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Music therapy piano

A new (musical) direction for healthcare?

Most would agree with the idea that music can have a powerful hold over us—our thoughts, feelings, and movements. Given this, how might music help measure thoughts, feelings, and movements in a way that allows professionals in healthcare improve client treatment?

The music therapy profession seems to be experiencing a surge in developing data-measuring tools that incorporate music in the client assessment. We’ve seen an increase of articles on the topic published in scholarly journals, the forming of a consortium, and a recent roundtable discussion.

Given this increase, we invited four music therapy experts to participate in a Q&A about music therapy assessments: Dr. Felicity Baker, who co-developed the Meaningfulness of Songwriting Scale (MSS); Dr. Eric Waldon, who co-developed the Music Attentiveness Screening Assessment, Revised (MASA-R); Dr. Julian O’Kelly, who co-developed the Music Therapy Assessment Tool for advanced Huntington’s Disease (MATA-HD); and Dr. Wendy Magee, who co-developed the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC).

Why did you create your particular assessment?

Felicity Baker: The MSS was designed primarily as a research tool, so I could map the degree of meaning the songwriting process held for participants with their outcome measures. This would enable me to theorise about why some participants are more responsive and have better outcomes than others. I also wanted to explore meaning-making as a mechanism of change activated by songwriting.

Eric Waldon: The MASA-R was designed to assess childrens’ ability to attend to musical stimuli and evolved from clinical work in pediatrics at University of the Pacific. It’s intended for use by clinicians to assist music therapists in designing music-based procedural support interventions for hospitalized children.

Julian O’Kelly: The MATA-HD was designed for both clinical and research purposes to measure Huntington’s disease (HD) patient responses to music therapy interventions across psychological, physical, social, and communication domains. HD is a complex condition, where subtle responses require the focussed attention of clinicians to accurately monitor. It was felt a robust and valid tool would assist this process and assist our ability to communicate clinical progress. From a research perspective, it was felt the tool would meet a need for a sensitive means of measuring the efficacy of music therapy.

Wendy Magee: The MATADOC, a standardized measure for assessment of patients with Prolonged Disorders of Consciousness (PDOC), was developed because my colleague Rosie Monaghan and I were both newly qualified music therapists. We were new to the population and we had many questions about what we should be doing in a music therapy session with people with such minimal responsiveness, how we could measure responses, and how we could communicate clinical events to colleagues in a way that could contribute to the patient’s overall assessment.

What were the greatest challenges you encountered when developing your assessment measure?

FB: I found the experience of gaining face validity the most fascinating part. Having developed the tool based on a combination of pilot work, our own experiences, and a synthesis of the literature, I approached a number of key researchers in our field to ask for their perspectives on the items. I found their input so valuable and did result in omitting some items and tweaking others. In terms of challenge, gaining test-retest data is tricky as dropout is quite critical. Missing data is also a real challenge!

JO: The development of the MATA-HD took a total of five years to reach publication, only two of which were funded and directly involved in data collection. This is by no means unusual, and is itself a challenge – managing the demands of ethics applications, data analysis, and the rigorous review process can be arduous!

Education Minister John O’Dowd with music therapist, Jenny Kirkwood and pupil Tessa Martin at the official opening of new facilities for Tor Bank School in Dundonald. Image by Northern Ireland Executive. CC BY-ND 2.0 via Flickr.

What recommendations do you have for assessment development, particularly from a scientific versus clinical perspective? 

WM: One of the most important things when developing a measure is to understand that the criteria a music therapist thinks are important may not be what the patient, family, or other team members think are important. This will influence the development of the measure’s items. Using terminology and incorporating concepts pertinent to the population are important too. This might be different from terminology more typical for a music therapist. For example, the MATADOC has a “verbal command” item. Though this may be uncomfortable for music therapists from particular perspectives, demonstrating that a person can respond to a verbal command is critical diagnostically.

EW: My recommendation is to focus on measuring a few clinically relevant skills, abilities, or responses that will lend themselves meaningfully to the assessment process. When psychologists employ testing as part of assessment, they use multiple tests as a part of a battery as opposed to one “big test” that measures everything. As tests become a larger part of music therapy assessments, I see clinicians employing such a “battery of tests.”

What do you envision is the role of music-based measures in healthcare? What differentiates them from non-music based ones?

JO: To a commissioner of services in healthcare today, there exists a bewildering array of choices to invest in when it comes to arts-based interventions which claim to support health or educational development. In this context, music-based assessments, tailored to some of the unique qualities of music therapy, can play an important role. Here, clinicians addressing shared goals of their multidisciplinary colleagues may with objectivity produce reliable and valid measures of what their input contributes to client care.

EW: Music-based tests are able to measure clinically relevant thoughts, feelings, and behaviors in a way non-music-based tests cannot. Furthermore, they are a way to view client functioning under a music condition that can be compared to evidence obtained under a non-music condition. But there is a place for BOTH music-based and non-music-based measures in clinical practice.

FB: I think the role of assessment is very important because to write accurate reports is tricky without rigorously tested assessment tools. Whether these need to be always music-specific is debatable and I think we have a tendency to create tools that are so discipline-specific they might only be meaningful for music therapists. I think it essential that if we use music therapy-specific assessments, we need to be mindful to report the findings in terms that relate to a person’s wellbeing and can be understood from a broader health agenda.

Featured image credit: music, piano by Jamille Queiroz. CC0 Public Domain via Unsplash.

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