MTR 301: Ethical Practice in Music Therapy - Syllabus

Spring 2018
CRN#: 10637
1 credit

Immaculata University, a Catholic academic community, founded and sponsored by the Sisters,
Servants of the Immaculate Heart of Mary, is committed to scholarship, formation of the whole
person for leadership and service, and empowerment of all to seek truth, promote justice, and
engage in dialogue between faith and culture.

Instructor Andrea McGraw Hunt Phone 610-647-4400 x3159

Office Faculty Center 7 E-mail ahunt1@immaculata.edu

Mondays 3-5pm
Office
Thursdays 9-11am Location Good Counsel 20
Hours
And by appointment

Course Meeting Days: Mondays, from January 15-April 30, 2018

Course Meeting Times: 2-3pm

Course Description: Course Description: An examination of ethical practices in music therapy. The
theoretical and clinical literature pertaining to these practices are reviewed, with a primary focus on clinical
practice. Special attention is given to ethical codes, boundaries, confidentiality, mandatory reporting,
record and documentation requirements, and work with minors. Students explore pertinent case examples,
develop forms for clinical practice, and cultivate resources for future use.

Students will participate in verbal discussion and dialogue, including discussions and debates of clinical case
studies focused on ethics. In addition, students will have opportunities to develop resources that will assist
them in future clinical practice.

__Check here if this course fulfills liberal arts core learning outcomes.

Music Therapy – Undergraduate Program Outcomes:

As described by the American Music Therapy Association, professionals are expected to possess the
following skills and attributes:
1. Demonstrate an understanding and implementation of the principles and methods of music
therapy assessment, treatment, evaluation, and termination for the populations specified in the
Standards of Clinical Practice.
2. Identify and assess clients’ therapeutic needs and develop treatment goals to meet these needs
taking into account each client’s culture and its impact on therapeutic expectations and process.
3. Design and implement music therapy experiences using the four methods of music therapy to
address clients’ therapeutic needs across various clinical settings.
4. Competently and expressively create live music experiences with keyboard, guitar, and voice
using a large variety of repertoire to meet clients’ therapeutic needs.
5. Complete appropriate documentation of client responses, progress, and outcomes with evidence-
based data collection for outcome evaluation.
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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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6. Effectively apply research, clinical, and theoretical literature in clinical practice.

7. Recognize the impact of self and the music on the client-therapist dynamic.
8. Utilize the dynamics and processes of groups to achieve therapeutic goals.
9. Adhere to the AMTA ethical standards of professional practice.

Course Outcomes and Assessments

Program
Assessment
Outcomes/AMTA Course Outcome
Competencies
PO: 1, 2, 6, 9 Written assignment
Demonstrate a working knowledge of the AMTA
AMTA: 17.1 Class presentations and
ethics document, applying its principles to a range of
discussion
ethical vignettes/cases
PO: 1, 2, 9 Graded Self-Study
Demonstrate an understanding of HIPAA and its
AMTA: 17.12-13 Class discussion
relevance to clinical practice
PO: 1, 2, 6, 7, 9 Demonstrate a clear understanding of how client- Written assignment
AMTA: 17.12, 20.4 therapist boundaries, mandatory reporting, work with Class presentation
minors, and informed consent can be understood for
an ethical perspective
PO: 1, 2, 9 Written assignment
Develop resources central to ethical practice,
AMTA: 17.12, 17.14,
including consent forms and methods for
20.4
documentation and confidentiality
PO: 9 Demonstrate a knowledge of the structure and Written assignment
AMTA: 17.14 functions of AMTA and CBMT

Required Text:
Dileo, C. (2000). Ethical thinking in music therapy. Cherry Hill, NJ: Jeffrey Books.

Additional Readings/Material
Bates, D. (2014). Music therapy ethics “2.0”: Preventing user error in technology. Music Therapy
Perspectives, 32(2), 136-141. (on MOODLE)
Pabrai, U. (2003). HIPAA certification [electronic resource]. Boston: Premier Press.
AMTA Code of Ethics: http://www.musictherapy.org/about/ethics/
AMTA Standards of Professional Practice
Radiolab Episode, Henrietta’s Tumor: http://www.radiolab.org/story/91716-henriettas-tumor/
AND additional resources posted on Moodle

Course Assignments - Overview:

 Readings and class participation
 HIPAA Self-study
 Group Presentation of Ethical Dilemma (x2)

Assignment Details:
1. Readings and Class Participation 35%
Readings are an integral part of this course. You will be expected to be familiar with assigned reading
materials including articles and other resources posted to Moodle. Be prepared to share your reflections
and contribute to discussion on these readings each week.

2. HIPAA Self-Study 15%

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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Read Chapter 1 of HIPAA certification (Pabrai, 2003), then complete the Self-Study posted in Moodle. Print
out the Self-Study and submit in class on 2/20.

3. Group Presentation: Case Analyses (x 2) 50% (25% each presentation)

You will be assigned to a small group who will prepare and present two separate 20-minute presentations in
the latter half of the semester. Each presentation will be based on an assigned chapter from Dileo’s (2000)
Ethical Thinking in Music Therapy. For each chapter’s presentation, your group will review one ethical
dilemma using EACH STEP of the Dileo ethical decision-making model. Each member must contribute to
the group presentation, and must provide separate, original responses regarding steps related to personal
reflection (steps 3 & 6). Group members will collaborate on a PowerPoint for each presentation, which the
group will upload into Moodle for the class to view. The PowerPoint must adhere to APA style and cite
references and sources appropriate with a reference list at the end. Group members will also each
complete a Peer Evaluation Form for each presentation (Appendix G).

