Medical Music Therapy
Michele Erich is a board certified music therapist and certified child life specialist with twenty years experience in the field. In this AMTA.Pro symposium, she shares valuable information gained from twelve years on the staff of the Healing Arts Network, an integrative therapy program at the New Hanover Regional Medical Center in North Carolina. Symposium topics include:
I. Descriptions of effective music therapy interventions in four medical settings: pediatric procedural support, cancer center, adult intensive care unit, and palliative care.
II. Details about successful strategies for creating music therapy programs in hospitals: (1) network, (2) sell the concept to administrators, staff, and customers, (3) scout out creative funding options, and (4) take systematic steps to sustain the program.
Click on the gray arrow below to listen to the audio discussion.
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Medical Music Therapy
Michele Erich, MM, CCLS, MT-BC
May, 2009
AMTA.Pro Symposium Script
Hello. Welcome to AMTA.Pro, an online symposium for AMTA members. I am Michele Erich, a Board Certified Music Therapist and a Certified Child Life Specialist at New Hanover Regional Medical Center in Wilmington, North Carolina.
In my work as a music therapist over the past two decades, I’ve had the privilege of working with children and adolescents in a private psychiatric facility, with adults in an outpatient partial hospitalization program, and with older adults in a nursing home before establishing a music therapy program and an integrative therapy program at New Hanover Regional Medical Center. The Healing Arts Network, an integrative therapy program established 12 years ago at our Medical Center, has 3 full-time positions – music therapy, dance/movement therapy, and expressive therapy – in addition to contracted professionals providing massage therapy, yoga, tai chi, craniosacral therapy, and therapeutic touch as well as a volunteer pet therapy program.
Music Therapy Interventions in Medical Settings
As a music therapist at New Hanover Regional Medical Center, I work with staff and patients in pediatric procedural support, in adult outpatient oncology, in adult intensive care, and in palliative care.
Pediatric Procedural Support. With the help of my music therapy interns, I started a pediatric procedural support program, helping in the treatment room during blood draws, IV starts, catheterizations, incision and drains, and spinal taps. My job is to introduce relaxation and redirection techniques to help the children breath, relax, cooperate and remain as calm as possible. Music, imagery, and other relaxation techniques help the children manage pain and develop positive coping skills.
Treatment room space is very tight, especially when the whole treatment team – two or three nurses, a parent, the patient and myself – are present. The tight space requires small instruments that appeal to children and that can be disinfected easily. The soprano glockenspiel seems to work best but I also use a rain stick, ocean drum, and egg shaker. Most children respond well to these instruments, making it easy to gently encourage the child to play the instrument with me while the procedure is being done. Bubbles, pinwheels, and singing facilitate relaxing breaths. I also use interactive songs to engage the child, encouraging them to fill in the blanks in the lyrics or to sing responses to familiar songs instead of focusing on the procedure.
Cancer Center. At the Zimmer Cancer Center of New Hanover Regional Medical Center, music therapy services are available for patients coming for appointments with their physicians, those receiving chemotherapy, and those receiving radiation therapy. My job as a music therapist is to help patients who are anxious, have difficulty tolerating the treatment, or have difficulty tolerating the length of time necessary to receive their treatment or to wait for their results or the physician. Some patients respond well to music, imagery, and relaxation techniques such as breathing and meditation. I try to empower the patients to develop their own “treatment routine” to be used during treatments and at home. An active treatment routine encourages a patient to select resources they can focus on during treatments as well as activities they can continue at home between treatments. These resources include books, journals, music, or art projects to fill their time, to capture their interest, and to help them relax. I also introduce relaxation and imagery with live or recorded music which may also become a part of their routine. Many patients respond well when they are actively involved in their care and are able to develop their own personalized treatment routine.
