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imagine.magazine Fall 2016 l Vol.7, No.1

2016 your resource for early childhood music therapy imagine 7(1), 2016


imagine.magazine ISSN 2153-7879 All rights reserved.

editor-in-chief Petra Kern, Ph.D., MT-BC, MTA, DMtG contributing editor Marcia Humpal, M.Ed., MT-BC editorial assistance Rose Fienman, MSW, MT-BC Gretchen Chardos Benner, LMSW, MT-BC Dana Bolton, M.Ed., MMT, MT-BC copyediting assistance Ashley Miller, MT-BC business manager & design production Petra Kern, Ph.D., MT-BC, MTA, DMtG publisher de la vista publisher imagine is the primary annual online magazine dedicated to enhancing the lives of young children and their families by sharing knowledge, strategies, ideas, and policies related to early childhood music therapy with colleagues and parents worldwide. Visit to access additional multimedia contributions and 20 years of archives.

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join imagine imagine publishes articles that are directly related to early childhood music therapy (ages: zero to five), grounded in evidence-based practice. topics include professional wisdom event reports and reflections research snapshots and reports innovative clinical practice parents can series children's corner early childhood music programs intervention ideas color of us series video/audio podcasts teaching episodes photo stories useful online resources book reviews with audio bookmarks ....and much more possible formats mutlimedia article video or audio podcast photo story, or invited teaching episode for more details, visit our website at

sponsorship imagine is currently free and accessible to everyone. Make a donation and help us to cover the editing, production, and website costs. Sponsors are listed as supporting partners on the imagine website. advertise imagine is the perfect place to advertise your products and services for young children and their families, or music therapy education. Advertisement rates and specifications may be obtained by visiting the imagine website or sending an email to disclaimer The opinions and information contained in this publication are those of the authors of the respective articles and not necessarily those of de la vista publisher or members of the editorial team. Accordingly, de la vista publisher and the editorial team assume no liability or risk that may be incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this publication. No endorsement of authors, products, or services is intended or implied.

next submission deadline May 15, 2017

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Early Childhood Music Therapy Advocacy: Demonstrating Our Passion for Young Children and Their Families Music therapy as a professional discipline has existed in the United States for over 60 years. Although parents, early childhood educators, physicians, service providers, and administrators may have heard about early childhood music therapy, they may be less familiar with the therapeutic process involved, available research-based outcomes, possible collaborations, and how music can be used for young children's learning and development in daily activities and routines. In this issue, over 70 authors from 12 countries share their dedication and passion for early childhood music therapy with imagine readers. Each article speaks to “What should a [...] know about early childhood music therapy and [...]. Illustrated by text, images, drawings, audio/video recordings, and hyperlinks to additional resources, this evidence-based resource is accessible to everyone.

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In the imagine “Wisdom” section, early childhood music therapy advocate Angela Snell suggests that everyone “be a leader” and “advocate from the very beginning.” Marcia Humpal, the imagine contributing editor and champion of working with young children and their families, offers past to present views of the young child and the development of early childhood music and therapy. In the 2016 featured multimedia article, Lori Gooding, Assistant Professor of Music Therapy at Florida State University, vividly illustrates and explains the therapeutic process of referral, assessment, intervention, evaluation, and termination of music therapy in a manner that can be clearly understood by all. Staying informed about the latest policies, trends, and research in music therapy and related fields is essential for effective advocacy. Reports from the 2015 AMTA Early Childhood Music Therapy Networking Meeting, the ZERO TO THREE National Institute (both Dana Bolton), and the National Early Childhood Inclusion Institute (Petra Kern), as well as the 2016 research snapshot (Andrew Knight & Blythe LaGasse), keep music therapists abreast of recent developments. The 2015-2016 publication list (Christopher Millett) and book reviews (Amy Meyer; Anne Parsons) provide additional references as do the organizational resources related to music therapy and early childhood education (Petra Kern). Research and practice articles in this issue target parents, students and specific professional groups and administrators who could benefit from knowing more about music therapy with young children in pediatric/ neonatal intensive care units (Dianne Gregory; Molly Moses; Ashley Miller, Olivia Swedberg Yinger, & Joseph Zwischenberger; Darcy DeLoach; Michael Detmer) and educational settings (Kate Gfeller; Alisha Luymes; Kathy Schumacher; Lorna Segall; Edward Schwartzberg; Petra Kern & Bonnie Hayhurst; Ellary Draper & Laura Brown; Ilene Berger Morris; Carol Blank). Each of these articles is carefully crafted and designed as a piece of advocacy for young children with health issues and disabilities who may benefit from music therapy services. Additionally, two tip sheets for students (Marcia Humpal; Darcy DeLoach & Petra Kern) and three infographics highlight how music can make a difference (Christopher Millett), how to teach social skills through song (Julie Guy & Angela Neve), and which early childhood music programs are available for families (Rose Fienman & Christopher Millett). imagine 7(1), 2016

The administrator’s guide to music therapy (Elizabeth Schwartz) may help decision-makers better understand the laws and regulations supporting music therapy as a related service. A quiz prepared by Dena Register tests the reader’s advocacy style. Are you a “loud and proud,” “not afraid to take the lead,” “behind-the-scenes sleuth,” or “support” person? Furthermore, Nicole Rivera reminds us to consider the impact of institutional culture when advocating for early childhood music therapy. Eight imagine podcasts presented by experienced music therapy educators and practitioners “in their own words” further address advocacy topics. The “Color of Us” series features short essays that describe current early childhood advocacy topics in 12 different countries. The “Teaching Episode” by Matt Logan offers five tips on how to be a rock star in a child’s life. Additionally, 20 hands-on intervention ideas for immediate implementation are provided by student authors, educators, and practitioners. The 2016 “Parents Can” series is written by parents of three young children with disabilities for other parents who might seek music therapy services for their child. Of special interest is the “Letter From a Child,” written by Dana Bolton, which spotlights a child’s view of a music therapy session. In the “Children’s Corner,” readers can view adorable responses from children to the question “What do we do in music therapy?” Finally, don’t miss out the coloring worksheet created by our youngest author, Madeleine Walworth. The imagine team thanks Lisa Jacobs and Rose Fienman for their editing service and dedication to the imagine.magazine over the past years. We welcome Ashley Miller as a new editorial assistant in 2017 and are excited to join the #MTCANN! led by Dr. Jayne Standley. Finally, thank you to all who raise their voices for young children with disabilities and their families and advocate for early childhood music therapy. May your voices be loudly and effectively heard! Sincerely,

Petra Kern, Ph.D., MT-BC, MTA, DMtG Editor-in-Chief, imagine



inside this issue editorial Early Childhood Music Therapy Advocacy: Demonstrating Our Passion for Young Children and Their Families Petra Kern............................................................


wisdom Advocacy in Early Childhood Music Therapy: Advocate From the Very Beginning Angela M. Snell.................................................... 10 reports 2015 Clinical Practice Committee Network Session: Early Childhood Music Therapy Meeting Report From 11-13-2015 Dana Bolton......................................................... 12 Reaching a Milestone: Connecting Science, Policy, and Practice: ZERO TO THREE National Institute Report Dana Bolton......................................................... 15

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More Than an Event: Extending the Learning National Early Childhood Inclusion Institute Report Petra Kern............................................................ 18 Announcing the International Consortium of Children's Music Therapy Experts to Promote Early Intervention Research, Advocacy, and Clinical Development Jayne M. Standley................................................. 20 reflection Past, Present, and Future: Making a Difference Through Music Therapy Marcia Humpal..................................................... 24 featured Music Therapy: An Overview of the Therapeutic Process Lori F. Gooding.................................................... 30


research 2016 Early Childhood Research Snapshot Andrew Knight and Blythe LaGasse.................... 36 Music Therapy Students’ Perceptions of Arts in Medicine Service Learning in a Pediatric Unit Dianne Gregory.................................................... 42 Mothers’ and Fathers’ Perceptions of Music Therapy for Their Hospitalized Child: A Survey Study Molly Moses........................................................ 46 practice Recognized and Researched: An Administrator’s Guide to Music Therapy Elizabeth K. Schwartz......................................... 50 Altering Perceptions: Research, Cost-Effectiveness Analyses, and Advocacy Ashley Miller, Olivia Swedberg Yinger, and Joseph Zwischenberger....................................... 53 Super Star or Behind the Scenes Sleuth: What is Your Advocacy Style? Dena Register...................................................... 58 Music Therapy for Hospital Procedures Darcy DeLoach.................................................... 62 The Use of Parental Singing: Enhancing Neurodevelopment in Premature Infants Michael R. Detmer................................................ 66 Sound Play for Preschoolers With Cochlear Implants Kate Gfeller.......................................................... 70 Selecting Songs for Language and Cognitive Development of Preschoolers Alisha Luymes...................................................... 74 Steady Beat: Laying a Foundation for Literacy Kathy Schumacher.............................................. 77 Tips: What Music Therapy Students Should Know About Working With Young Children Marcia Humpal.................................................... 80 Eight Ways Music Makes A Difference Christopher R. Millett........................................... 81 Early Childhood Development, Music, and the Grief Process Lorna E. Segall..................................................... 82

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What Happens in Music Therapy? A Coloring Worksheet Madeleine Walworth............................................ 86 Letter From a Child Dana Bolton......................................................... 88 Institutional Culture: Considering the Impact on Early Childhood Music Therapy Nicole R. Rivera................................................... 90 Music Therapy for Children With Autism Spectrum Disorder: Developing and Sustaining Professional Relationships with Pediatricians Edward Todd Schwartzberg................................ 93 Teaching Social Skills Through Song: A Teaching Hierarchy for Children with ASD Julie Guy and Angela Neve................................. 96 Skill Generalization: Intentional Use of Apps in Music Therapy Sessions and Beyond Petra Kern and Bonnie Hayhurst......................... 98 Let’s Stay Together: Collaboration in Inclusive Early Childhood Music Therapy Settings Ellary Draper and Laura Brown......................... 102 Q&A: What Prospective Students Should Know About Music Therapy and Early Childhood Darcy DeLoach and Petra Kern......................... 105 Empowering Immigrant Latino Parents to Support Their Children’s Developing Literacy Skills Through Music Ilene Berger Morris............................................ 106 Quality of Early Childhood Music Programs in the Community: A Guide for Parents Carol Ann Blank................................................. 110 programs Summary of Early Childhood Music Programs Featured in imagine 2013-2015 Rose Fienman and Christopher R. Millett.......... 114 parents can Ideas for Parents From Parents Bolton Music Therapy......................................... 117 Ideas for Parents From Parents Therabeat............................................................ 118 Ideas for Parents From Parents UofL Music Therapy Clinic................................. 119


intervention ideas Come and Sing With Me: Call and Response Layne Guyer........................................................ 120 Hey! Hello!: Introducing a Theme Scott Sams......................................................... 121 The Leaves Are Changing: Learning About Autumn Colors Bethany Wilker.................................................... 122 I See Autumn Time: Learning About Early Math Concepts A’Marie Rust....................................................... 123 How Does It Move?: Identifying Sounds and Movements Anna Lazeski....................................................... 124 Mr. Dragon Is Sleeping, Shh!: Practicing Indoor and Outdoor Voice Caroline Seitzinger.............................................. 125 What Could It Be?: Learning About Early Math Concepts Danielle Coffinbarger........................................... 126 Know Your Days: Learning About the Concept of Time Faith Wright........................................................ 127 Colors of the Rainbow: Recognizing Colors Everywhere Grace Wines....................................................... 128 Wash Your Hands: Practicing Proper Hand Washing Procedures Karissa Rhodes................................................... 129 Waiting My Turn: Preparing Children With Waiting Strategies Nathan Chuba..................................................... 130 Moving Our Bodies: Enhancing Mobility Skills Elizabeth Sharp................................................... 131 Strum Song: Enhancing Fine Motor Skills Brandon Wright, Amy Calderon, and Elizabeth Sharp................................................... 132 Riding on a Motorbike: Fostering Imagination Tracey Elliott....................................................... 133 My Turn, Please: Encouraging Communicative Interaction Jonathan Tang.................................................... 134 My Magic Balloon: Deep Breathing and Relaxation Erin Aubrey Batkiewicz,...................................... 135

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It’s Time to Sleep: Behavioral Regulation in Infants With NAS Michael R. Detmer.............................................. Wait!: Building Patience Petra Kern........................................................... Bubbles in the Air: Working on Shifting Gaze Adrienne C. Steiner............................................. Mindful Me: Engaging Children in Mindfulness Practices Darcy DeLoach...................................................