Course Grading:
The overall course grade will be computed according to the following weightings of course assignments
and exercises:

Readings and Class Participation 35%

HIPAA Self-Evaluation 15%
Group presentations x 2 50% total (25% each)
50% of each presentation grade based upon Peer Evaluation feedback (see Appendix G)

Course Grading/Evaluation:
Grade: Score: Grade: Score:
A 94-100 C 74-76
A- 90-93 C- 70-73
B+ 87-89 D+ 65-69
B 84-86 D 60-64
B- 80-83 D- 55-59
C+ 77-79 F below 55

Note:
 All assignments are to be handed to the instructor on the date they are due. If assignments are not
submitted in a timely fashion, points will be deducted from the assignment for each day that the
assignment is late.

One letter grade (A, A-, B+, B-, etc.) will be removed for each day of a late assignment)
Students must receive a grade of C or higher to pass the course.

Format for Written Work:

All assignments must be printed in a WORD document. No other format will be accepted. All assignments will
be in TIMES NEW ROMAN 12 point font with 1” margins on each side, top, and bottom, single-spaced (1.0),

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with no extra spacing between paragraphs. Assignments must be paginated and saved with the student’s
name and the type of assignment in the filename. Assignments may not be emailed.

All written assignments must be proofread and formatted according to APA style 6 th Edition. This applies to
the body of the assignment, including references in the text, and final references. All assignments MUST
contain headings and sub headings related to the assignment sections. These must also be in APA format.
Grades will be deducted for incorrect formatting and lack of adherence to APA style.

Immaculata’s Writing Center is available for assistance with writing and APA style. Students can also consult
the APA style guide on the Immaculata University Library Home page – click on “Citing Sources.”
Alternatively, there are a number of online guides with easy access to APA rules such as the one found on
the Owl Purdue English site:
https://owl.english.purdue.edu/owl/resource/560/01/Attendance Requirements: The Immaculata
University Attendance Policy is available in the current edition of the undergraduate catalog.

Classroom Decorum

Students are expected to contribute to a positive and respectful learning environment. Discussion and
questions are welcome. A positive learning environment is also one that is free from distractions such as
talking or making noise. Food and drink is allowed in the classroom, but please be mindful of the volume of
your food (i.e. noisy or crinkly packages and food that is crunchy and distracting to others such as carrots,
celery, etc. are contraindicated for the classroom).

Technology Policy

Students may use laptops and other electronic devices for academic purposes that pertain directly to the
class activity during class. Students may not use these devices (including phones) for nonacademic purposes
that are not directly related to current classroom agenda. Any student who uses these devices for any other
reason will lose 10 points from the final grade for a first offense and every offense thereafter.

Academic Integrity: The Immaculata University Academic Integrity Policy is available in the
current edition of the undergraduate catalog.

Disability Statement: Students with a documented disability (learning, physical, psychological),

who are requesting reasonable academic accommodation, must contact Disability Services at
AcademicSuccess@Immaculata.edu . The Learning Accommodations Policy is available in the
current Undergraduate catalog.

Week/ Topic Reading Due For Assignments Due

Date Class Today
Introduction
Week1
Assign presentation
1/15/18
topics/groups
Week 2 Ethical Codes – reviews and Dileo ch. 1 & 2
comparisons
1/22/18 Informed Consent lecture
Week 3 Boundaries and Dual Dileo ch. 4 Informed consent
1/29/18 Relationships lecture presentation 1

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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Week/ Topic Reading Due For Assignments Due

Date Class Today
Research Ethics lecture Dileo ch. 8 Boundaries and Dual
Week 4
Radiolab podcast Relationships
2/5/18
presentation 2 &14
Ethics and the Law, Dileo ch. 5
Week 5 Confidentiality, Clients in Research
2/12/18 Danger Presentations 3 & 11

HIPAA lecture Chapter 1 of HIPAA Ethics and the Law

Certification, by Uday
Week 6 Pabrai, using the URL presentation 4 & 12
2/19/18 link on the Immaculata HIPAA Self-
library catalogue
Assessment;
(search for title)
Financial Issues lecture; Dileo ch. 9
Week 7
orientation to resources for HIPAA presentation 4
2/26/18
Diversity/Cultural Humility
Week 8 Professional Issues lecture Dileo ch. 10 Financial Issues
3/12/18 presentations 5
Technology and Ethics lecture Bates (2014) Professional issues
Week 9
presentation 6
3/19/18

Ethics in Education and Dileo ch. 11 Technology and

Week 10
Supervision lecture Ethics presentations 7
3/26/18
& 13
Diversity/Cultural Humility Dileo ch.7
Education and
Week 11 discussion Assigned word in
Supervision
4/9/18 “Under Our Skin”
presentations 8
website
Social Justice and Ethics Diversity/Cultural
Week 12
lecture/discussion Humility presentations
4/16/18
9 & 10
Social Justice and Ethics Social Justice and
Week 13
discussion Ethics presentations
4/23/18
10
Week 14 Course wrap-up: Promoting Dileo ch. 12
4/30/18 Ethical Behavior

Syllabus is subject to change based on students’ needs

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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Alternative Instructional Equivalencies (AIEs)

Classroom Instruction F2F
Hours

Total number of face to face (F2F) instructional hours scheduled 14

AIE
Activity AIE* Used for Activity Hours
Listen to Radiolab podcast, write
and share reflection on research
ethics Lecture activity – audio (podcast) 2

Review of peers’ performance in group

project Peer-review assessment 1

Total Instructional Hours (F2F + AIE) 17

*See “Alternative Instructional Equivalencies (AIEs) – IU Approved List April 2011” for approved AIEs.
Instructional hours equal 14 clock hours per credit of instruction, not counting final examinations.

