H1N1 flu and client appointments: Considerations for psychologists

Psychologists should become knowledgeable about the virus and consider issues such as when to cancel appointments and when to encourage patients to stay home

by Public Relations Staff

October 22, 2009 — Fears that the H1N1 influenza could become more widespread and increasingly serious have many people tracking this flu closely. Schools and businesses have been planning for scenarios in which large numbers of students and employees may become sick and unable to attend school or work.

Fortunately, to date, most people in the U.S. who have contracted H1N1 flu have not become seriously ill. Many have been able to recover with rest and care within three to five days without seeking medical attention or hospitalization. But sadly, as of mid-October, almost a hundred children and several hundred adults have died from H1N1 flu in 2009.

As a practicing psychologist, you may get questions from patients or clients about H1N1 flu and their appointments with you. The following recommendations can help you determine an appropriate course of action should H1N1 become widespread in the community.

Be knowledgeable about the vaccination
Public health experts promote vaccination as the best prevention. At present, there is greater demand for the vaccine than availability. Increased availability is hoped for as production continues to roll out. Some populations, such as children, childcare providers and pregnant women, have been identified as priority populations to receive the H1N1 vaccine.

Another priority population is "healthcare and emergency medical service personnel." The Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) identified this group because sick health care workers could infect vulnerable patients and absenteeism among health care professionals could reduce health care system capacity.

Psychologists will need to determine based on their work setting whether they fit into this category. Those who work in hospitals or health clinics where they could have greater risk of being exposed to sick people and to spreading illness may be a priority population for vaccination. Hospital or clinic employers may have vaccine recommendations for staff.

Psychologists working in other settings would not likely qualify as "healthcare and emergency medical services personnel" and therefore would not be a priority population for vaccination. Once the H1N1 vaccination is available to the general public, psychologists can choose to get the vaccine to protect themselves and prevent the spread of illness to any clients or colleagues. (Find a flu shot near you at www.flu.gov)

The federal government has faced some unanticipated communication challenges with the release of the H1N1 vaccine. Because the vaccine targets H1N1 flu and not seasonal flu, it is technically a "new" vaccine.

However, the techniques that have been used for decades to produce vaccines have been used in manufacturing the H1N1 vaccine. So, fears of a potentially risky, rushed-to-market vaccine has created a scare that experts say is not warranted. Unfortunately, this scare might prevent people who could benefit from the vaccine from getting it.

Encourage clients who report flu-like symptoms to stay home.
It's better to err on the side of caution and have clients who are not feeling well stay home. The Centers for Disease Control recommends that individuals with influenza-like illness stay at home until at least 24 hours after they are free of fever (100° F/37.8° C or higher), or signs of a fever, without the use of fever-reducing medications.

Similarly, if your client or patient is a parent or guardian providing care to a sick child or children, encourage him or her to stay home.

Cancel your appointments and stay home if you feel sick.
Engaging in self-care is an important part of being a psychologist. You have a responsibility to yourself and your clients to cancel appointments and stay home if you are experiencing flu-like symptoms.

The APA Ethical Principles of Psychologists and Code of Conduct supports such action. According to Standard 2.06, "psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner." If you are not feeling well, your work could be affected.

Consider exceptions to your attendance policy.
The CDC is advising employers to develop non-punitive leave policies for employees who are concerned that they may have the flu. A similar policy would be helpful for therapy sessions.

Because people who contract the flu tend to get better within three to five days, many people could recover within one week of illness onset. This relatively short time frame may have a limited impact on any one client's therapy schedule.

You may decide that clients can cancel appointments without penalty if they have flu-like symptoms, are caring for sick children or are concerned about possible exposure. Once the flu threat is curtailed, you can announce a return to your usual attendance policy on your practice Web site, billing statements or appointment cards.

Inform clients that they can ask their insurance companies about authorizing short-term telephone therapy if they are sick.
Some insurance companies will approve telephone therapy in the short term for patients who can not make it to their therapy appointments because of illness or injury. Insurance companies may be willing to apply this policy in the event of a flu outbreak. Clients can ask their insurance company in advance to determine the extent, if any, to which their insurance plan would cover short-term telephone therapy. Psychologists can also check on the availability of this alternative with the major insurance companies used by their clients.

Keep appointments with clients who are not sick but live with individuals who are sick.
The CDC encourages people who live with individuals who are sick, but are not sick themselves, to go about their usual routines. Not all people who are exposed to people who are sick will develop the flu. According to the CDC, if someone in your household has H1N1, you have an eight to twelve percent chance of catching the flu from that sick individual.

At the same time, the CDC encourages these individuals to regularly monitor their health for flu symptoms. People who have contracted the flu may not experience symptoms for one to seven days, and more likely one to four days after exposure.

If clients begin to feel sick while at your office, encourage them to go home. As part of routine office cleaning, commonly touched areas such as door knobs, arm rests and desk tops should be disinfected. Provide alcohol-based hand sanitizers in waiting and therapy rooms for clients to use, especially after coughing or sneezing.

According to the CDC, flu viruses can survive on hard surfaces for approximately two to eight hours and can infect people who come in contact with the virus. In addition, following the hygiene recommendations of the CDC can minimize your exposure to the flu virus. See the resources below for additional information about these recommendations. 

A special thank you to: Helen L. Coons, PhD, ABPP; Ester Cole, PhD; Raymond F. Hanbury, PhD, ABPP and Richard A. Heaps, PhD, ABPP for their assistance in preparing this document.