136 137 138


color of us A note to [...] From Music Therapists Around the World Petra Kern and Rose Fienman.......................... 141 podcasts Creating Capacity: What Music Therapists Need to Know About Advocacy for Music in Early Childhood Dena Register..................................................... 148 What Music Therapists Need to Know About Engaging in Advocacy Amy Rodgers Smith............................................ 148 What Music Therapists Need to Know About Starting a Private Practice Kimberly Sena Moore......................................... 149 What Administrators Need to Know About Early Childhood Programming Budgets Adrienne C. Steiner............................................. 149 What Educators in Mexico Need to Know About Music Therapy and Early Childhood Patricia E. Altieri Ramírez.................................... 149 Beyond the Clinic: What Music Therapists Need to Know About Extending Their Services Into the Home Rachel Rambach................................................ 149 Pay Attention!: What Interns Should Know About Early Childhood Music Therapy and Autism Spectrum Disorder Beth McLaughlin................................................. 149 What Music Therapy Students Need to Know When Conducting Service Projects in Latin American Countries Hakeem Leonard................................................ 149


resources Organizations: At Your Service Petra Kern ......................................................... 150 publications New Publications 2015-2016 Christopher R. Millett........................................ 152 reviews Teaching Young Children (2015). Expressing Creativity in Preschool. Washington, DC: National Association for the Education of Young Children. Amy L. Myers................................................... 154 Division for Early Childhood (2015). DEC Recommended Practices: Enhancing Services for Young Children with Disabilities and Their Families (DEC Recommended Practices Monograph Series No. 1). Los Angeles, CA: Author. Anne Parsons....................................................... 156

Acknowledgment We would like to express our gratitude to all long-term authors and newcomers as well as those individuals and organizations who support imagine through their collaborations and advertisements.

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Angela M. Snell, MSEd, MT-BC Monroe County Intermediate School District, Michigan

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Advocacy in Early Childhood Music Therapy: Advocate From the Very Beginning There are different levels and types of music therapy advocacy ranging from how one represents the field in their everyday work to formal efforts on local, state, and national levels. Audiences may include parents, caregivers, administrators, or legislators. Effective advocacy in early childhood music therapy focuses on the child’s needs and music therapists’ scope of practice and research. Below are ten effective ways music therapists serving young children and their families can advocate for continued access to music therapy at the direct-service level. 1. Be a leader! Define music therapy, its scope of practice, and music therapy goals addressed in early childhood rather than waiting for those without training to fill in the blanks. 2. Use plain, relatable language so non-music therapists can grasp the information and share it with others. 3. Focus on music’s role in child development, including communication, cognitive, physiological and emotional functioning. 4. Explain the music therapy assessment process and how engagement in the music medium can expose hidden strengths and needs. 5. Support caregivers to engage in music in front of the children at their comfort level. Explain how this is beneficial for both the adult and the child. 6. Data, Data, Data! Use both qualitative and quantitative data, even if the agency does not

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request it. Align the outcomes with the vision and mission of the agency. Understand the rules and regulations that shape the agency’s priorities and expose how music therapy impacts the bottom-line (e.g., outcomes, costefficiency, parent involvement, and public relations). Use a variety of communication strategies (e.g., music demonstrations, brief statements, data graphs, videos, handouts, and written narratives). Embrace challenges and misunderstandings about music therapy as opportunities that are a normal part of your professional practice. Repeat, Repeat, Repeat! Don’t assume non-music therapists can generalize information across situations or in successive music therapy sessions. Continue to educate and share information in an ongoing basis.

Generalize the above strategies to other levels by networking and joining coordinated team efforts. Go to the AMTA’s Policy & Advocacy section to the for information, updates, and resources. Explore other sources such as Wrightslaw to remain current with rules and regulations of special education law, and check out the highlights in IDEA 2004 Part C (Early Intervention). Seek advocacy training to become comfortable communicating with community leaders and elected officials. By integrating advocacy into each work day, music therapists foster public understanding of the field’s scope of practice and strengthen client access to services. Being an advocate is an integral part of being a music therapist. Therefore, advocate from the very beginning!



2015 Clinical Practice Committee: Network Session Early Childhood Music Therapy Meeting Report From 11-13-2015 Dana Bolton, MEd, MMT, MT-BC co-owns Bolton Music Therapy in Murfreesboro, Tennessee, and has worked in the early intervention field for 12 years. Dana joined the imagine editorial team in 2014. Contact: 1. Welcome The Early Childhood Network (ECN) co-chairs, Dr. Petra Kern and Angela Snell, called the meeting to order. Fourteen students and professionals representing nine states (SC, IL, TN, NY, KS, MI, CA, OH, MN) and one foreign country (Switzerland) attended the meeting.

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2. Early Childhood Network Information

Update on imagine Dr. Kern, the editor-in-chief acknowledged the work of the imagine editorial team and thanked the present authors for their contributions. 2015 marked the 5th anniversary of imagine. Over the past five years, imagine has published 340 articles, 84 audio clips, and 108 video clips from authors residing in 37 countries. Celebrations of the 5th anniversary included a) an imagine team video, b) a new Facebook fan page, c) an online event, d) a happy hour for authors at the conferences, and e) print versions of imagine. Full-color paperback books of the past five imagine issues are now available to purchase online ( contributorId=1371176). These will be a great resources for university libraries to have on hand. A five-bundle copy was presented to Marcia Humpal in honor of her service to early childhood music therapy. The 2015 issue of imagine has been disseminated to 1.6 million potential readers.


Social Media The ECMT Facebook group has grown to over 1,200 members (about 200 more than in 2014). This year, the new Facebook fan page (https:// was created. The page currently has 782 likes. It may be opened up for guest posts in the future. The number of twitter followers @imagineECMT has doubled over the past year. An Instagram account is in planning. Government Relations In September, the head of the federal Office of Special Education wrote a personal email to every state director of special education informing them that music therapy is a related service even though it is not included in the language of the law. An email was sent to AMTA and will be shared with members soon. Judy Simpson (Director of Government Relations) is gaining permission to share content. This email made a difference instantly (within 3 days) for a music therapist in Rhode Island. A 40-page policy statement on inclusion of children with disabilities in early childhood programs has been developed by the U.S. Department of Health and Human Services and the U.S. Department of Education. Across the nation there is a movement toward full inclusion, involving the dismantling of current facilities and the integration of residents into community settings. In New York, there will no longer be an option for segregated classrooms. This is also happening in Michigan. Advocacy and New Trends President Obama has launched an early childhood initiative. The White House was a sponsor of the Invest in Babies campaign at the 2014 ZERO TO THREE Conference. New Developmentally Appropriate Practices (DAP) from DEC have been published. The DEC Conference will be held next year in Louisville, KY. Proposals are being accepted now and must fit within DAP. Family-centered practice and generalization of music therapy sessions to family life is becoming increasingly important, as is communication with teachers.

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3. Year 2015 in Review Research Projects/Reports Todd Schwartzberg shared about Phase 2 of a memory study at an Autism Spectrum Disorder camp (average age 15 years, range 9-43 years) and with neurotypical individuals. It is investigating the difference between male and female voices chanting and singing, on and off video while teaching. Jeff Wolfe shared about a qualitative study on music therapy with victims of domestic violence using treatments for cult survivors. Dr. Nicole Rivera shared her research on museum exhibit evaluations, family learning, how early experiences influence affect and learning experiences. Presentations & Publications See AMTA’s 2015 conference program for preconference trainings, institutes, and CMTEs as well as concurrent sessions on ECMT. See imagine 6(1), 2015, p. 132-133, for ECMT publications in 2015. 4. Sharing Resources edWeb Arts and Music in Early Learning Community: Free, archived webinars to help educators integrate fine arts and music into their classrooms. Music Together app – free in Apple Store, coming soon for Android. Statewide Autism Resources and Training (START) – Michigan – website with data forms; videos; and materials for sensitivity trainings, socialization tracking, attendance, engagement, and selfmanagement skills. The Institute for Child Success – When Brain Science Meets Public Policy. Autism Navigator – free “About Autism in Toddlers” module, as well as modules available to early intervention providers through state systems. . Vroom app – parenting tips from the Bezos Family Foundation. Tips are delivered directly to parents in high risk areas. 5. Upcoming Events

Please visit the event calendar on the imagine website at


Due to the changing nature of the Clinical Practice Committee Network Sessions at the AMTA national conference (formerly Special Target Populations Networking Lunch), the Early Childhood Network (ECN) will no longer hold a formal business meeting during this time. However, do feel free to stop by the early childhood table to meet and informally network with other music therapists working with this population. Early childhood information will be disseminated through imagine and the Facebook fan page. We invite you to join us for a happy hour at the 2016 AMTA conference in Sandusky, Ohio, in honor of our imagine authors. Thank you to Dr. Petra Kern and Angela Snell for co-chairing the formal meetings from 2006-2016.

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Reaching a Milestone: Connecting Science, Policy, and Practice ZERO TO THREE National Institute Report Dana Bolton, M.Ed., MMT, MT-BC Bolton Music Therapy, Murfreesboro, Tennessee

Over 2,500 early childhood professionals from the fields of early childhood education, early intervention, mental health, Early Head Start, child welfare, parent education, and pediatrics attended the 30th annual ZERO TO THREE National Training Institute in Seattle, WA, from December 2-4, 2015. The conference included 231 speakers across six general sessions, 74 breakout sessions, five interactive pre-Institutes, eight issue intensives, poster showcase, and hot topics sessions. This year’s Rally4Babies encouraged conference attendees to tweet questions to presidential candidates about their plans for addressing the needs of young children in areas such as affordable, quality childcare; services for children experiencing abuse, neglect, and trauma; early childhood education; paid parental leave; effects of poverty; and assistance for military families.

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At the opening session, Jackie Bezos of the Bezos Family Foundation introduced their partnership with ZERO TO THREE in conducting a national parent survey targeting mothers and fathers in the Millennial and Generation X generations. The purpose of the survey, given in October 2015, was to learn what millennial parents need and want and how they want information delivered. Today’s parents know that the early years matter, and that they make a significant difference. Parent focus groups identified the following common issues: Serious challenges with discipline; fathers feeling devalued; parents wanting to be better than their parents; wanting their children to be better than they are; feeling judged as parents; relying heavily on the internet, social media, and friends for support and information; appreciation, but wariness, of professional advice; and a deep desire to be the best parents they can be. Survey results were released in Spring 2016, and a web portal was created to disseminate survey results and resources, including infographics, videos, and articles. This online information can be accessed at Additional avenues for disseminating information to parents were shared with conference attendees. The Vroom app, an initiative of the Bezos Family Foundation, is a free resource to help parents turn everyday moments into brain-building moments, while explaining the science


behind early development in accessible language. The free app is available on the App Store, Google Play, and Amazon. More information can be found at http:// ZERO TO THREE has also partnered with the streaming service Hulu on East Los High, a Hulu original series with an all-Latino cast targeting teenage audiences. Information on child development and positive parenting practices are embedded into the show in an effort to reach young parents. Three seasons are available for streaming on Hulu Plus, and a fourth season will be released this year. The keynote plenary, “Building the Foundations of Life Course Health,” was presented by Nadine Burke Harris, MD, from the Center for Youth Wellness in San Francisco, California. Dr. Burke Harris spoke about the effects of adverse childhood experiences (ACEs) and toxic stress on the health and development of children. She presented a rationale for ACE screening during pediatric well visits and introduced two tools, the CYW Adverse Childhood Experiences Questionnaire (CYW ACE-Q) and the BCHC-CYW Integrated Pediatric Care Model. Dr. Burke Harris’ work, along with access to the CYW ACE-Q, can be found online at http:// Andrew Meltzoff, Ph.D., and Patricia Kuhl, Ph.D., of the University of Washington Institute for Learning & Brain Sciences, presented the science plenary entitled “Minds, Brains, and How Babies Learn: From Infants to Society.” They presented the latest research on social-emotional learning, early language, human touch, and brain development and how to connect research to practice. They reminded attendees that the brains of children are developed through the experiences adults provide for them. They discussed the critical period for language learning, the word gap between children in different socio-economic classes, and the need for infants to have a social adult to learn from. They presented research suggesting that bilingual children are more cognitively flexible than monolingual children. Dr. Kuhl presented research showing that exposure to music in a triple meter enhanced infants’ abilities to detect and predict auditory patterns. According to Dr. Meltzoff, infants learn through observation of those around them. In a study of infant imitation and memory, infants observed novel play actions with toys but were not given the chance to manipulate the objects. Seven days later, they displayed