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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THE FOLLOWING APPENDICES ARE PROVIDED AS INFORMATION ONLY

AND AS EXAMPLES FOR YOUR OWN CLINICAL PRACTICE

NO RECOMMENDATION OR ENDORSEMENT IS MADE

ALWAYS CONSULT LEGAL ADVICE

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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APPENDIX A

DUAL RELATIONSHIPS

PERSONAL RELATIONSHIPS

I have an ethical responsibility to not develop personal friendships or have other relationships
with clients/patients or their immediate family members outside the healthcare setting.

A multiple relationship occurs when a healthcare/mental health professional is in a professional

role with a person and:

1. At the same time is in another role with the person

2. At the same time is in a relationship with a person closely associated with or related to
the person with whom the healthcare/mental health professional has the professional
relationship, or
3. Promises to enter into another relationship in the future with the person or a person
closely associated with or related to the person

A healthcare/mental health professional refrains from entering into a multiple relationship if the
multiple relationship could reasonably be expected to impair the healthcare/mental health
professional’s objectivity, competence, or effectiveness in performing his or her functions as a
healthcare/mental health professional, or otherwise risks harm or exploitation to the person with
whom the professional relationship exists.

Multiple relationships that would not necessarily be expected to cause impairment or risk
exploitation or harm are not unethical.

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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APPENDIX B

CONSENT FOR THERAPY:

SAMPLE CONCEPT

CHECKING VALIDITY OF CONSENT: Do clients read them? Because of crisis,

backgrounds, cultures, worldviews, etc… you need to test validity of the consent.

TAKE A FEW MINUTES TO VERBALLY STATE THE FOLLOWING TO YOUR

CLIENTS AS SOON AS POSSIBLE IN THE CLINICAL RELATIONSHIP:
 Information about the clinical relationship
 Information about mandatory reporting

PUT THIS INFORMATION INTO YOUR OWN WORDS—

WORDS THAT YOU ARE COMFORTABLE WITH…

You have the right to autonomy & self‐determination; a right to privacy concerning medical
information; a right to participate in treatment decisions; and refuse treatment.

“I have an ethical responsibility not to form relationships outside the counseling

relationship with my clients” [You can talk more about situations that are relevant or of
concern to you, your client or your situation‐IE: Rural town]

The counseling relationship cannot guarantee saved marriages, continued employment, social
acceptance, or elimination of presenting symptoms.
Nor, is it a guarantee that symptoms won’t worsen. If you ever feel counseling is not helping
you, please talk to me.

There are many options available that we can discuss.

You’ll help the process by being present, talking and sharing, and being honest.

I will take every precaution to protect your confidentiality, however if you share with me
harmful intentions toward yourself or toward others, or speak of abuse or neglect of children or
vulnerable adults, you could place me in the position of having to report to appropriate sources
according to the laws.

CORE VALUES
FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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HOWEVER, with this said, please do not withhold such thoughts and feeling—I am here to
help and support you as needed.

CORE VALUES
FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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GUIDELINES for
CONSENT/PRIVACY NOTICE

ALWAYS INCLUDE YOUR STATE’S REQUIRED STATEMENTS

 Must be accurate & conform to regulations.
 May be printed in a format of the clinician's choice.
 Must be specific to the type of treatment/service offered by clinician.
 Must be written in plain language that is easily understood by the client.
 Must be provided to client no later than date of first service delivery and before
implementation of a treatment plan.

Header: "This notice describes how medical information about you may be used and disclosed
and how you can get access to this information. Please review it carefully."

Clinician's Responsibilities:
 Secure written acknowledgment of all documents received by client
 Retain client's written acknowledgment of receipt.
 Keep copies of document available at service delivery site for clients to request &
receive a copy.
 Post document in a clear & prominent location at service delivery site where it is
reasonable to assume a client could read it.
 Whenever document is revised, make the revised document available upon request.
 Retain copies of all versions of document.
 If you maintain a practice web site, this document should be available on your website.
While provision of an electronic version fulfills your requirements, if requested by the
client, a paper copy must also be provided.
 Whenever a material change occurs to: 1) Permitted uses or disclosures; 2) Clients'
rights; and/or 3) Clinician's legal duties or other privacy practices described in this
document, the clinician must promptly revise and distribute the document.
 Except where required by law, changes to this document may not be implemented prior
to the effective date of the revised Notice in which such material changes appear.

Required Inclusions:
 Name of firm, business, agency, clinician's practice name, and/or clinician's name
Clinician's business address & telephone number.
 Statement of client's right to refuse treatment.
 An accurate description of the extent of a client's confidentiality rights.
 Description of types of uses & disclosures the clinician is permitted to make for
purposes of treatment, payment, and operations of the practice, with examples of each
type.
 A clear and detailed description of other purposes for which the clinician is permitted or
required to disclose PHI without a client's written authorization.

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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 An acknowledgment that other uses & disclosures will be made only with client's
written authorization and that client is legally permitted to revoke such authorization.
 An acknowledgment of the clinician's intention or practice (if applicable) of contacting
clients to provide appointment reminders, or to provide any information about treatment
alternatives or other health-related benefits and services that may be of interest to
clients.

Required Inclusions Regarding Client's Rights:

 Right to refuse treatment.
 An accurate description of the client's rights with respect to their protected healthcare
information (PHI), and a brief description of how the client may exercise those rights.
 Right to request restrictions on certain uses and disclosures of their PHI along with the
caveat that the clinician is not obligated to agree to a requested restriction.
 Right to receive confidential communications regarding PHI.
 Right to inspect and copy their written health record.
 Right to amend their written health record.
 Right to receive an accounting of disclosures made of their PHI.
 Right to receive a paper copy of the clinician's this document

Required Inclusion Regarding Client's Responsibilities:

 Statement that it is the responsibility of client to choose the clinician and treatment
modality that best meets their needs.