Through a collaborative effort with a radiation oncology nurse, I have begun providing music therapy for patients receiving radiation therapy for head and neck cancers. The treatment involves wearing a plastic mesh mask custom molded from the patient’s face. It is a tight fit, but has many tiny holes in the mesh. The mask is placed over the patient’s face and basically bolted to the table so they are not able to move – allowing precise administration of the radiation therapy. The mask is confining and often requires awkward positioning. To add to the discomfort, the staff must leave the room during the radiation treatment. The staff can see and hear the patient at all times but the patient is alone in a room and cannot move. As you may have guessed, some patients find this very difficult and get very anxious. The radiation oncology nurse asked if I could help a particularly anxious patient who was having difficulty cooperating with the treatment. I worked with the patient to select their preferred music and images to focus on during the treatment, allowing them to relax. The first patient responded very positively to the music therapy interventions, so the nurse became an outspoken advocate, increasing the demand for music therapy in radiation therapy for head and neck cancers.
Adult Intensive Care Unit. Adults in the intensive care unit are not typically alert enough or strong enough to play instruments, but they can often benefit from listening to relaxing music. I improvise relaxing melodies while introducing peaceful or positive images of rest, healing or regaining strength to help establish a calm and healthy environment. In order to help calm the patient and to help with pain management, I might use recorded music, singing, or music improvised on the alto xylophone.
The alto xylophone became one of my favorite instruments in the medical center when I realized how non-threatening and engaging it was to patients. The xylophone happens to fit nicely on the cart I use to transport my equipment, and I often hear staff and family members playing it when I leave it on the cart it in the hallway. When entering a patient room to complete an assessment, I often park the cart just inside the door to get it out of the hallway. The instrument is a conversation starter, with patients expressing curiosity or a desire to play the xylophone, making it an excellent tool for establishing a relationship and engaging the patients in interactive music making.
Family members can also benefit from the relaxation techniques and music improvisation, and they appreciate participating in the care of their loved one. When the patient is stable enough, I encourage the family to bring recordings of the patient’s favorite music to play in their room.
Palliative Care. As a result of referrals initiated by the palliative care physician, I also help family members cope with the pending death of a loved one. Music therapy interventions include gathering family for singing and improvising music outside of the patient room as well as helping family members share music with the patient and other family members in the room as they say their goodbyes.
Several months ago, I worked with a family in the Coronary Care Intensive Care Unit. The patient – in his late 70’s – had suffered a severe heart attack in his home and had been hospitalized for a week. His oldest grandson had started CPR before the EMS ambulance arrived. His wife, their adult children, and five grandchildren, ranging in age from 5 to 16 years, were all present at the hospital. The family had made the decision to remove him from the ventilator that afternoon, so the adult children asked for help in explaining the patient’s failing health and his pending death to the grandchildren. I met with the adult children, then gathered the grandchildren in a conference room on the intensive care unit while the adults were in the patient room saying their goodbyes as the ventilator was removed. During that time, the grandchildren shared memories of their grandfather with me and asked many questions about death and heaven. They expressed a strong religious faith and shared some of their grandfather’s favorite hymns. While we talked and sang, the children also drew pictures for their grandmother and grandfather. At one point, we realized that none of us knew all the words of one song they all liked. Fortunately, I had the song on a CD. After listening, we decided it would be a great song for them to sing in their grandfather’s room all together. We sang the song through several times, then told the parents the children wanted to sing this song for their grandfather. After preparing the children for the appearance of the room and their grandfather, we walked into the patient room. I introduced myself to the patient’s wife and explained that the grandchildren wanted to share a special song. Everyone gathered around the patient’s bed and I started the music. We all sang – the grandchildren, me, the adult children, a few other relatives, and the patient’s wife. The room was full of people, love, and many other emotions. It was powerful and a very meaningful experience for everyone. After comforting each other, the grandchildren left with a few of the adults. The adult children and the patient’s wife expressed their gratitude for supporting them in this difficult time. The music gave them a chance to express their feelings and come together as a family under stressful circumstances.