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deferred imitation by imitating the play actions they had perviously seen. Other research showed that babies with better gaze following at 11 and 12 months had better language at 24 months. Dr. Meltzoff also discussed emotional eavesdropping, the concept that babies will process negative emotions directed towards others around them and regulate their behavior accordingly. Online training modules on these topics and more are available at A moving practice plenary entitled “Attachment, Trauma, and Reality: Creating Trauma-Informed Systems for Infants, Toddlers, and Their Families” was presented by Alicia Lieberman, Ph.D., and Chandra Ghosh Ippen, Ph.D., from the University of California in San Francisco. They shared a case study detailing Child-Parent Psychotherapy over time with a young child who was a victim of severe child abuse. They illustrated core trauma concepts such as the idea that trauma can generate distressing reminders that may affect the child’s life and functioning long after the event has ended. Helping children make meaning out of these triggers is an important step in therapy. Trauma can also rupture spoken and unspoken social contacts, leading children to view adults as dangerous or absent and causing dysregulated patterns of adaptation. Lieberman and Ippen highlighted the importance of caregivers, including foster parents and preschool teachers, working together throughout the therapy process. It is important for adults to acknowledge the child’s experience and the behaviors that communicate his/her experience, as well as to honor the child’s need to remove him/herself from triggering situations. Additional plenary sessions addressed policy issues related to the infant-toddler agenda. Breakout sessions covered a variety of topics, a few of which are highlighted here. In a session entitled “It’s Not Just About Eating: Possible Signs of Emerging Autism During Infant Feeding,” presenters Mary Beth Steinfeld, MD, Jennifer Black, CCC-SLP, MA, Jamaica Plain, MA, and Denise Findlay, BSN, RN, described feeding as the first turn-taking dialogue in a child’s life. Communication is an essential part of feeding an infant or toddler, and because autism spectrum disorder impacts reciprocal social communication, as many as 89% of children with ASD have feeding issues including eating less than 20 foods and having nutritional deficiencies. The presenters introduced the NCAST Feeding Scale as a way to look


for predictors and early signs of risk for developmental delay. They also introduced the Barnard Model showing how caregiver/parent characteristics of sensitivity to cues, alleviation of distress, and provision of growthfostering situations interact with infant/child characteristics of clarity of cues and responsiveness to parent/caregiver. Interference in this cycle caused by maternal factors (e.g., illness, substance abuse, low parenting knowledge) or child factors (e.g., low birthweight, illness, disability, prematurity) can lead to a breakdown in the relationship between parent and child. They discussed the variety of cues that children use to signal their needs, wants, desires, and self-regulation. An impaired relationship can cause parents to miss subtle disengagement cues (e.g., hand to ear, pouting, gaze aversion), often causing potent disengagement cues (e.g., throwing, tray pounding, overhand beating) to follow. While the NCAST Feeding Scale is not designed to identify ASD, and there was a wide range of scores among children diagnosed with ASD, there was a correlation between higher scores and lower incidence of ASD at age 3. “Infant Crying and Family Functioning: Clinical Screening and Referral,” presented by Tiffany Burkhardt, Ph.D., Linda Gilkerson, Ph.D., and Leslie E. Katch, MSW, addressed an issue common to many parents. Excessive crying occurs in about 20% of infants in the United States and is one of the most common complaints parents bring to pediatricians. Crying can be related to infant factors (reflux, allergies, sensory issues), maternal factors (prenatal exposure to cigarettes and alcohol, maternal mental health), and/or relationship factors (parent-infant dysfunction). Only 5-10% of babies with excessive crying have a physiological reason for doing so. Possible treatments include medical and behavioral interventions, depending on the root cause. Negative outcomes from excessive crying include stress in the maternal-infant relationship from the mother’s inability to soothe her infant, higher rates of depression and stress and lower self-efficacy among parents, and higher risk of abuse, specifically Shaken Baby Syndrome, for infants. Parents’ perceptions of their child’s crying was the strongest predictor of parental distress and poor functioning, regardless of the actual amount of crying. Burkhardt, Gilkerson and Katch presented a new tool, the Infant

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Crying and Family Functioning Tool, as a screening instrument to identify families in need of support. They suggested that care providers have a conversation with families to determine if they are struggling with crying and fussing, if they have support or want it, and if referrals to local support services are approbriate. “Making Connections: How Executive Function and SelfRegulation Form the Foundation for Lifelong Learning and Success” was presented by Sherri L. Alderman, MD, and Megan McClelland, Ph.D. The environment a child grows up in is something that can be controlled by the adults in his’her life. Temperament is often a result of the environment in utero and can affect a child’s learning throughout their life. Infants seek out connections for safety and survival and depend on their parents or caregivers to act as their prefrontal cortex, requiring adults to be mindful of their emotional reactions around children. A study of sleeping infants showed that they were still able to hear and respond to what happened around them. Infants in high-stress environments showed elevated levels of the stress hormone cortisol. Cortisol has a two-hour half life, leading to a build-up of toxic stress for these children. In conclusion, the presenters shared a song by Cookie Monster from Sesame Street titled “But Me Wait” as a fun way to teach executive functioning skills to children ( watch?v=9PnbKL3wuH4). The NTI has been renamed the ZERO TO THREE Annual Conference for 2016. Registration is now open for the event December 7-9 in New Orleans, Louisiana.

About the Author Dana Bolton, MEd, MMT, MT-BC coowns Bolton Music Therapy in Murfreesboro, Tennessee, and has worked in the early intervention field for 12 years. Dana joined the imagine editorial team in 2014.



More Than an Event: Extending the Learning National Early Childhood Inclusion Institute Report Petra Kern, Ph.D., MT-BC, MTA, DMtG University of Louisville Louisville, Kentucky

Over 570 participants from 40 states and 3 countries gathered at the sold-out 2016 Early Childhood Inclusion Institute from May 10-12, in Chapel Hill, North Carolina, USA. “This is the biggest event for early childhood inclusion in the world that might affect the lives of children across countries,” said Dr. Samuel Odom, Director of UNC’s FPG Child Development Institute during the opening plenary. Institute Chair Dr. Tracy West and Dr. Pam Winton (Institute Chair Emerita) welcomed professional development providers, practitioners, families, local and state administrators, and policy makers who eagerly heard different voices, perspectives and ideas on inclusion presented in a powerful keynote address and engaging plenary, concurrent, and reflection sessions. In their keynote address “Implementing Science and Family Experiences: Where the Rubber Meets the Road,” Dr. Allison Metz and Dr. Anne Turnbull noted that despite positive scientific outcomes, inclusion practice is not as widely implemented in the U.S. as it should be. The presenters recognized that putting research into effective practice requires a systematic approach of support following four specific stages of implementation: a)

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Exploration (i.e., form team; develop ways of work; establish a communication protocol), b) Installation (i.e., develop team competence; assure resources to support practice), c) Initial Implementation (i.e., troubleshoot and problem solve; use data at each team meeting to promote improvement), and d) Full Implementation (i.e., use improvement cycles; develop test enhancements). Reflecting on research outcomes, historical aspects, and family perspectives, the speakers concluded that besides the involvement of various key stakeholders involved in each of the four stages, a parental voice is crucial in providing a more robust and sustainable change in building partnerships for inclusion. Moderated by Dr. Pam Winton, the first plenary session featured federal early childhood leaders Amanda Bryans, Libby Doggett, and Ruth Ryder. The panelists shared information on three recently released polices: U.S. Department Of Health And Human Services And U.S. Department of Education Policy Statement On Inclusion of Children With Disabilities In Early Childhood Programs U.S. Department Of Health And Human Services And U.S. Department of Education Policy Statement On Expulsion And Suspension Policies In Early Childhood Settings U.S. Department Of Health And Human Services And U.S. Department of Education Policy Statement On Family Engagement From The Early Years To The Early Grades. While referring to additional policy letters and memos released by the Office of Special Education Programs (e.g., RTI Policy Letter; Preschool LRE Policy Letter), the panelists invited participants to ask questions and share perspectives on implementing inclusive practices at the local and state level.


Fifty-three concurrent sessions addressed various inclusion topics, a few of which are spotlighted here. Building upon the keynote address, presenters Laura Louison and Dr. Caryn Ward looked into what it takes to improve outcomes for early childhood and inclusion practice. They introduced the formula, “Effective Practice x Effective Implementation x Enabling Context = Child Outcome” and focused on “It Takes a Village” – one of the four key themes for active implementation of inclusion practice and policies in early childhood. As research demonstrates, “Making It Happen” requires an implementation team (i.e., the village) that provides an accountable and sustainable structure to move an evidence-based practice through the four stages of implementation significantly faster and more effectively. In a session titled “STEM Learning for Toddlers and Preschoolers with Disabilities,” ZERO TO THREE leaders Jodi Whiteman and Rebecca Parlakian playfully engaged participants in children’s thinking about science, technology, engineering, and math. Combining activities with research outcomes, as in the “Paper Clip Challenge,” illustrated divergent thinking abilities at different ages. Powerful “What” questions applied in video examples exemplified how young children can be supported in the thinking process in all four areas. Finally, creative adaptations for children with various disabilities demonstrated that all children can engage in learning basic concepts of STEM. Successful examples shared by the presenters and attendees validated that high quality inclusion of young children with disabilities in preschool settings is possible. “Creating an Inclusive Restorative Garden for Children,” presented by Dr. Nilda Cosco, illustrated natural environments that can support all developmental areas of children of all ability levels. Dr. Deborah Mugno questioned, “Does Nature Always Nurture?” while focusing on children with emotional and behavioral challenges. Both sessions outlined the research-based benefits of outdoor play (e.g., enhanced motor skills, sensory experiences, and social interactions) and invited attendees to think through children’s possible challenges (e.g., “It’s too loud,” “I’m scared of bugs,” or “I don’t know what to do”) and viable solutions for creating a safe physical and emotional experience. Overall, presenters welcomed the new trend of better risk

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management for nature play, allowing children to explore the outdoor environment to its fullest potential while keeping everyone safe. An all-time favorite, presented by Camille Catlett, was “The Right Stuff: Resources to Support the Full Participation of Each Young Child.” Starting with inclusion basics (i.e., Person First Language; Know the Facts; Joint Positions Statement; Joint Policy Statement) and four frameworks for contextual inclusion (i.e., DEC/ NAEYC Definition; Developmentally Appropriate Practice; DEC Recommended Practices; Evidence-Based Practices that Support Inclusion), the presenter introduced numerous annotated resources categorized into evidence sources, print sources, audiovisual sources, and online resources. The selection is an excellent reference list for teaching and professional development purposes that can convince anyone that inclusion is desirable. Overall, the National Early Childhood Inclusion Institute attained its promise of being “More than an Event.” Attendees walked away with the most current information, new policies and guidelines, and a refreshed understanding of the value and benefits of inclusion for young children with disabilities, their families and society at large. Inclusion is not an illusion – it is a human right! To learn more about the speakers and the entire program, visit About the Author Petra Kern, Ph.D., MT-BC, MTA, DMtG, business owner of Music Therapy Consulting, is adjunct Associate Professor at the University of Louisville, serves as editor-in-chief of imagine and on CBMT’s Board of Directors. This year, she was an invited speaker at the National Early Childhood Inclusion Institute and presented “All Children Can Make Music: Access, Participation, and Supports in the Outdoor Environment.” Contact:



Jayne M. Standley Robert O. Lawton Distinguished Professor

Colleges of Music and Medicine Florida State University Tallahassee, Florida


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The Challenge Music therapy services for improving developmental outcomes of children encompass a variety of early intervention endeavors. From our historical beginning in institutions for those with developmental disabilities, music therapists have moved into many types of diverse, contemporary, human service agencies. NICU-MTs now provide the earliest possible interventions for premature infants in the Neonatal Intensive Care Unit. Other MTBCs improve medical care for pediatric patients; provide infant stimulation, early intervention, and parent training; co-treat with speech and physical therapists in developmental clinics; specialize in pediatric palliative care; and provide a plethora of other children’s services through burgeoning private practices. Music therapists have initiated jobs in these areas, but the profession is still struggling at the national level to achieve the status of being considered a necessary and established program component. Unfortunately, music therapy still develops jobs within one agency and location at a time. It is time to elevate the national perception of music therapy for children – its neuroscience potential, its developmental benefits, its clinical competence, its research and clinical creativity, its programmatic NECESSITY for improved childhood development.

Consortium Announcement We have formed a consortium of specialized music therapy experts and researchers called the international Music Therapy Children’s Advocacy and Neurodevelopment Network (MTCANN). Included here is a chart that shows the array of affiliated universities and hospitals and a directory of MT-BCs committed to the consortium. Our primary goals are: to improve care and welfare of children by disseminating accessible, evidence-based information and assistance through web-based tools and social media. to generate sustained research on selected topics with multi-site studies, replication, clinical

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applications, and cost-benefit analyses conducted by individual researchers or like-minded persons forming coalitions. to identify and support focused lines of research across diverse clinical areas. to develop a national clinical database by patient area. to create evidence-based procedural manuals, curricula, and training programs that fit service delivery models of specific agencies (e.g., medical, developmental, palliative) addressing patient problem, evidence-based music therapy procedures, methods for implementing procedures, expected outcomes, and cost-benefit analyses of clinical use. imagine will be the primary resource for disseminating evidence-based information created by the consortium among organizations, music therapists, other professionals, parent and client groups, and anyone who wishes to learn more about what we have to offer. Additionally, we envision a wealth of electronic resources generated by the consortium including books, continuing education training programs, certificates in specialty areas of music therapy, blogs, and research materials.