Required Inclusions Regarding Clinician's Responsibilities:

 Statement that clinician is required by law to maintain privacy of client's PHI and to
provide client with notice of clinician's legal duties & privacy practices as they relate to
the client's PHI.
 Statement that the clinician is required to abide by terms of their current Disclosure &
Notice document.
 Statement that clinician reserves the right to both change the terms of their document,
and to make the new provisions effective for all PHI maintained.

CORE VALUES
FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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APPENDIX C

EMAIL TAG FOR CORRESPONDENCE

Confidential Email Statement

Email Confidentiality Statement: This message and accompanying documents are

covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521, and
contain information intended for the specified individual(s) only. This information is
confidential. If you are not the intended recipient or an agent responsible for delivering it
to the intended recipient, you are hereby notified that you have received this document
in error and that any review, dissemination, copying, or taking of any action based on
the contents of this information is strictly prohibited. If you have received this
communication in error, please notify us immediately by E-Mail, and delete the original
message.

This is a sample of an older statement’s simplicity…

This email and any files transmitted with it are confidential and intended solely for the
use of the individual or entity to who it is addressed. If you have received this email in
error please notify the sender by email, delete and destroy this message and
attachments.

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FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
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APPENDIX D

EXCEPTIONS TO THE RULE OF CONFIDENTIALITY

Exceptions to the general rule of confidentiality

In spite of the general presumption that medical information is confidential, courts have found a
number of exceptions to the standard protections against disclosure of confidential information.
Regardless of the legal theory protecting medical information, courts do not treat privacy or
confidentiality interests as absolute, particularly when "supervening interests of society or the
private interests of the patient intervene" (Horne vs. Patton, 287 So.2d 824 (Ma. 1973)). Courts
have concluded that physicians may disclose medical information without liability under a
number of different circumstances.

 When information is already available to others. For example, medical information in an employee's records has been
exempted from confidentiality protection with respect to the patient's employer (Valencia vs. Duval Corp., 645 P.2d
1262 Ariz. Ct. App. 1982).
 To protect patients' interests. The state's interest in obtaining medical records to determine whether a patient needs to
be committed may outweigh the physician-patient privilege (State vs. Kupchun, 373 A.2d 1325 (N.H. 1977)). Similarly,
disclosure alleging that someone is mentally ill and in need of supervision, care or treatment may not lead to liability
(Schwartz vs. Thiele, 51 Cal. Rptr. 767 (Cal. Ct. App. 1966)).
 When the patient waives the physician-patient privilege. Patients who place their medical conditions at issue in
litigation or by filing worker's compensation claims are deemed to have waived the physician-patient privilege or to
"forfeit" claims for violation of the right of privacy (Heller vs. Norcal Mutual Ins. Co., 876 P.2d 999 (Cal. 1994);
Kaplowitz vs. Borden, Inc., 594 N.Y.S.2d 744 (N.Y. App. Div. 1993); Home Insurance Co. vs. Aetna Life & Casualty
Co., 644 A.2d 933 (Conn. App. Ct. 1994)). Courts usually consider the privilege waived only to the extent that the
medical records concern an element of the claim or defense; it is not waived with respect to unrelated medical
information (Vredeveld vs. Clark, 504 N.W.2d 292 (Neb. 1993)).
 In the interest of justice. Some statutes deem defendants' hospital records to be admissible in criminal trials (see State
vs. O'Brien, 232 So.2d 484 (La. 1970)). In several cases, courts allow disclosure of confidential medical information
that is relevant to a criminal prosecution (State vs. McAbee, 463 S.E.2d 281 (N.C. Ct. App. 1995), review denied, 467
S.E.2d 730 (1996)) or a grand jury investigation for Medicaid or IRS fraud (in re: Grand Jury Investigation, 441 A.2d
525 (R.I. 1982) (Medicaid fraud); United States vs. MHC Surgical Ctrs. Assocs., 911 F. Supp. 358 (N.D. Ind. 1995)
(IRS fraud)). Similarly, a patient's statutory right to medical privacy may be subordinate to the right of the state in
alleged cases of patient abuse or criminal treatment (in re: Application to Quash Subpoena Duces Tecum in Grand Jury
Proceedings, 455 N.Y.S.2d 945 (N.Y. 1982)).
 To ensure quality medical treatment. Courts will allow disclosure of medical information in the interest of ensuring
that medical care is adequate, particularly in the context of investigations of matters affecting patient health, such as a
physician's alleged addiction to drugs and alleged administration of anesthesia while under the influence of addictive
drugs (Arnen vs. Dal Cielo, 42 Cal. Rptr. 2d 712 (Cal. Ct. App. 1995)); allegations of improper experimentation on
patients, (Hyman vs. Jewish Chronic Disease Hospital, 258 N.Y.S.2d 397 (N.Y. 1965)); or a hospital staff committee's
examination of the qualifications of a staff physician (Klinge vs. Lutheran Medical Center, 518 S.W.2d 157 Mo. Ct.
App. 1974)). Courts have ruled differently with respect to the permissibility of hospital disclosure of a physician's HIV-
positive status to colleagues or patients. Some allow such disclosures (in re: Milton S. Hershey Medical Ctr., 595 A.2d
159 (Pa. Super. 1991), aff'd 634 A.2d 159 (Pa. 1993)), whereas others believe that a hospital must take "reasonable
measures" to maintain the confidentiality of a physician's HIV-positive status, (Estate of Behringer vs. Medical Center,
592 A.2d 1251 (N.J. Super. 1991)).
 To protect the best interests of the child. Several courts find that in parental termination, custody or child-abuse cases,
the best interests of children outweigh the parents' protected confidentiality interests in their medical records and
communications (Jane Doe vs. Davies County Division of Children and Family Services, 669 N.E.2d 192 (Ind. Ct.
App. 1996), transfer den (1996)). Physician-patient privilege statutes often do not protect matters relating to child abuse
and some courts deem the privilege abrogated with respect to child abuse (State ex re. Udall vs. Superior Court, 904
P.2d 1286 (Ariz. Ct. App. 1995)). Finally, statutory requirements for health care professionals to report child abuse and
neglect usually preclude actions for breach of confidentiality (Hope vs. Landau, 486 N.E.2d 89 (Mass. Ct. App. 1985)).