This is just one example of the value of music therapy for patients and their families in a medical setting. Each patient and situation is unique, but the music therapist can develop effective interventions by focusing on this question: How can music therapy help (1) increase relaxation, (2) decrease pain, and/or (3) give the patient an opportunity to express their feelings related to their illness, injury or disease?
Creating a Medical Music Therapy Program
Obviously, I feel strongly about the benefit of music therapy in medical centers. I encourage my colleagues to consider creating music therapy programs in medical settings where none exist now. Time does not allow me to detail every step involved in setting up a new program, but I would like to share four areas I found important to address when developing the music therapy program at New Hanover Regional Medical Center.
Network. In my opinion, it is almost impossible to create a music therapy position or program in a medical center without an inside connection. In my case, I was contacted by a colleague’s coworker whom I met at conferences and visited with over the years at various workshops. When this person began looking for a music therapist to run an integrative therapy program at New Hanover Regional Medical Center, she thought of me. I eventually interviewed and accepted the offer. That casual professional connection led to an exciting new career opportunity.
If you don’t already know someone in the medical center, I suggest you get to know a nurse manager, director, or another employee who has been at the facility for several years. Their insights will help you to understand the work environment, and they can guide you to the department director or manager who will most likely be interested in music therapy for their patients. Music therapy may fit nicely into established programs in a medical center such as the child life department, the pain management program, the palliative care program, and the integrative therapy program. You can also approach the directors of a particular unit such as oncology or pediatrics.
Even after your music therapy program is firmly established, you will want to continue networking and nourish professional relationships. Successful collaboration among professionals results in better services and programs and greater benefits for the patients being served. In a medical setting, you will most likely depend on referrals for music therapy services, so the very survival of your program is dependent upon a clear understanding of Music Therapy and professional collaboration. Referrals generally come from physicians but may be initiated by any member of the interdisciplinary team.
My experience with the oncology nurse seeking me out for assistance with anxious patients receiving radiation therapy for head and neck cancers is a good example of the benefits of professional networking and collaborative efforts.
Sell the concept. Do your homework before developing a professional presentation to introduce music therapy to the facility and their patients. Know the hospital’s mission and find out what goals they are addressing. Collect information about cost effectiveness, patient satisfaction, and patient health benefits. Find out what services competing hospitals offer. Make a detailed list of your professional strengths and the benefits you bring to this position and program. Be prepared to share current music therapy research in the medical setting. Pull all this information into a short but compelling presentation with PowerPoint slides or a DVD, a brochure and other literature as well as a demonstration of a music therapy intervention. Prepare different length presentations depending on the audience and time allowed.
Be prepared to talk with a group of physicians, a foundation board, or the CEO of the hospital. Hopefully they will be impressed with music therapy and your presentation. Once you have “wowed them” and are given the okay to create a music therapy program, the next key group to sell on the concept of music therapy is the staff you will work with on a regular basis. Educate the staff about music therapy and help them get to know you and the new service joining the health care team. They will want to know how you fit in the interdisciplinary team, and they will want to know how music therapy benefits the patients. Patients and family members are also important members of the team, so let them know about music therapy as well. This education process will probably require several in-services at staff meetings and at different departmental meetings. Remember that time is a premium, so develop a clear, concise, convincing presentation using visual aids, brochures, and don’t forget to use our strongest tool, interactive music, to get your message across.
Scout out creative funding options. Without funding, a music therapy program in a medical setting will never get off the ground, no matter how strong your support or how convincing your sales job. Even music therapists in established programs should always be on the lookout for various sources to pay for salaries, supplies, music instruments, and continuing education and training.
My position is full time. I have a 1.0 FTE “full time equivalency” which is divided between three different departments. They each pay for a portion of my time and services. I am one of three therapists in an integrative therapy program in our medical center. A hospital could also have a stand-alone music therapy program with one or more board-certified music therapists. Music therapists at different hospitals might have a full time staff position, a partial FTE, or a contracted position, working a certain number of hours for a specified number of days for one or more units or departments.