Additional Affiliations In order to raise national awareness and recognition of the benefits and necessity for music therapy in developmental programs, we will also seek affiliation with parent groups, advocates, and other professions and non-profit organizations with similar interests. We will link our websites and publications with these groups for the widest possible dissemination of information. We will also assist international music therapy programs with development and training in our specialty areas. The various universities in the consortium have already established affiliations with programs in the United Kingdom, Japan, Spain, Thailand, Poland, Germany, and China and will develop further international liaisons.


Collaborating Universities, Institutes, Hospital Affiliations, Organizations, and International Liaisons Florida State University National Institute for Infant and Child Medical MT Hospital Affiliations: Tallahassee Memorial Hospital, Florida Hospital, Wolfson’s Children’s Hospital, Yale-New Haven Children’s Hospital, Vanderbilt Kennedy Center, Nationwide Children’s Hospital Organizations: Preemie Parents Organization International Liaisons: United Kingdom, Japan, Spain

West Virginia University Hospital Affiliation: TBA International Liaison: Thailand

University of Louisville Hospital Affiliations: Norton Healthcare, UofL Hospital, Kosair Children’s Hospital International Liaisons: Poland, Germany

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Drury University Hospital Affiliation: Cox South Hospital

University of Alabama Hospital Affiliation: DCH Regional Medical Center

University of Kentucky Hospital Affiliation: UK Medical Center International Liaison: China


DIRECTORY OF COLLABORATORS Florida State University Jayne M. Standley, PhD, MT-BC, NICU-MT is a Robert O. Lawton Distinguished Professor and the Ella Scoble Opperman Professor of Music at Florida State University. She is the director of the National Institute for Infant and Child Medical Music Therapy and is a NICU-MT researcher. She recently was awarded the first ever research award from the World Federation of Music Therapy (WFMT) for her NICU-MT research. Lori Gooding, PhD, MT-BC, NICU-MT is an Assistant Professor of Music Therapy at Florida State University. Lori is an Institute Fellow whose specialty is medical and mental health counseling. Amy Robertson, MM, MT-BC, NICU-MT developed the Florida Hospital NICU Program in Orlando, Forida, and is currently a doctoral student at Florida State University. She is an Institute Fellow and NICU-MT researcher. Katrina Tabinowski, MM, MT-BC, NICU-MT is the coordinator of the Medical Music Therapy/Arts in Medicine partnership between Florida State University and Tallahassee Memorial HealthCare. Brittany Mohney, MM, MT-BC, NICU-MT is a NICU-MT clinician on the staff of Tallahassee Memorial Healthcare Center. She coordinates the Institute’s hands-on training activities. University of Alabama Andrea Cevasco-Trotter, PhD, MT-BC, NICU-MT is the Director of Music Therapy at the University of Alabama and is an Institute Fellow. She is a NICU-MT researcher and an infant stimulation expert. University of Louisville Darcy DeLoach, PhD, MT-BC, NICU-MT is a former coordinator of the Medical Music Therapy/Arts in Medicine partnership between Florida State University and Tallahassee Memorial HealthCare. She is the Director of Music Therapy at the University of Louisville. She is an Institute Fellow, a researcher in NICU-MT, and an expert in early intervention for children with Autism Spectrum Disorder. Petra Kern, PhD, MT-BC, MTA, DMtG, NICU-MT is an adjunct Associate Professor at the University of Louisville. She is the editor-in-chief of the imagine online magazine published by her company de la vista publisher. She is an expert in early childhood music therapy focusing on Autism Spectrum Disorder, inclusion, and coaching caregivers. Michael R. Detmer, M.M.E., MT-BC, NICU-MT is a lecturer and clinical supervisor at University of Louisville and Norton Women’s and Kosair Children’s Hospital in Louisville, KY. West Virginia University Dena Register, PhD, MT-BC, NICU-MT is the Director of Music Therapy at West Virginia University. She is an Institute Fellow and researcher in early intervention, literacy, and child development. University of Kentucky Olivia Yinger, PhD, MT-BC, NICU-MT is the Director of Music Therapy at the University of Kentucky. Olivia is an Institute Fellow and researcher in pediatric medical interventions. Lorna Segall, MM, MT-BC, NICU-MT is a doctoral candidate at Florida State University who assists with clinical training in NICU music therapy and who will be an assistant professor of music Therapy at the University of Kentucky beginning Fall 2016. She is an Institute Fellow and expert in training music therapy students for NICU-MT. Jennifer Peyton, MM, MT-BC, NICU-MT is an Institute fellow and clinician at the University of Kentucky Medical Center. She is an expert on neurodevelopmental enhancement of premature infants. Jessy Rushing, MM, MT-BC, NICU-MT is the Director of the Clinical Music Therapy Program at the University of Kentucky Medical Center. She is an expert on reimbursement in music therapy and is a doctoral student at the University of Kentucky. Katherine Goforth, MM, MT-BC, NICU-MT is an Institute Fellow and a clinician at the University of Kentucky Medical Center. She developed the NICU-MT program at Wolfson’s Children’s Hospital in Jacksonville, Florida. Drury University Natalie Wlodarczyk, PhD, MT-BC, NICU-MT is the Director of Music Therapy at Drury University. She is an Institute Fellow and researcher in hospice/palliative care. Yale New Haven Medical Center Judy Nguyen Engel, MM, MT-BC, NICU-MT is a former Coordinator of the Medical Music Therapy/Arts in Medicine partnership between Florida State University and Tallahassee Memorial HealthCare. She is an Institute Fellow and NICU-MT researcher currently at Yale New Haven Children’s Hospital. Nationwide Children’s Hospital, Columbus, Ohio Ellyn Hamm, MM, MT-BC, NICU-MT is the Senior NICU Music Therapist at Nationwide Children’s Hospital in Columbus, Ohio. She is an Institute Fellow whose research specialty is using music therapy for dealing with infants with neonatal abstinence syndrome and those with special feeding problems. Chiltern Music Therapy, London, UK Rosie Axon, MM, MT-BC, NICU-MT is Managing Director of Chiltern Music Therapy in London, England. She is developing NICU-MT in London hospitals. Angela Vogiatzoglou,MM, MT-BC, NICU-MT is on the staff of Chiltern Music Therapy in London, England. She is developing NICU-MT in London hospitals.

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Past, Present, and Future: Making a Difference Through Music Therapy Marcia Humpal, M.Ed., MTBC Cleveland State University Associate Editor, imagine Olmsted Falls, Ohio

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In my bedroom hangs a lovely sampler, crossstitched by a favorite aunt. It reads, “Children are like snowflakes…each with their own pattern.” This is a simple message, but one that has guided my long career as a music therapist working mainly with those in early childhood. As I reflect back over the years, I realize that much has changed in how society views the young child; yet we have learned from the past and have gained a better understanding of this unique stage called early childhood.

From Historical to Present Views of the Young Child Looking at previous generations, we can see that early childhood was regarded very differently than it is today. In the 18th and 19th centuries, the European influence prevailed. Children were considered to be little adults and were to be seen but not heard. During the early 20th century, the hardships of American life often forced very young children to work, almost eradicating any type of playfulness in their lives. A new baby often did not usher in joy, but instead added a burden in the form of another mouth to feed. By


the mid-twentieth century conditions had improved, and childhood became a more carefree time, yet those of preschool age were philosophically considered to be little elementary school children (Elkind, 1986). In 1965 Head Start was founded, giving some young children a better foundation through improved school readiness skills. By the mid-1980s, educators and policy makers realized that early childhood was a unique and distinct developmental stage (Bredekamp, 1986). In the United States, federal laws and funding supported early intervention programs for young children aged 3 to 5 as well as services for at-risk infants and toddlers. Over the years these laws have been amended, updated and clarified, and changes continue today. As research about early childhood development grew, so did the need for new approaches in early childhood education. In the mid1980s, the National Association for the Education of Young Children (NAEYC) pioneered Developmentally Appropriate Practice (DAP). This philosophy is based on the underpinnings of child development theories and categories of levels of play. It stresses age appropriate practice, provides for all areas of a child’s development and a wide range of interests and abilities, and plans environments to facilitate learning through interactive play with adults, peers, and materials (Bredekamp, 1987).

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Changing viewpoints, laws, and updated information regarding young children have emerged over time. While NAEYC’s definition of early childhood encompasses the ages birth through age 8, wide variations in education and culture make a universal definition of the term impossible. In the United States, the age range is more accurately described as birth through age 5 due to regulations specified in federal legislation, increasing educational demands and accountability. In 2009, NAEYC added updated guidelines for DAP, to further promote meeting the needs of children of all abilities. These most recent revisions require meeting children where they are and enabling them to reach goals that are challenging yet achievable, call for reduction in the achievement gap, endorse a comprehensive, effective curriculum, and stress improving teaching and learning (Copple & Bredekamp, 2009). More indepth information and online resources may be accessed at positionstatements/dap. In the latter part of the 20th and into the 21st century, many early childhood organizations (e.g., the Council for Exceptional Children and its Department of Early Childhood, ZERO TO THREE, and the International Society for Early Intervention) incorporated evidencebased practices that supported the varied needs of young children. These organizations developed mission statements and determined effective practices for early childhood settings. Many noted the highly motivating aspects of music for this age group.

From Early Childhood and Music to Early Childhood Music Therapy Embracing the overall missions and visions of these organizations, several early childhood music organizations and subcommittees of established national music associations surfaced. Early childhood music teaching approaches such as Kindermusik®, and Music Together® became popular; others based on the teachings of Orff, Kodaly, Dalcroze, and Suzuki captured the attention of parents as well as music professionals. Independent teachers and music therapists addressed distinctive needs of the children and families they served by developing their own eclectic programs for young children. For spotlighted examples see the infographic in the programs section of this edition of imagine.

Interest in early childhood music was growing, and in 1993, publicity surrounding a study by Rauscher, Shaw, and Ky caught the world by storm. The authors proposed that listening to classical music might improve spatial-temporal reasoning. Many in the general public drew the oversimplified conclusion that music can make one smarter. The issue, dubbed “The Mozart Effect,” became highly controversial yet yielded vastly increased interest in


how the brain processes music. Neuroscientists soon began to seriously study the effects of music on the brain and research helped unlock some of its mysteries as well as implications for and benefits of using music to facilitate learning, especially during the formative early childhood years (Rauscher, 1996; Brown, 2013). My experience with early childhood music therapy began in 1989 with an assignment that required me to specialize in working with young children. In preparation, I decided to research trends in early intervention preschool programs and how music therapy was being utilized in these settings. At that point, very little could be found about this population. In the 1970s, Cartwright and Huckaby (1972) had written about using music in a preschool language program. Others reported using music to help with body part identification for young children with hearing impairments (Galloway & Bean, 1974). By the 1980s, researchers had employed music as a stimulus and contingent reward for spontaneous speech (Harding

& Ballard, 1983), advocated for music therapy for infants and parents (Witt & Steele, 1984) and stressed how improvised musical play could teach social skills (Gunsberg, 1988). Though studies also focused on enhancing cognitive development, motor development, communication and social integration via music, they did not reference specific age parameters. Equally important, little had been written about music’s potential for educating the young learner with special needs. This prompted me to reflect in Music Therapy Perspectives (Humpal,

those of early childhood age in settings such as hospitals, schools, and within the community.

1990) that there was a very real need for more research concerning the use of music therapy in the realm of early intervention programming. I also envisioned then that “music mainstreaming could offer much promise for the development of integrated programs fostering interactions and sensitivity to, and acceptance of, individual differences” (Humpal, 1990, p. 34). Soon thereafter, specific studies by music therapists

our profession and colleagues were invited to speak at conferences and to be a part of national summit meetings.