In child custody disputes, however, some courts continue to uphold the physician-patient
privilege, while noting that the state's interest in correctly determining who is the proper
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caretaker is weighty enough to allow the court and other interested parties to examine the
parents' records privately (D. vs. D., 260 A.2d 255 (N.J. Super. Ct. 1969). In contrast, however, a
number of courts find that the medical records of parents are protected from disclosure by the
physician-patient privilege, period (Best Koshman vs. Superior Court of Sacramento County, 168
Cal Rptr. 558 (Cal. Ct. App. 1980); Wing vs. Wing, 393 So. 2d 285 (La. Ct. App. 1980); Bond vs.
Pecaut, 561 F. Supp. 1037 (N.D. Ill. 1983)).

 To protect third parties. Courts often will find that the public interest in protecting others from disease or threatened
violence overcomes the confidentiality of medical information. Thus, if a patient presents a risk of transmitting a
disease to others, several courts have found that the physician may disclose as much information and to such persons as
is reasonable and necessary to prevent the spread of disease (Simonsen vs. Swenson, 177 N.W. 831 (Neb. 1920)). In
addition, privacy interests may not be violated when a healthcare professional informs authorities that the patient
threatened another's life (Viviano vs. Moan, 645 So.2d 1301 (La. Ct. App. 1994), cert. denied, 650 So.2d 254)
(psychologist informed law enforcement officials that a patient was threatening a judge's life), or when physicians
reveal information related to investigations of rape suspects (Bryson vs. Tillinghast, 749 P.2d 110 (Okla. 1988) (no
cause of action when a physician disclosed information concerning a patient with injuries similar to those of a rape
suspect).
 To serve a "substantial and valid interest" of the employer. Some courts have reasoned that an employer "may have a
substantial and valid interest in aspects of an employee's health that could affect the employee's ability effectively to
perform job duties." Thus, when a court considers the interest "substantial and valid, it is not an invasion of privacy ...
to disclose information to the employer" (Bratt vs. International Business Machines Corp., 467 N.E.2d 126 (Mass.
1984)).

A few of these cases have involved the military's need for information regarding employees' use
of drugs or alcohol. In those cases, the courts usually find that the military's security needs may
require knowledge of the employee's health status. For example, courts have found no cause of
action when physicians informed the military of a patient's alcoholism when the patient was a
military employee (Clark vs. Geraci, 208 N.Y.S.2d 564 (N.Y. 1960)), or of a patient's husband's
use of alcohol and illegal drugs because the husband held a high-level security clearance position
(Howes vs. United States, 887 F.2d 729 (6th Cir. 1989)).

 To provide insurers with information. Most of the cases dealing with exceptions to the confidentiality of medical
information do not involve disclosure to insurers. One notable case, however, held that, in applying for insurance,
plaintiffs lost the rights to nondisclosure that they otherwise had (Hague vs. Williams, 181 A.2d 345 N.J. 1962)).
 When medical information is shared by two parties. Prenatal records present complications when an infant-plaintiff
raises issues regarding her delivery. In most cases, courts consider the records open to disclosure, even though they
reveal information about the mother, because the child's suit acts as waiver to the physician-patient privilege and
because the records are shared, belonging to both infant and mother (the doctrine of inseparability) (Palay vs. Superior
Court, 22 Cal. Rptr. 2d 839 (Cal. Ct. App. 1993)).
 Disclosure of medical information to spouses. Some courts reason that the physician-patient privilege or right of
privacy does not protect against disclosure of a patient's medical records to the other spouse. Courts have allowed
disclosure of a wife's medical records to her husband during their separation based on the theory that the husband had
an absolute right to those records and to authorize their disclosure to others (Pennison vs. Provident Life & Accident
Insurance Co., 154 So. 2d 617 (La. Ct. App. 1963), cert. denied 156 So. 2d 266). Similarly, another court found no
invasion of privacy when a physician discussed his patient's condition with the patient's wife, even though the couple
was involved in divorce proceedings (Mikel vs. Abrams, 541 F. Supp. 591 (W.D. Mo. 1982)). Finally, a physician was
not liable for revealing medical information to a patient's husband, even though the husband intended to use the
information in divorce proceedings, on the theory that each spouse has the right to know of any disease that has a
bearing on the marital relationship (Curry vs. Corn, 277 N.Y.S.2d 470 (N.Y. Misc. 1977)).

A number of courts do, however, consider medical information privileged or protected by

privacy rights even with respect to the other spouse (Khairzdah vs. Khairzdah, 464 So. 2d 1311
(La. Dist. Ct. App. 1985)). Indeed, one court reasoned that a more stringent standard should
apply with regard to psychiatric information, since a spouse often seeks counseling for problems

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that could affect the spousal relationship (MacDonald vs. Clinger, 446 N.Y.S.2d 801 (N.Y. App.
Div. 1982)).