A medical center uses a variety of funding sources and cost centers, so look at all options. Funding for music therapy services could be in the departmental budget, or it could come from gifts and donations to the medical center foundation. Sometimes a combination of sources can pay for music therapy. Partial funding can come from internal or external grants or other departments. For example, the auxiliary department may pay for supplies while another department pays for the salary. Other possibilities in a medical center are the float pool, spiritual care or wellness departments. The public relations department might even contribute a portion of the position since music therapy could be promoted as a service not offered by the competition.
Take systematic steps to sustain the program. Even well-established music therapy programs need nurturing in order to survive and thrive. I believe successful, on-going programs are those that fit into the existing organization and adjust to the changing work environment. The focus of any successful music therapy program must stay in line with the goals of the medical center. For example, patient satisfaction and productivity are two areas constantly on the radar of the CEO, directors, and managers at my facility. Participating in a research study to show the impact of music therapy on the increase in patient satisfaction definitely helps demonstrate how music therapy is in line with the medical center’s goals.
Developing a system to document and illustrate therapist productivity also helps garner support for music therapy services. For example, it made a difference when we recently added session duration to our notes, allowing generation of a report illustrating patient contact time.
Efficient documentation is critical. From the very beginning, work with the information services department and with the medical center’s documentation team to align music therapy documentation procedures with the existing system. Work with the information services department to make certain the documentation method is efficient and collects relevant information.
Documentation provides valuable data when looking at quality improvement projects to help you to refine your program design. You can periodically look at any aspect of your music therapy program to recognize what is working and what needs improvement. Then you can look at options for improving music therapy services and implement the necessary changes to refine your program.
Conclusion
The Healing Arts Network at New Hanover Regional Medical Center is definitely a work in progress. We constantly learn about new requirements, changes in funding, changes in patient care and medical procedures. Our program thrives because we recognize needs and because we remain flexible and willing to adapt our services. In my opinion, opportunities abound for music therapists in the medical arena.
For additional information, check out the resources section of this AMTA.Pro symposium by clicking on the AMTA website, www.musictherapy.org. Please feel free to join the conversation by clicking on the comments section of this symposium on the AMTA website. I encourage questions from colleagues want to know more about music therapy in medical settings, but I also welcome insights and recommendations from therapists with experience in this exciting professional field. I look forward to hearing from you. This is Michele Erich. Thanks for listening.
I’d like to thank Justin Hauenstein of South East Area Health Education Center and Cathy Knoll, MT-BC for their talents and guidance in my first venture into the world of recording a podcast.
Resources
AMTA Fact Sheets
+ Music Therapy and Medicine
+ Music Therapy and Pain Management
Dileo, C. Ed. (1999). Music Therapy and Medicine: Theoretical and Clinical Applications. Silver Spring, MD: American Music Therapy Association.
Hanson-Abromeit, D. & Colwell, C. (Eds.). (2008). Effective Clinical Practice in Music Therapy: Medical Music Therapy for Pediatrics in Hospital Settings Using Music to Support Medical Interventions. Silver Spring, MD: American Music Therapy Association.
Robb, S. Ed. (2003). Music Therapy in Pediatric Healthcare: Research and Evidence-Based Practice. Silver Spring, MD: American Music Therapy Association.
Standley, J., Gregory, D., Whipple, J., Walworth, D., Nguyen, J., Jarred, J., Adams, K., Procelli, D., & Cevasco, A. (2005). Medical Music Therapy: A Model Program for Clinical Practice, Education, Training, and Research. Silver Spring, MD: American Music Therapy Association.
© Copyright 2009 by the American Music Therapy Association, Inc.. All Rights Reserved. Content herein is for personal use only. No part may be reproduced in any form or by any means, electronic or mechanical, including photocopying or recording by any information storage or retrieval system, without express written permission from the American Music Therapy Association.