Other professionals also began to recognize how music and music therapists could benefit their youngest patients or clients. Collaborative studies across disciplines were reported in journals outside of music therapy circles (e.g., Pediatric Nursing, Young Children, and Music Educators Journal). Society in general sought more information about how music could be used with young children. Media attention began focusing on

After attending the World Congress of Music Therapy in Washington, D.C., in 1999, an official from Sesame Workshop™ requested that music therapy be represented in its symposium on music and young children. Two music therapists traveled to New York City and met

POINTS TO PONDER Early intervention is key. Everyone can be successfully included in music. Early music experiences must be nurtured by those who know them best. Repetition, repetition, repetition, repetition anchors learning!

gained much attention in medical arenas, especially within Neonatal Intensive Care Unit (NICU) settings (Standley, 1991). Gradually the public began to embrace the value of music therapy specifically for

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with national leaders from many professions and creative writers from Sesame Workshop™. Intense brainstorming sessions generated main messages from this advisory panel that eventually yielded a


product called Music Works Wonders. This resource included a videotape of Sesame Street™ characters making music with young children in various settings, one of which was led by a music therapist working with children with a wide range of abilities (Morris, 2012). The videotape was accompanied by hands-on suggestions for families and early childhood educators. The packet was distributed nationwide at no cost to recipients.

process of meaningful early childhood music making. The influence of music therapists’ input on this summit is evident in the stated tenets that music can be a basic medium for communication, cultural expression, self-expression, cooperation, learning and school readiness; and of paramount importance, music must be encouraged and utilized by those who know the young children the best – their families, caregivers, and early educators (MENC, 2000).

Shortly thereafter, the U. S. Department of Education hosted a summit to examine effective instructional strategies, cultural and socio-economic factors and possible action plans to publicize that research was cementing the connections between music and learning for young children. This meeting evolved into the Start the Music Initiative that created products and spotlighted the

Music therapists made valuable contributions to early childhood and music education, and, conversely, early childhood and music educators expanded the knowledge base of music therapists. Early childhood educators recognized the unique developmental and learning styles of this age group; they knew that these children’s music making experiences should be active and multi-sensory. Through

collaboration with early childhood and music educators, music therapists began to incorporate the voice, instruments, and found sounds into their sessions with young children. Music therapists exposed children to quality music and created their own songs. Most importantly, music therapists presented developmentally appropriate music and engaged those of all ability levels. The American Music Therapy Association (AMTA) has a long history of supporting early childhood music therapy. Its Early Childhood Network (ECN) was founded in 1995 at the national conference of its predecessor, the National Association for Music Therapy. Shortly thereafter, this group initiated an early childhood newsletter that was the precursor to imagine, the publication you are now reading.

MUSIC THERAPISTS WORKING WITH YOUNG CHILDREN SHOULD Understand both typical and atypical development. Help children learn through play. Set children up for success. Engineer the environment–remove distractions from the area. Give children several ways to respond. Use musical transitions. Share music, ideas, and information with families and colleagues. Collaborate.

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For the past several decades, AMTA’s institutes, CMTEs, concurrent sessions, and publications have presented cutting edge research and methodology specific to young children. Currently, 13% of music therapists work with young children (AMTA, 2015). While relatively few music therapy university programs offer courses specifically dedicated to early childhood, continuing education opportunities abound and the internet provides an abundance of information and resources for increasing the knowledge base of those working with early childhood. Music therapists and related professionals are now quite prolific in their research and publication of issues pertaining specifically to young children. In the present decade alone, researchers are exploring such topics as music for preterm infants, the impact of early music exposure and experiences on the brain, music for young children with Autism Spectrum Disorder, and the benefits of early music programs for parents and children (LaGasse, 2013; LaGasse, 2014). Music therapists’ work is being published not only in our own music therapy publications, but also in a broad assortment of other professional journals, both nationally and internationally and in hard and electronic versions. Subjects range from pediatric oncology, NICU advances, attachment and pain management to evidence-based practice, engagement, Autism Spectrum Disorder, family-centered service delivery, early intervention and

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international models (Kern & Millett, 2014; Millett, 2015). Computer programs and apps have become commonly employed tools in statistical evaluation of data for research, record-keeping, and observation, as well as in the provision of musically rich and creative service delivery. Social media and blogs provide information, strategies and music to more people than ever could have been imagined when I first entered the field decades ago. It is indeed an exciting time to be a music therapist. As we move into the future, music therapists have much to celebrate, but an alarming reality is that child poverty has reached record levels (National Center for Children in Poverty, 2014). Across the world major issues confront families and young children. Many are refugees, fleeing oppressive governments, violence, and discrimination. Seeking a better life for their families, they find themselves unwanted and facing an uncertain future. Providing for their children’s basic needs presents an overwhelming burden for families as well as for the countries in which they live. Although international conferences are stressing the necessity of providing safe and nurturing homes as well as accessible and high quality, affordable early childhood education and early intervention services, even in our own nation violence and discrimination continue to fill mass media. Young children cannot be shielded from

this reality. Helping them feel protected and insulated from harm is an ongoing concern of major stakeholders, with future trends appearing to focus on narrowing the achievement gap, universal Pre-K, inclusion, more awareness of and access to technology, universal screening to identify possible delays or challenges early, and provisions for increased child care quality (National Institute for Early Education Research, 2016). Our children have a right to these benefits; it is our responsibility to see that they obtain them. The future holds major implications for music therapists working with young children. Quick access to limitless and immediate research, resources, interventions and music via the internet and social media will prove invaluable for keeping up with the latest valid information. The times will continue to change, but the message will remain the same: young children are our future. Music therapy is the therapy that can reinforce all other therapies and theoretical frameworks. Music therapists have a unique set of skills and a powerful tool – our music. We can help enrich the lives of young children and their families and truly make a meaningful difference in both today’s world and in that of the future. References AMTA. (2015). 2015 AMTA member survey and workforce analysis: A descriptive statistical profile of the AMTA membership. Silver Spring, MD: Author. Bredekamp, S. (Ed.). (1987). Developmentally appropriate


practice in early childhood programs serving children from birth to age 8. Washington, DC: National Association for the Education of Young Children. Brown, L. (2013). The benefits of music education. Retrieved from parents/education/music-arts/ the-benefits-of-musiceducation/ Cartwright, J., & Huckaby, G. (1972). Intensive preschool language program. Journal of Music Therapy, 9(3), 137-146. Coppel, C., & Bredekamp, S. (2009). Developmentally appropriate practice in early childhood programs serving children from birth through age 8 (3rd ed.). Washington, D.C.: National Association for the Education of Young Children. Elkind, D. (1986). Formal education and early childhood education: An essential difference. Phi Delta Kappan, 631-636. Galloway H., & Bean, F. (1974). The effects of action songs on the development of body-image and body-part identification in hearing impaired preschool children. Journal of Music Therapy, 11(3), 125-134.

Gunsberg, A. (1988). Improvised musical play: A strategy for fostering social play between developmentally delayed and nondelayed preschool children. Journal of Music Therapy, 25(4), 178-191. Harding, C., & Ballard, K. (1983). The effectiveness of music as a stimulus and as a contingent reward in promoting the spontaneous speech of three physically handicapped preschoolers. Journal of Music Therapy, 20(2), 86-101. Humpal, M. (1990). Early intervention: The implications for music therapy. Music Therapy Perspectives, 8, 30 35. Kern, P., & Millett, C. (2014). New publications 2013-2014. imagine, 5(1), 126-127. LaGasse, B. (2013). 2013 early childhood research snapshot. imagine, 4(1), 30-33. LaGasse, B. (2014). 2014 early childhood research snapshot. imagine, 5(1), 42-45. Millett, C. (2015). New publications 2014-2015. imagine, 6(1), 132133. Morris, I. (2012). “Sunny Days” for music therapy: Sesame Street

and AMTA share the value of making music with young children. imagine, 3(1), 16-19. MENC. (2000). Start the music. Reston, VA: Author. National Center for Children in Poverty. (2016). Child poverty – a report of the National Center for Children in Poverty. New York, NY: Columbia University. National Institute for Early Education Research. (2016). Early education in the news. Retrieved from news-events/early-educationnews Rauscher F., Shaw, G., & Ky, K. (1993). Music and spatial task performance, Nature, 365, 611. Rauscher, F. (1996). What educators must learn from science: The case for music in the schools. Early Childhood Connections, 2(2), 17-21. Standley, J. (1991). The role of music in pacification/ stimulation of premature infants with low birthweights. Music Therapy Perspectives, 9(1), 19-25. Witt, A., & Steele, A. L. (1984). Music therapy for infant and parent. Music Therapy Perspectives, 1(4), 17-19.

ABOUT THE AUTHOR I am Marcia Humpal. I love working with students as an adjunct faculty member at Cleveland State University and doing clinical work in the Toddler Rock program at the Rock and Roll Hall of Fame. Being associate editor of imagine also keeps me busy! You can contact me at

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Music Therapy: An Overview of the Therapeutic Process Lori F. Gooding, Ph.D., MT-BC Florida State University Tallahassee, Florida

Dr. Lori Gooding is Assistant Professor of Music Therapy at Florida State University. She currently serves as President of the Southeastern Region of the American Music Therapy Association and as a member of the Editorial Board of the Journal of Music Therapy.

What is music therapy? How are children referred to music therapy services? Do music therapists conduct assessments? These are just a few of the questions that parents, educators, and allied health professionals may have when first encountering music therapy in the early childhood setting. This article provides a brief overview of music therapy and outlines the major aspects of the systematic treatment process.


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What is music therapy? Music therapy is an allied health profession in which a credentialed music therapist uses developmentally appropriate music-based interventions to address nonmusical goals in the areas of communication, academic, motor, emotional, social, and sensory (Humpal & Tweedle, 2006). Music therapists use a variety of music therapy techniques such as singing, playing instruments, listening to music, and moving to music to promote change. Music therapists also pair music with other modalities like art, drama, and literature (Humpal & Kern, 2012). Regardless of the specific intervention, music therapists employ music, which is both natural for children and socially appropriate, to meet global, individual, curricular, and/or Individualized Education Program (IEP) goals and objectives (Humpal, 2015). The Music Therapy Treatment Process The music therapy treatment process is systematic, providing structured experiences that meet identified goals efficiently and effectively (Hanser, 1999). Children are first referred to music therapy services by parents, teachers, interdisciplinary team members, physicians, or IEP teams. After Referral, music therapists then a) assess client needs and formulate goals (Assessment), b) plan and implement music therapy intervention (Intervention), c) evaluate and document clinical change (Evaluation), and d) terminate (Termination) (Davis, Gfeller, & Thaut, 2008). Both the client’s diagnosis and history are considered, as are the individual’s level of functioning and needs across multiple domains (American Music Therapy Association & Certification Board for Music Therapists, 2015). Referral Depending upon facility protocols, music therapy referral may occur in a number of ways. In some facilities, children may be referred by teachers, parents, therapists, or other specialists for music therapy evaluation. In this model, children must be determined eligible for services before moving forward with the treatment process. Evaluation is typically associated with IEP-based service delivery and children must meet pre-established criteria. Other models may forgo evaluation and move directly into the assessment process. Again, children may be referred by a wide range of individuals. Finally, formal referrals may not be necessary in programmatic or

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consultative models. Instead music therapists address global developmental needs or work with teachers or specialists to adapt classroom instructional strategies for entire classes. Individualization may still occur, although it is typically more informal. For more information on the referral aspect of the treatment process see the corresponding video.

Assessment The Scope of Music Therapy Practice mandates that music therapists collect systematic, comprehensive, and accurate information to determine if and what type of music therapy services should be provided for clients and evaluate individuals’ responses to interventions (American Music Therapy Association & Certification Board for Music Therapists, 2015). This process of collecting information is known as assessment. Assessment generally falls into one of three categories: a) initial assessment, which is used to determine baseline functioning (i.e., functioning without intervention), b) comprehensive assessment, which is used to determine if services are warranted, and c) ongoing assessment, which is used to evaluate music therapy effectiveness over the course of treatment (Hanser, 1999). During assessment, data are collected using surveys, tests, or other assessment tools, some of which are adapted for use in music therapy and others which are specifically developed to meet site and/or individual needs. Areas assessed typically include a)


motor, b) communication, c) social-emotional, d) academic, and e) responsiveness to music (Chase, 2004), and music therapists are particularly interested in responses related to target behaviors as well as responses that impact how a client will respond to music therapy (Hanser, 1999). One of the primary functions of assessment is to determine relevant and appropriate goals for music therapy intervention. Goals can be both long and short term and are frequently SMART in nature (Specific, Measurable, Attainable, Relevant, and Time based). Music therapists may work as part of multidisciplinary (independent), interdisciplinary (independent with info exchange), or transdisciplinary (integrated and collaborative) teams to design goals that are functional, understandable, developmentally appropriate, and behavioral (i.e., observable). Often, the level of collaboration between the music therapist and the educational team is determined by her or his relationship with the facility (i.e., contract employee, part time, or full time employee). Ultimately, music therapists should be fully integrated into the educational team to ensure maximum input and appropriate goal development (Kern, 2012).