 Disclosure to siblings. Courts are more likely to be reluctant to disclose medical information to siblings than to a
spouse, even in cases where the information would be relevant to elements of a tort suit. For example, in a suit alleging
malpractice in the birth of a child, the statutory privilege precluded disclosure of medical records concerning the child's
healthy siblings, even though the records were relevant to the defense theory that the defect was genetic (Diderikx vs.
Cottage Hospital Corp. 393 N.W.2d 564 (Mich. Ct. App. 1986)).
 To protect a criminal defendant's constitutional rights. In a few cases, courts have held that medical records otherwise
protected by the physician-patient privilege should be disclosed if they are essential to vindicate a criminal defendant's
constitutional right of confrontation (Shartzer vs. Isaraiels, 1997 Cal. App. 487 (Cal. Ct. App. 1997)) or right to have
access to exculpatory evidence (People vs. Presto, 176 N.Y.S.2d 542 (N.Y. App. Div. 1958)).
 Absence of malice or intent to do harm. In a few jurisdictions, the absence of malice or intent to do harm has been
recognized as a defense for unauthorized disclosure of medical information (Collins vs. Howard, 156 F. Supp. 322
(D.C. Ga. 1957) (no liability without maliciousness or lack of justifiable cause for disclosure); Clark vs. Geraci, 208
N.Y.S.2d 564 (N.Y. 1960)(no recovery for unauthorized disclosure without showing intent to do harm)).

The vast number of exceptions to the general rule against disclosure of medical information
demonstrates the great leeway one has in arguing for or against a cause of action for
unauthorized disclosure of medical information. A few common themes emerge, however. First,
information communicated or obtained in the course of treatment is presumed to be protected
against unauthorized disclosure unless the interest in disclosing the information is weightier than
the patient's interest in avoiding disclosure. The competing interests most likely to supersede the
patient's interest in confidentiality or privacy are the interests in 1) protecting parties, 2) justice
and prosecuting crimes, and 3) protecting the integrity of the medical profession.

A point of key importance in the area of genetics is that, even when statutes prohibit
unauthorized disclosure of medical information, employers and insurers might nevertheless have
legitimate access to genetic information in some circumstances. Thus, in the often - cited
hypothetical case of an airline pilot who tests positive for Huntington's, a court might reason that
it is in both the employer's and the public's interest to disclose the information to the employer so
that it can monitor the pilot for neurological decline. The legality of such disclosure is even more
likely if the employer is the United States military because of national security interests.

The willingness of many courts to disclose confidential information to spouses might influence
the legality of genetic counselors' disclosing genetic information to spouses. Courts might
conclude that disclosure would not be actionable because this information affects reproductive
decision making and therefore could benefit the spouse, especially if they rely on cases
presuming that medical information should be shared between spouses.

Courts might be more reluctant to allow disclosure to siblings, since one presumes less intimacy
exists among siblings. The sibling cases, however, usually involve disclosure only for the benefit
of litigation, which might be deemed a less pressing interest than disclosure for the benefit of
making reproductive decisions. Thus, even in those instances, a court might theoretically decide
that a sibling's interests are sufficiently weighty to overcome the patient's interest in
nondisclosure.

Duty to Warn

The second aspect regarding the disclosure of medical information concerns whether physicians
or health care professionals have an obligation to disclose otherwise confidential medical
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information or to warn of risks that patients present to third parties. The courts have found a
number of instances in which physicians are legally obligated to protect a third party from a
patient's medical or psychological condition. In some of the early cases, the information a
physician was obligated to share did not concern confidential information. For example, the
family might already have known that the patient was sick but not that the illness was infectious.
More recently, the issue of confidentiality is avoided when physicians fulfill the duty to protect
third parties by informing the patient of the infectiousness of the disease. For example,
physicians may fulfill the duty to their patients' sexual partners by informing the patients of the
sexually transmissible nature of their disease (Reisner vs. Regents of University of California, 37
Cal. Rptr. 2d 518 (1995) (HIV); DiMarco vs. Lynch Homes-Chester County, 525 A.2d 422 (Pa.
1990) (hepatitis B)).

Courts often will impose the duty to protect or disclose information to third parties on the person
who actually poses the risk. Several jurisdictions require those who know they are infected with
a venereal disease to protect their partners by refraining from sexual intercourse or by informing
their partners of their infection (see Meany vs. Meany, 639 So.2d 229 (La. 1994)). Some courts
have found that a person infected with a venereal disease may be liable not only to his sexual
partner for failing to warn of the disease, but also to foreseeable partners, such as the spouse of
his sexual partner (Mussivand vs. David, 544 N.E.2d 265 (Ohio 1989)). In addition to duties
imposed by tort law, some states make it a crime to intentionally infect another with HIV (Idaho
Code, § 39-608 (1995); Mo. Ann. Stat. § 191.677.1(2) (Vernon 1995)).

The duty to warn is particularly interesting when it requires health professionals to disclose
medical information that otherwise would be confidential. In the famous case of Tarasoff vs.
Regents of University of California, 551 P.2d 334 (Cal. 1976), the California Supreme Court held
that psychotherapists may have a duty to warn third parties of the danger of the psychotherapist's
patient, even though it would require disclosure of confidential information. Most courts restrict
this duty to cases in which the victim is known or identifiable, although a few jurisdictions apply
the duty even when there is no specifically identifiable victim. Not all jurisdictions, however,
follow the Tarasoff approach. (see, for example, Nasser vs. Parker, 455 S.E.2d 502 (Va. 1995)).
A number of courts also have imposed a duty on physicians to warn third parties or take steps to
protect them from patients who take medications that might result in dangerous side effects, such
as impaired driving abilities (Welke vs. Kuzilla, 375 N.W.2d 403 (Mich. Ct. App. 1985)).

