID-19 pandemic, and the ongoing stressors are taking a collective toll on community mental health needs for clients and therapists alike. We continue to encourage everyone to take good care of yourselves and your loved ones -- physically, emotionally, socially, and mentally. Take time to process and grieve losses and changes, get outside, play music for yourself, and try your best to get adequate rest and nutrition. In times of overwhelm, different types of rest may be helpful to consider (for more, view this resource from Dr. Saundra Dalton-Smith on the seven different types of rest).

The AMTA Community Conversation from June on Supporting Caregiver Health remains available for viewing, in addition to the resources on self-care on the AMTA COVID-19 Resources page. The National Association of School Psychologists also has a wealth of resources on the COVID-19 response section of their website.

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