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Intervention In addition to goal development, data collected during assessment are used to plan music therapy intervention. Music therapists must determine appropriate therapeutic strategies, which includes selecting appropriate service delivery models (e.g., direct services) and music therapy experiences that target specific, nonmusical goals and objectives in a developmentally appropriate manner (Wellman, 2011). Strategies selected must a) encourage participation, b) address multiple needs, and c) promote success (Humpal, 2015). Music therapy sessions often follow a structured format based on familiar routines. Sessions are approximately 30 minutes in length and typically start and end with hello and goodbye songs. Most sessions include 9-12 dierent activities; these activities incorporate various music therapy techniques such as singing and playing instruments and are designed with developmental level, musical abilities, and children’s interests in mind (Barrickman, 1989; Gooding, 2013). Interventions are also chosen based on programmatic, thematic, or individual goals and objectives, and specific activities are ordered to promote engagement. The therapist uses behavioral techniques like modeling, cueing, and reinforcement to improve learning (Gooding, 2013; Humpal & Kern, 2012). Group music therapy sessions are common, and the research suggests that group-based early childhood music therapy can promote the development of meaningful communication skills, motor skills and academic/pre-academic skills, and inclusion (Gooding, 2013; Humpal, 2015; Humpal & Tweedle, 2006; Standley & Hughes, 1997). Groups may be inclusive (children with and without disabilities), integrated (one class of children with special needs combined with one class of typically developing children), reverse mainstream (majority of children with special needs and a few children with no disabilities), parent/caregiver and child-based, or specialized (classes specifically for children with special needs) (Humpal, 2004; Kern, 2015). Though group sessions are common, music therapy is also easily adaptable to an individual format, which allows for greater flexibility in meeting individual needs.


Evaluation Once implementation begins, the music therapist evaluates treatment eectiveness and uses the data to make future treatment decisions or recommendations. Music therapists also communicate with other team members and families as well as document progress to support funding for services (Kern, 2012).

Using the goals identified during the assessment phase, music therapists observe and measure progress related to each goal. Music experiences are structured to facilitate data collection, and progress is tracked quantitatively (e.g., number of occurrences, percentages) when possible. More formal evaluation may also occur in the form of annual or bi-annual evaluations. In this case, the initial evaluation used to determine service eligibility may be repeated to determine broader progress. The above evaluation process may be referred to as ongoing assessment. It involves systematic observation of the frequency and duration of target behaviors, a functional analysis of the surrounding conditions, and clinical interpretation (subjective analysis) of the data (Hanser, 1999). Previous music therapy research has identified several formats used for collecting data in early childhood settings including a) checklists, b) behavioral observations, and c) use of standardized assessment tools (Hanser, 1999; Register, 2001; Martin, Snell, Walworth, & Humpal, 2012; Standley & Hughes, 1996).

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Please see the Evaluation video for an example of how evaluation may be incorporated into music therapy intervention. Termination The final phase of music therapy can have a large impact on therapy outcomes. Termination planning and


discharge should, whenever feasible, be an essential part of the music therapy process (Hudgins, 2013). Music therapy services end for a variety of reasons ranging from curricular or schedule changes to personnel changes, but ideally termination occurs when the goal has been met (Kern, 2012). The decision to terminate music therapy services may be reached by the music therapist alone or by an interdisciplinary team. Providing opportunities to reflect on progress is also important, as is incorporating music and providing the opportunity to say “goodbye” (Hanser, 1999; Hudgins, 2013). See the Termination video for more information on the final stage of the music therapy treatment process.

Conclusion Music therapy is highly compatible with a play-based approach; it is collaborative, developmentally appropriate, and designed to meet a wide range of needs simultaneously. Music therapy is also adaptable to group or individual formats and addresses client's IEP based goals. The music therapy treatment process is both systematic and robust; it encompasses assessment, planning, implementation, evaluation, and termination planning. Music therapy can be a valuable part of an early childhood education curriculum and support children's learning in all developmental domains.

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References American Music Therapy Association & Certification Board for Music Therapists. (2015). Scope of music therapy practice. Retrieved from file:///C:/Users/ ldg07c.FSU/Downloads/CBMTAMTA_SoMTP_V6%20(2).pdf Barrickman, J. (1989). A developmental music therapy approach for preschool hospitalized children. Music Therapy Perspectives, 7, 10-16. Chase, K. M. (2004). Music therapy assessment for children with developmental disabilities: A survey study. Journal of Music Therapy, 41, 28-54. doi: 10.1093/jmt/41.1.28 Davis, W. B., Gfeller, K. E., & Thaut, M. H. (2008). An introduction to music therapy theory and practice (3rd ed.). Silver Spring: American Music Therapy Association. Gooding, L. F. (2013). Structuring early childhood music therapy groups. imagine, 4, 54-57. Retrieved from http:// Hanser, S. B. (1999). The new music therapist’s handbook (2nd ed.). Boston: Berklee Press. Hudgins, L. (2013). Closing time: Clients’ shared experiences of termination of a music therapy group in community mental health. Qualitative Inquiries in Music Therapy, 8, 51-78. Retrieved from http:// QIMT8-3_Hudgins.pdf Humpal, M. (2015). Music therapy for developmental issues in early childhood. In B. L. Wheeler (Ed.), Music therapy handbook (pp. 265-276). New York: Guilford Press. Humpal, M., & Kern, P. (2012). Strategies and techniques: Making it happen for young children with Autism Spectrum Disorders. In P. Kern & M. Humpal (Eds.), Early childhood music therapy and autism spectrum disorders: Developing potential in young children and their families (pp. 162-180). London and Philadelphia: Jessica Kingsley Publishers. Humpal, M., & Tweedle, R. (2006). Learning through playA method for reaching young children. In M. Humpal & C. Colwell (Eds.), Early childhood and school age educational settings: Using music to maximize learning (pp. 153-173). Silver Spring, MD: American Music Therapy Association.


Kern, P. (2015). Inclusion practices in music therapy: Creating a win-win situation for everyone. imagine 6, 40-43. Kern, P. (2012). Collaborative consultation: Embedding music therapy interventions for young children with Autism Spectrum Disorders in preschool settings. In P. Kern & M. Humpal (Eds.), Early Childhood Music Therapy and Autism Spectrum Disorders: Developing Potential in Young Children and their Families (pp. 183-198). London and Philadelphia: Jessica Kingsley Publishers. Martin, L. K., Snell, A. M., Walworth, D., & Humpal, M. (2012). Assessment and goals: Determining eligibility, gathering information, and generating treatment goals for music therapy services. In P. Kern & M. Humpal (Eds.), Early Childhood Music Therapy and Autism Spectrum Disorders: Developing Potential in Young Children and their Families (pp. 79–98).

London and Philadelphia: Jessica Kingsley Publishers. Register, D. (2001). The effects of an early intervention music curriculum on prereading/writing. Journal of Music Therapy, 38, 239-248. Standley, J. M., & Hughes, J. E. (1996). Documenting developmentally appropriate objectives and benefits of a music therapy program for early intervention: A behavioral analysis. Music Therapy Perspectives, 14, 87-94. Standley, J. M., & Hughes, J. E. (1997). Evaluation of an early intervention music curriculum for enhancing prereading/writing skills. Music Therapy Perspectives, 15, 79-86. Wellman, R. (2011). Understanding development in early childhood music therapy. imagine, 2, 61-63.

The music therapy treatment process is both dynamic and purposeful. Each phase—referral, assessment, intervention planning and implementation, evaluation, and termination—plays an important role in facilitating change and promoting progress in the clients, patients, and children with whom music therapists work.

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2016 Early Childhood Research Snapshot Andrew Knight, Ph.D., MT-BC Blythe LaGasse, Ph.D., MT-BC Colorado State University Fort Collins, Colorado

Congratulations to Dr. Blythe LaGasse on her 2015 AMTA Research/ Publications award and to Dr. Andrew Knight on his 2015 AMTA Service Award.

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Early childhood encompasses a variety of diagnoses for music therapists. The research applied to inform evidence-based practice is fairly eclectic. For this research snapshot, the authors searched with two methods to cull research articles that could be applicable for readers looking for an overview of recent publications pertaining to early childhood. First, we directly searched the indexes of music therapy-specific journals: Journal of Music Therapy, Music Therapy Perspectives, Nordic, British, Australian, Canadian journals, and Voices, the online forum for music therapy. Second, we conducted database searches for research in the last year using term groupings including “music therapy,” “early childhood,” “young children,” “special needs,” “special education,” and “music” with the AND or OR operators


depending on the databases, including Google Scholar and Academic Search Premier (EBSCOhost). A total of 127 articles were reviewed for appropriateness and inclusion in the following research review. Four general categories emerged: Music Therapy, Neuroscience, Neonatal Intensive Care Unit (NICU)/Infant, and Early Childhood Education. Parental involvement and understanding of the therapeutic process appeared to be important themes across all of the general early childhood categories. Music Therapy Of the five articles published that included music therapists as authors or in the study procedures, only two were published in music therapy journals in the past year. Yang (2016) investigated 26 mother-child dyads, where the children were 1-3 years old with a diagnosed developmental disability. The forty-minute in-home sessions were focused on five response-teaching strategies and resulted in parent-child synchrony improvements from pre- to post- conditions. The second music therapy-specific journal article also focused on the parent-child relationship, although both papers studied mother-child bonds. Thompson and McFerran (2015) performed a qualitative analysis of the caregiver connection to children 3-6 years old diagnosed with Autism Spectrum Disorder. The semi-structured interviews with 11 mothers reflected on music therapy sessions that included family-centered and improvisational approaches for 16 weeks. The three emergent themes from the analysis were the overall quality of the parent-child relationship, the parent perception of the child, and the parents’ responses to the child. Outside of the music therapy journals, but also focused on the caregiver bond, Jacobsen and McKinney (2015) examined the utility of an assessment tool for cases of emotional neglect of children 5-12 years old. Despite the majority of these ages as outside of a traditional understanding of “early childhood,” the study may help inform our understanding of emotional communication and attunement, which are both central to EC care. The revised tool, the Assessment of Parent Competencies (APC-R) was deemed to be reliable and valid as an observational instrument for music therapists to use in clinical assessment.

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The final two articles in the music therapy category focused on young children on the autism spectrum. Vaiouli, Grimmet, and Ruich (2015) conducted a multiple baseline design with case study on three children in a kindergarten classroom and found weekly 30-minute music therapy groups for nine months resulted in increased levels of focusing on faces, responding to joint attention, and initiating joint attention, all measures of social competence for children on the spectrum. This manualized protocol also included a session outline of greeting song, child-led, adult-led, and goodbye-portions for ease of replicability in future studies. Observations from parents and teachers in the case study seemed to corroborate the notion that improvements for all three children occurred across various settings and trainers. Spiro and Himberg (2016) took a more longitudinal approach in focusing on communication issues in children with Autism Spectrum Disoder who were 4-5 years of age at the start of the study. In five client/ therapist pairs, the researchers examined variables on video such as facing, moving in the room, pulse, and musical structure during sessions, and found that “shared pulse” (both individuals making music with nearly simultaneous dominant beats, also called mirroring or matching in some improvisation parlance) occupied a small part of overall clinical time. Additionally, questionnaires were given to the therapists repeatedly during the course of the study that helped researchers to understand the therapists’ perceptions of the development of their clients. The authors reiterated the importance for this population of therapeutic change as a function of rapport with the therapist. It seems that this research methodology may be the start of a new system for capturing data when working with young children in particular. Neuroscience Although the neuroscience literature is continuing to grow rapidly with young child populations, translational research in this area is still in its infancy. It is incumbent upon music therapy practitioners to have a baseline of neurological understanding in order to use new research articles to benefit current clientele. Three articles in particular seem appropriate for the current discussion.