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APPENDIX E

TAKING CHARGE OF A DANGEROUS PERSON

 If a counselor (Therapists, Psychologists or EAP Counselor) “takes charge” of a

dangerous person you may be viewed as having assumed the duty to control the person’s
behavior
 “One who voluntarily takes charge of a third person who they know is likely to cause
bodily harm to others if not controlled is under a duty so to exercise his/her control as to
prevent the third person from doing such harm” TORTS LAW 319

FEATURES OF DANGER

 Dangerous is defined as “attended with risk; perilous; hazardous; unsafe”

 Danger is defined as “jeopardy; exposure to loss or injury; peril

A serious risk of violence to another is within the scope of these

definitions

In assessing dangerous behavior five components must be considered:

1. Its nature
2. Extent
3. Probability
4. Imminence
5. Frequency

 Violent ideation: thoughts, fantasies, and dreams of violent acts; delusions or

hallucinations commanding violent acts
 Affect: person manifests intense, overwhelming rage, destructive impulses, drivenness, or
fear of inability to control violent impulses
 Behavior: physical agitation, accompanying psychosis, intoxication, or delirium;
explosive rage; or domestic violence

FEATURES OF DANGEROUS

Immediate danger signs of imminent violence:

1. Motor activity is irritable with an inability to be calmed
2. Verbal indicators such as threats when stated loudly, defamatory statements, and sexual
verbal aggression
3. Nonverbal indicators include glaring eyes, demanding demeanor, tense, forward-leaning
posture, and a hyper-alert state
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FEATURES OF DANGEROUS

Is there a “psychological profile” of dangerous?

1. Low self-esteem
2. Inability to delay gratification
3. History of violence
4. Profound sense of entitlement
5. Compelling need to seek vengeance
6. Borderline, paranoid, or antisocial personality disorders

Are there “biological components” of dangerous?

1. Drug and alcohol intoxication or withdrawal
2. Head traumas
3. Illnesses accompanied with high fevers
4. PTSD (Military or other)

Are there “sociocultural features” of dangerous?

1. Male, 14-24 years of age
2. Poor
3. Low level of education
4. History with substance abuse or violence
5. Job and residential instability
6. History of arrests
7. Isolation (Anti social)

“Developmental profile” of dangerous:

1. History of childhood violence
2. Delinquency
3. Reckless driving record
4. Child abuse and neglect
5. Children of parents with severe psychiatric disturbances
6. Extremes in Value System(s)

PROTOCOL FOR DEALING WITH A DANGEROUS PERSON

 Try not to be alone
 Employ active listening
 Express concern; exploring alternative to violence
 Check for the here-and-now transference
You said everyone hates a drunk; do you think I do?
 Perform a mental status exam
 Take a careful history
 Inform about legal realities
 Refer for psychiatric consultation; hospitalization; or call authorities
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LAWS
CIVIL RIGHTS REMEDIES FOR GENDER-MOTIVATED VIOLENCE ACT [42 USC 13981]
 All personas within the United States have the right to be free from crimes of violence
motivated by gender

VIOLENCE AGAINST WOMEN ACT of 1994

 Battered spouse act

COMPENSATION FOR VICTIMS OF VIOLENCE

 California and New York are the only States in the USA that have enacted legislation
toassure some compensation to those who have suffered at the hands of criminals
regarding violent acts
 Those eligible are the victims, surviving spouse or children of a dead victim, or any other
person dependent on the dead victim as their principle support

Factors that increase an employee’s risk of being involved in workplace

violence

These factors include the following:

1. Contact with the public
2. Exchange of money
3. Delivery of passengers, goods, or services
4. Having a mobile workplace such as a taxicab or police cruiser
5. Working with unstable or volatile persons in health care, social service, or criminal
justice settings
6. Working alone or in small numbers
7. Working late at night or during early morning hours
8. Working in high-crime areas
9. Guarding valuable property or possessions
10. Working in community-based settings

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Prevention Strategies

Environmental Designs
 Cash-handling policies
 Physical separation of workers from customers, clients, and the general public
 The height and depth of counters are also important considerations in protecting workers,
since they introduce physical distance between workers and potential attackers
 Visibility and lighting
 Numerous security devices may reduce the risk for assaults against workers and facilitate
the identification and apprehension of perpetrators
 Personal protective equipment

Prevention Strategies

Administrative Controls
 Staffing plans and work practices
 Increasing the number of staff on duty
 Use of security guards or receptionists to screen persons entering the workplace and
controlling access to actual work areas
 Work practices and staffing patterns during the opening and closing of establishments
and during money drops and pickups should be carefully reviewed for the increased risk
of assault they pose to workers
 Policies and procedures for assessing and reporting threats allow employers to track and
assess threats and violent incidents in the workplace
 Such policies clearly indicate a zero tolerance of workplace violence and provide
mechanisms by which incidents can be reported and handled
 Training and education efforts are clearly needed to accompany such policies.

Prevention Strategies

Behavioral Strategies
 Training employees in nonviolent response and conflict resolution
 Training that addresses hazards associated with specific tasks or worksites and relevant
prevention strategies
 Training should emphasize the appropriate use and maintenance of protective equipment,
adherence to administrative controls, and increased knowledge and awareness of the risk
of workplace violence

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MTR301 Ethical Practice in Music Therapy Page 22

CONCLUDING THOUGHTS ON THREAT IDENTIFICATION

Although we are beginning to have descriptive information about workplace violence, a number

of research questions remain:

1. What are the specific tasks and environments that place workers at greatest risk?
2. What factors influence the lethality of violent incidents?
3. What are the relationships of workplace assault victims to offenders?
4. Are there identifiable precipitating events?
5. Were there any safety measures in place?
6. What were the actions of the victim and did they influence the outcome of the attack?
7. What are the most effective prevention strategies?