Moreno and colleagues (2015) compared short-term training between music and French language lessons and found lasting functional brain changes. In 36 monolingual, English-speaking children between 4-6 years of age, event related potentials (ERP) and electroencephalography (EEG; both are ways of measuring brain activity) resulted in increased amplitude to both stimuli in pre-, post-, and one year follow ups for vowel tones and piano tones. One suggestion from the authors was that this finding furthers a theory that there is a bi-directional link between language processing (learning a new language, in this case) and musical processing (twenty days of two 1-hour sessions per day). The second neuroscience article also focused on musical training, this time with 3-5 year-old children, as it relates to selective auditory attention (Strait, Slater, O’Connell, & Kraus; 2015). While the study compared three age groups (young children, school-aged, and young adults), no differences were found in preschoolers’ selective attention on cortical response variability. Musical training, in this case, was a minimum of 12 months of a Kindermusik® or Orff-based early childhood music and movement program. The authors noted that there were differences between preschool musicians versus nonmusicians. The musician group showed heightened attentional effects on auditory-evoked response variability over the prefrontal cortex, a formative part of early childhood brain development. Future research might help us learn whether this is a reflection of innate dispositions or training-related malleability of brain networks in early childhood. Another study completed by Zhao and Kuhl (2016) investigated how a music intervention would impact neural activations to music and speech in 9-month-old infants. The researchers recruited 47 infants from English-speaking families. Infants were randomly assigned to a play or music group. The music group targeted temporal learning of triple meter and incorporated many elements of early childhood music classes with motor activity, social engagement, and repetition. Infants in the play group also participated in experiences that involved social interaction, motor activity, and repetitive experiences; however, without music. Infants were involved in twelve 15-minute sessions held over four weeks. Following completion of

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the intervention, the infants’ cortical responses to changes in the temporal structure of music and speech were recorded using EEG. When compared to the play group, infants in the music group showed significantly larger responses in the auditory and prefrontal regions for both music and speech stimuli. These results suggest that even at 9 months of age music may aid in learning temporal structure of stimuli. Neonatal Intensive Care Unit/Infant The area of NICU research continues to explode in popularity as the variety of research methods and techniques is disseminated. Although not as often published in music therapy journals, a majority of articles seem to include music therapists as authors and/or interventionists. These six articles highlight the variability of methodologies and techniques being used in the field while also reiterating the importance of working with the infants’ caregivers. Music during painful procedures, like venipuncture, creating songs of kin, and sound levels are of primary importance in these studies. Shoemark, Hanson-Abromeit, and Stewart (2015) provide an overview of optimizing the newborn experience in the NICU, explaining how music therapists play a critical role in designing the soundscape for these delicate environments. Their article concludes with a well-laid out hypothetical case scenario on how to use music to mask environmental sounds that are unwanted, while increasing various musical stimuli based on characteristics such as tempo changes, consonance, melodic contours, avoiding harmony, and using lower pitches generally for very young ears. Timmons (2015) also studied sound levels in her thesis and found NICU levels can often supercede the 45dBA threshold for environmental stimuli (Shoemark Hanson-Abromeit, and Stewart, 2015 mentioned 50dBA for music levels, by comparison). Regarding music for discomfort in newborns, two studies suggest music should remain an indicated treatment option. Moran and colleagues (2015) randomized 26 infants to a traditional respiratory physiotherapy condition or an experimental condition who heard three minutes of classical music before the therapy began. While they found no differences for heart rate or oxygen saturation levels, the inclusion of music accounted for


30% of variation in respiration rate frequency. Overall, the infants who were in the experimental condition retained a lowered respiratory rate during and after the physiotherapy procedure. These are cautious findings, since they did not incorporate a therapeutically relevant application of music, found significant results in only one of the three conditions, and used a fairly small sample size. Another study focusing on lullaby singing for infants amidst discomfort in the Nordic Journal of Music Therapy demonstrated a unique way to assess infants via a case study with microanalysis (Ullsten, Eriksson, Klässbo, & Volgsten, 2016). Two infants were studied via minute video recordings taken of directed lullaby singing. The musical stimuli took place for 2.5 minutes after two minutes of silence, during the preparations and venipuncture, and for 2.5 minutes after the procedure. This was the musical intervention, while standard care during venipuncture was the control situation, recorded for analysis. The two preterm infants were enrolled in the study between 4-5 weeks of age. Both babies showed “more stable and regular patterns throughout the procedures compared to the procedures with standard care only” (p. 15). This study reminds clinicians of the importance of continuous assessment during live singing toward the goal of homeostasis for preterm babies. The protocol for Ullsten and colleagues’ research was inspired by Joanne Loewy’s work, particularly her notion of “song of kin,” which is the final featured article in this section (Loewy, 2015). This paper details data from 272 neonates in 11 NICUs over three years around the US. The notion of “song of kin” is meant to reflect a cultural heritage and preferences of the infant’s parents, singing in the vocal range of a parent and educating them on how to engage musically with their children, ultimately personalizing the music psychotherapy treatment for the whole family unit. Three live interventions were randomized (song of kin versus “Twinkle, Twinkle Little Star”) over two week periods for babies with issues that are most commonly occurring in the NICU: Sepsis, SGA (small for gestational age), and respiratory distress. Parents who sang resulted in infants with positive outcomes for heart rate response across all three diagnoses, and

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song of kin resulted in significantly higher caloric intake and sucking rate compared to “Twinkle, Twinkle Little Star,” which seemed to elicit better oxygen saturation. Notably, parental stress was significantly reduced pre to post lullaby. Early Childhood The final area includes a study that, while including music as activities with young children, does not have a direct tie for music therapists. Implications for clinicians, however, may be drawn from the findings. Williams and colleagues conducted a longitudinal study in a two stage clustered design from a sample of 3,031 Australian children from the ages of 2-3 years until they were 4-5 years of age. Parents of the children reported the home musical activities over the time period of the study. Teacher report and direct testing were also used to compare home musical activities to shared book reading. They found a small significant partial association on children’s vocabulary, numeracy, attention, prosocial skills, and emotional regulation. Parents who shared more musical experiences compared to book reading also reported fewer behavioral problems. From these two studies, music therapists might consider a more in-depth analysis of the culture of music in their locales and a better understanding of how parents and caregivers shape the microculture of young children’s musical experiences. While the literature in It is important to continue to early strive for implications and childhood applications of these findings in music our work as music therapists. continues to expand and fascinate scholars as to the importance of music in many aspects of one’s early years, it is important to continue to strive for implications and applications of these findings in our work as music therapists. Clinicians should continue to pursue research at their own level of expertise and partner with more experienced scholars to build the evidence base with both breadth and depth in order to improve our approaches and techniques using a stimulus as powerful as music.


References Jacobsen, S. L., & McKinney, C. H. (2015). A music therapy tool for assessing parent–child interaction in cases of emotional neglect. Journal of Child and Family Studies, 24(7), 2164-2173. Loewy, J. (2015). NICU music therapy: Song of kin as critical lullaby in research and practice. Annals of the New York Academy of Sciences,1337(1), 178-185. Moran, C. A., Cacho, R. D. O., Cacho, E. W. A., Sousa, K. G., Souza, J. C. D., Fonseca Filho, G. G. D., & Pereira, S. A. (2015). Use of music during physical therapy intervention in a neonatal intensive care unit: A randomized controlled trial. Journal of Human Growth and Development, 25(2), 177-181. Moreno, S., Lee, Y., Janus, M., & Bialystok, E. (2015). Short‐term second language and music training induces lasting functional brain changes in early childhood. Child Development, 86(2), 394-406. Shoemark, H., Hanson-Abromeit, D., & Stewart, L. (2015). Constructing optimal experience for the hospitalized newborn through neuro-based music therapy. Frontiers in Human Neuroscience, 9, 487. doi: 10.3389/fnhum.2015.00487 Spiro, N. & Himberg, T. (2016). Analysing change in music therapy interactions of children with communication difficulties. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1693), 1-11. doi: 10.1098/rstb. 2015.0374 Strait, D. L., Slater, J., O’Connell, S., & Kraus, N. (2015). Music training relates to the development of neural mechanisms of selective auditory attention. Developmental Cognitive Neuroscience, 12, 94-104. Thompson, G. & McFerran, K. S. (2015). “We’ve got a special connection:” Qualitative analysis of descriptions of change in the parent–child relationship by mothers of young children with autism spectrum disorder. Nordic Journal of Music Therapy, 24(1), 3-26. Timmons, S. L. (2015). The effects of music therapy and its impact on sound levels in the neonatal intensive care unit. Theses and Dissertations—Music. Paper 49. Dissertations--Music. Paper 49. http://

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Ullsten, A., Eriksson, M., Klässbo, M., & Volgsten, U. (2016). Live music therapy with lullaby singing as affective support during painful procedures: A case study with microanalysis. Nordic Journal of Music Therapy, 1-25. doi: 10.1080/08098131.2015.1131187 Vaiouli, P., Grimmet, K., & Ruich, L. J. (2015). "Bill is now singing:” Joint engagement and the emergence of social communication of three young children with autism. Autism, 19(1), 73-83. Williams, K. E., Barrett, M. S., Welch, G. F., Abad, V., & Broughton, M. (2015). Associations between early shared music activities in the home and later child outcomes: Findings from the longitudinal study of Australian children. Early Childhood Research Quarterly, 31, 113-124. Yang, Y. (2016). Parents and young children with disabilities: The effects of a home-based music therapy program on parent-child interactions. Journal of Music Therapy, 53(1), 27-54. Zhao, T.C., & Kuhl, P. K. (2016). Musical intervention enhances infants' neural processing of temporal structure in music and speech. Proc Natl Acad Sci., 113(19), 5212-7. doi: 10.1073/pnas.1603984113. About the Authors Blythe LaGasse, Ph.D., MT-BC is Associate Professor and Coordinator of Music Therapy at Colorado State University. She is also the founder of the Music Therapy Research Blog, a resource aimed at helping music therapy clinicians maintain an evidence-based practice. Contact: Andrew Knight, Ph.D., MT-BC is Assistant Professor of Music Therapy at Colorado State University and a Music Together Within Therapy provider for early childhood music and movement. Contact:


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Music Therapy Students’ Perceptions of Arts in Medicine Service Learning in a Pediatric Unit


Dianne Gregory M.M,. MT-BC Florida State University Tallahassee, Florida

Dianne Gregory M.M,. MT-BC is Associate Professor in the Music Therapy Program in the College of Music at Florida State University in Tallahassee, Florida. Contact:

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Community service is emphasized in high schools and colleges, not only as a civic responsibility, but as a way to try out the “real world” of possible career paths. Volunteering in a pediatric unit in a hospital, for example, is an excellent way for music therapy students to help nurses and hospital staff members and at the same time gain experience working with children in a medical setting. What can students learn about patients and themselves in pediatric units when engaging in the Arts in Medicine Service? Is this information beneficial to music therapy educators? Arts in Medicine Service (AIMS) courses provide all college students with opportunities to volunteer in hospitals and interact with patients of all ages and medical situations. Reflections of music therapy students engaged in AIMS’ self-directed


experiential service learning as pediatric unit volunteers provide some insight into possible benefits. What do they find enjoyable, challenging, and valuable? What do they learn about themselves? What do they learn about children? Does the experience have any impact on their future plans? Do the reflections correlate with expectations of students’ participation in more structured systematic goal-directed music therapy practica? Background An Arts in Medicine Service learning course at Florida State University (FSU) provides an opportunity for all students in all majors to volunteer in an Arts in Medicine (AIM) program in a general hospital (Gregory, 2005; Gregory, 2014). AIMS is a required course for undergraduate music therapy majors but an elective for all university students. A board-certified music therapist on the medical music therapy (MMT) staff at the hospital organizes the AIM program and oversees community and college volunteers. The music therapist collaborates with the FSU supervisor of the AIMS course who structures the course’s academic requirements for college volunteers. Students select units and maintain a weekly schedule in the same units for the semester. Most students volunteer for two hours per week for one credit hour; the maximum is six hours a week for three credits. Students visit patients in their rooms to offer distracting conversation and appropriate passive non-music recreational activities. In the pediatric unit, volunteers also supervise activities in the playroom. Students with music performance expertise can also opt to perform music once a week in one of the public venues in the hospital. Performance is an additional requirement for music therapy majors. The pediatric unit and selected adult units (oncology, cardiology, neurology, internal medicine, and diabetes) are available to all students, regardless of academic major. Students’ unit selection is based on a first-come, first-served basis after completion of hospital clearance procedures and receipt of the official badge that allows them to enter patients’ rooms. The majority of students opt to volunteer in the adult units because there are more opportunities and the schedule is more flexible. The pediatric unit is relatively small and offers only two or three openings each semester with predetermined

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schedule possibilities. Each semester, pre-med, psychology and child life majors interested in working with children vie for the open positions with music therapy majors also interested in the pediatric unit. Some students volunteer in both adult and pediatric units, if available. Method At the end of the semester all students submit a final reflective written assignment structured around open ended questions. The assignments of music therapy majors who completed all of their AIMS volunteer hours in the pediatric unit during the last 4 years (N=25) were collected. The group included seven sophomores, eight juniors, seven seniors, and three equivalency-graduate students. Only three students - a junior, a senior, and an equivalency-graduate student - reported what could be considered extensive previous experiences working with children; the majority of students could be considered novices. Answers to the first six questions of the students’ final assignments were categorized to provide general information. The purpose was to summarize music therapy students’ perceptions of selfdirected experiential learning with children to determine if their perceptions were positive, personally rewarding, and correlated in any way with expected outcomes of the more structured and systematic goal-oriented preinternship practica with children included in music therapy curricula. In essence, is volunteering in a pediatric unit through an AIMS course an effective learning opportunity for music therapy students? Most of the students included a single response in their paragraph answers to the open ended questions. A few paragraphs included more than one discrete answer resulting in totals greater than 25 answers for each question. The questions and summary of answers are provided below. Examples of students’ responses are provided in some cases to illustrate the variety of responses within summaries. Results


What was the most enjoyable part of your experience at the hospital? Answers to the enjoyment question (N=28) included being able to interact


with children (64%), learning skills for working with children (14%), and performing in public venues (17%). Interaction enjoyment responses included personal references (“being able to make children smile”) and patient-oriented references (“seeing reactions of kids after playing with them”). An example of a skill-learning enjoyment reply was “learning different skills to work with different personalities like shy, outgoing, or energetic children.” What was the most challenging part of your experience? Answers to this question (N=26) included completing assigned tasks and responsibilities (61%), interpersonal skills (23%), and affective reactions (15%). Specification of tasks and responsibilities in the answers included learning the routine, remember the codes, finding activities for teenage patients, being the only person in charge of the playroom at night, and working with children who did not want to cooperate. Interpersonal challenges included replies such as “being shy in front of parents who joined their children in the playroom,” “building rapport with the staff to receive adequate referrals,” “constantly being around new people,” and “trying to stay neutral without facial expression when listening to family predicaments.” Affective challenges included responses like “seeing pain in children” and “seeing so many children hurt and sick.” One of the affective responses mentioned “handling my fear of hospitals.”