THREAT IDENTIFICATION
Start by Answering These Questions:

1. How does violence from the surrounding community affect your workplace?
2. Do services like trauma or acute psychiatric care increase the likelihood of violence?
3. Does the facility's physical layout invite violence -- for example, do doors open to the
street or are waiting rooms cramped?
4. How frequently are assault incidents, threats and verbal abuse occurring? Where? Who is
involved?
5. Are incidents being reported?
6. Are current emergency response systems effective?
7. Is post-assault treatment and support available to staff?
8. Are staffing patterns sufficient and is the staff experienced?

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APPENDIX F

E-THERAPY
One of the newest challenges for mental health practitioners is the issue of informed consent in e-
therapy.
1) Anonymity on the Internet makes it more difficult to determine the clients mental capacity
and/or legal age
2) Potential conditions such as suicidal behaviors and eating disorders may not be suitable for on-
line therapy
3) There is limited empirical research available through limiting both the practitioner and clients
understanding of the either the efficacy and/or the risks associated with e-therapy
4) And Internet identity issues place more burden on the practitioner to determine whether the
client is legally and ethically able to consent

Virtual or E-therapy
Depending on their mental health focus and where they practice many mental health practitioners
offer online therapy services through real-time chats, email, videoconferencing, telephone
conferencing, and instant messaging.

The benefits touted by supporters of on-line therapy include as benefits the ability to:
 Serve millions of people who would otherwise not participate (e.g., people with certain
conditions such as agoraphobia, persons living in remote locations, or those concerned about
the stigma of counseling)
 Decrease inhibitions clients may have about fully disclosing relevant information
 Increase the thoughtfulness and clarity of communication as an unintended by-product of written
communication
 Produce a permanent record that can be easily referred to, forwarded to clients or colleagues for
review and consultation purposes
 Substantially reduce overhead costs, thus reducing costs for the consumer. As discussed
earlier in this training, one of the major areas still under debate as a result of this new
technology is that of jurisdiction. Here are some thought provoking considerations
o When the client lives in a different state, it is difficult to avoid violating licensure
laws and it is still unclear as to what state's laws would be applicable
o Is the origin or location of counseling in the client's community or the therapist's? Or
is it somewhere in cyberspace?
o And what defines location if a busy executive is involved in an online session while
flying from Tucson to Bangkok?

This is clearly an ambiguous area that will undoubtedly continue to be discussed.

Some of the other concerns raised regarding the use of e-therapy:

 E-therapy does not allow practitioners to observe and interpret facial expressions and body
language
 The Internet poses serious risk to security and thus to confidentiality
 Inappropriate counseling may occur due to therapist ignorance about location-specific
factors related to the client (e.g., living conditions, culture)
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 Clients cannot be sure as to the credentials, experience, or even

identity of the person they are trusting to provide services
 Clients may not have any legal recourse formal practice, given unresolved questions
about jurisdiction and standards of care

Limiting Risk in the Practice of E-therapy

For those practicing E-therapy as follows:
1) Full disclosure - This relates to informed consent and the need to fully disclose the
possible benefits and risks of distance counseling, including informing the client that
this is a new area of practice, which has not had the benefit of longterm study.
2) Comprehensive assessment - Provide clients with detailed and complete assessment tools
and encourage full disclosure by client.
3) Confidentiality and disclosure of safeguards - Take all precautions to safeguard the
confidentiality of information and avoid misdirected emails, eavesdropping, hacking, etc.
Alert the client to these potential risks as well.
4) Emergency contact - Obtain information for an emergency contact and together develop a
clear emergency plan.
5) Consult Your Association's Code of Ethics - Review standards regarding informed consent,
confidentiality, conflict of interest, misrepresentation, etc.
6) Consult state licensing provisions - Research both the statutory regulations of your board as
well as those in the client's home state.
7) Consult a malpractice/risk management attorney - Consider asking a legal specialist to
review website materials to determine compliance with standards Of care and potential
malpractice issues.
8) Provide communication tips - If communicating solely by textbased messaging,

CORE VALUES
FAITH ▪ CARING ▪ SERVICE ▪ INTEGRITY ▪ LEARNING ▪ TEAMWORK
 Appendix G

Peer Evaluation Form for Group Project

Your name ____________________________________________________

Write the name of each of your group members in a separate column. For each person, indicate the extent to which you agree with the statement on
the left, using a scale of 1-4 (1=strongly disagree; 2=disagree; 3=agree; 4=strongly agree). Total the numbers in each column.

Evaluation Criteria Group member: Group member: Group member: Group member:

Attends group meetings regularly and

arrives on time.

Contributes meaningfully to group

discussions.

Completes group assignments on time.

Prepares work in a quality manner.

Demonstrates a cooperative and

supportive attitude.

Contributes significantly to the success of

the project.

TOTALS

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FAITH  COMMUNITY  KNOWLEDGE  VIRTUE  SERVICE
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Feedback on team dynamics:

1. How effectively did your group work?

2. Were the behaviors of any of your team members particularly valuable or detrimental to the team? Explain.

3. What did you learn about working in a group from this project that you will carry into your next group experience?

Adapted from a peer evaluation form developed at Johns Hopkins University (October, 2006)

CORE VALUES
FAITH  COMMUNITY  KNOWLEDGE  VIRTUE  SERVICE