What was the most valuable part of your experience? Answers to this question (N=37) included practicing interpersonal skills (49%), experiencing the hospital setting (27%), and learning what was expected (24%). Examples of interpersonal skills included “growing more comfortable in my own skin,” “being forced to be an extrovert,” and “becoming impervious in my reactions to physical deformity.” Hospital setting replies included “learning basic inner working of a hospital” and “learning about different reasons children are in a hospital.” Articulation of


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learning expectations included “learning to take initiative on programs that needed implementing,” “realizing my role of distraction,” and “learning how to work with the child life specialist.” What did you learn about yourself personally? Answers to this question (N=33) included task-related replies including interpersonal skills (56%) and replies referring to affective responses (43%). “I found out what to say to parents and kids to help them let me make a difference,” “supervising the playroom reminded me I need to keep my patience in check,” and “had to censor certain things I said when with patients” are examples of task-related replies. Positive replies referring to general interpersonal skills included “I learned I know what I am doing and should be confident with interactions” and “I can be more outgoing than I originally believed.” Only one reply was stated negatively, “I am not good at persuading people to do things if they do not want to.” Examples of affective replies included “I have an extreme amount of sympathy and emotional sensitivity,” “how energizing it can be to care for someone else’s need instead of my own,” and “truly enjoy brightening another’s day; it felt good to help others.” Other replies indicate introspective reflections like “My confidence needed a big boost before I was able to feel comfortable,” “I take things too personally sometimes and shouldn’t be offended by anything,” and “I need to have a tougher skin.”


What, if any, impact did your experience have on your future plans? Although any response is a positive answer according to traditional careerrelated service learning objectives, the replies of the music therapy AIMS volunteers (N=35) were categorized and tallied as positive and negative reactions to three distinct possibilities: Working in the hospital setting (40%), working with children (40%), and pursuing the music therapy degree(20%). Within the setting statements, 71% were positive, e.g., “thinking of



hospital as a possible internship or career site.” Examples of negative statements include “do not want to work in a hospital,” and “passions for music therapy lie outside the hospital setting.” Responses related to working with children were positive (93%) and included statements like “it solidified the fact that I want to work with kids in some way or another” and “confirmed I want to work with babies and children.” Of the seven responses referring to pursuing the music therapy degree, 70% were positive (“even more excited and anxious to enter the field of MT”). One of the two responses considered negative, “I am still not sure if music therapy is what I want to do,” indicates continued hesitation, perhaps, instead of certainty. Discussion Generally speaking, music therapy students reacted positively to multiple facets of their AIMS experience in the pediatric unit. The large majority reported they enjoyed working with children and learning interactive skills compared to performing weekly in the public venues. The large majority reported completing tasks and learning interpersonal skills as the most challenging parts of the experience. Half of the group also said that practicing interpersonal skills was the most valuable part. Replies also suggested that, upon reflection about what they learned about themselves, the focus was on interpersonal skills, in general, and very personal affective reactions to working with children in a hospital setting. Unstructured self-directed experiential learning also allows students to learn about other people - family, visitors, and hospital staff - through observation and interactions. Their reported conclusions about children in hospital settings were practical and for the most part useful possible predictors of behaviors of young children and parents in future medical and non-medical settings. Impacts of the course on their future plans were highly positive and career-related either by setting, population, or pursuit of the music therapy degree. Conclusion Do students’ perceptions about participation in AIMS in a pediatric unit match expectations of students’ participation in more structured systematic goaldirected music therapy practica? The expected

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outcome of music therapy practica with supervision is that students can design and apply intervention skills with music to reach non-musical goals with children. This is obviously lacking in the AIMS experience, but it is apparent from the findings of this analysis that students confront, learn, and expand prerequisite interpersonal skills that expedite learning in music therapy practica and clinical internships. Being allowed to interact with children in an unstructured hospital play environment also provided a realistic perspective of possible behaviors that could be predicted in future structured interventions in medical and non-medical settings. It could also be argued that any learning experience that allows students to experiment with new populations and settings also functions as an effective self-screening mechanism to make future personal decisions more reality-based. References Gregory, S. D. (2014). Arts in Medicine. In L. F. Gooding (Ed.), Medical Music Therapy (pp. 59-74). Silver Springs, MD: American Music Therapy Association. Gregory, S. D. (2005). Arts in Medicine service learning course: Design and university student perceptions. In J. M. Standley et al. (Eds.), Medical Music Therapy: A Model Program for Clinical Practice, Education, Training, and Research (pp. 11-30). Silver Spring, MD: American Music Therapy Association.

"Impacts of the course on their future plans were highly positive and career-related either by setting, population, or pursuit of the music therapy degree."



Mothers’ and Fathers’ Perceptions of Music Therapy for Their Hospitalized Child: A Survey Study Molly Moses, M.M., MT-BC Florida State University Tallahassee, Florida

Admission to the hospital can be a highly stressful time for children and their families. Music therapy may be implemented to reduce anxiety, help the child express himself/herself, and alleviate pain, among other goals. Parental opinions of services provided for children are typically obtained only from mothers, but it may be helpful for staff to know both parents’ expectations and experiences. Mothers and fathers interact differently with their child, so it is necessary to gather information from both mothers and fathers. This survey study examined the perceptions of mothers and fathers whose child received music therapy. Although both parents tended to rate music therapy highly, mothers were more likely to be knowledgeable of services and of what occurred in the sessions, while fathers were less likely to be aware that their child received music therapy and more likely to trust the mother’s opinion. Findings suggest further research is necessary to more completely understand how parental gender differences affect perspective. Parents are viewed as reliable informants of their child’s behavior and tendencies (Achenbach, McConaughy, & Howell, 1987). Although many studies have addressed the accuracy of parent reports, the majority of this research uses the term “parent” while most of the information comes only from mothers. Parents and healthcare professionals tend to perceive mothers’ perceptions as the most accurate identifier of the child’s emotional and behavioral problems (Loeber, Green, & Lahey, 1990), and fathers’ opinions have only recently been given the same consideration as mothers’. Although on some assessments mother and father inter-rater reliability is high,

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there are certain differences between how mothers and fathers perceive their child. Cepanec, Lice, and Simlesa (2012) found that mothers are likely to rate the child’s misbehavior as more frequent, but fathers are likely to rate problems as more severe. Fathers are more likely to report hyperactivity and conduct issues than do mothers. Mothers are more likely to report and focus on one behavior, while fathers tend to identify two or more. The success of child programs often depends on support from parents. Parent acceptability is correlated with improvements in child behavior and actions (MacKenzie, Fite, & Bates, 2004) as well as long-term sustainment of those improvements (McMahon & Forehand, 1983). Although there are several factors that influence parent satisfaction with programs, overall, fathers tend to report less acceptability of their child’s services than do mothers (Brannan, Sonnichsen, & Heflinger, 1996). Studies have also found a positive correlation between length of treatment and satisfaction for both mothers and fathers (Gaston & Sabourin, 1992). Contrary to previous beliefs, research shows no correlation between father involvement and treatment acceptability (Tiano, Grate, & McNeil, 2013). The purpose of this study was to examine, evaluate, and compare the opinions of mothers/female caregivers and fathers/male caregivers whose child has received music therapy services in the medical setting. The outcomes may provide knowledge for music therapists and medical staff to help better understand the families with whom they work. Method Participants Participants consisted of 54 parents (44 mothers and 10 fathers) of children hospitalized at a large Midwestern children’s hospital between 2013 and 2014. Instrument Design A 24-items questionnaire was developed by the author and pre-tested by two music therapists and a university professor. The survey addressed parental demographics, knowledge of their child’s music therapy services, perception of services, and a comment section.

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Procedure Upon Institutional Review Board approval, 475 eligible participants were contacted via telephone by the author.   All participants who provided an email address (n = 195) received access to the Qualtrics survey system and preceding consent form as well a link to opt-out of the survey. 

Results Participants were asked to rate a series of questions regarding music therapy their child received. For the statement “my child enjoyed music therapy,” most mothers (85%) chose either “strongly agree” or “agree,” while 15% selected “not applicable” or “neutral.” Seventy-eight percent agreed/strongly agreed that music therapy helped to reduce their child’s anxiety, and 55% felt it reduced their child’s perception of pain. Eighty-five percent of mothers agreed/strongly agreed that music therapy was beneficial for their child, and 86% believed that their child responded positively during music therapy. Seventy-percent agreed/strongly agreed that their child continued to respond positively after music therapy. When addressing enhancement of coping skills, 76% strongly agreed/agreed. Almost two-thirds of the mothers did more music at home since receiving services. Sixty-eight percent of mothers would want music therapy for their child again in the future, if applicable. Eighty-nine percent of mothers were present for at least one session, and 68% participated. The next questions addressed the influence of music therapy services on participants’ view of the hospital. Seventy-six percent of mothers were more likely to recommend the hospital to other families because of their music therapy program; 65% felt that music therapy increased their overall satisfaction with the hospital. Eighty-one percent felt the number of sessions was adequate, though 12.5% disagreed/strongly disagreed; this was the only statement for which a mother selected “strongly disagree.”


Participants were given the option to leave a comment before exiting the survey. Twelve mothers left comments, including: “music therapy was so wonderful,” “the only thing that helped comfort him was music therapy,” “even in her short stay, the music therapy significantly improved her mood (mine too!). She still talks positively about the music therapy session almost a year later… we have used music to help her learn/concentrate, express her emotions,” “it was a joyous experience,” and “there was still something incredibly special about my toddler's ability to connect with a masked stranger through music, when she was absolutely terrified of anyone else. The session offered my child control (she loved telling the music therapist what to play and watching her requests be honored) and helped ease her into a much needed nap.”

Ten fathers returned completed surveys. Eighty percent of participating fathers had a child age 2 or younger at the time of hospitalization, and 70% reported their child’s hospitalization was for longer than 1 month. When asked how many music therapy sessions their child received, 50% said five or more, while 10% selected “I did not know my child received music therapy.” Fifty percent of fathers were present for one or two sessions; 20% of fathers were not present for any sessions. Sixty-percent did not participate. Ninety percent of fathers believed their child enjoyed music therapy. Eighty percent of fathers agreed/strongly agreed that music therapy was effective at reducing anxiety; 40% of fathers reported that music therapy helped alleviate their child’s pain. Eighty percent of fathers felt music therapy was beneficial for their child, and 70% said their child responded positively during music therapy. For the statement “music therapy helped my child cope better,” sixty percent agreed/strongly agreed. Forty percent of fathers did more music at home since experiencing music therapy. Eighty percent of fathers would want music therapy for their child again in the future, and 50% would recommend the hospital to other families because of its music therapy program. Seventy percent of fathers

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reported that music therapy increased their overall satisfaction with the hospital. Of the ten fathers who participated, one chose to comment: “I may have not been present for the music therapy but my child is thriving. We play music for him every night… he loves to dance.” Discussion Over four times as many mothers responded to the survey as fathers. This is consistent with related studies, where more mothers responded (Webster-Stratton, 1988) or only mothers responded. It is also consistent with research in which the term “parent” is applied, but information comes only from mothers (Phares, 1997). Whereas mothers were more likely to decline by saying, “my child did not have music therapy,” fathers were more likely to say, “ask my wife” or “his/her mom would know.” Although parents were only contacted if their child had received music therapy, when the mother was unaware of services, her response was typically that there was no music therapy, not that she was unaware. Fathers were more likely to acknowledge that their child might have received a service of which they were unaware of. Based on the comments, mothers not present for any sessions still valued the experience and knew what had occurred, even though they were not physically there. Most fathers had a child under 2 and reported a hospitalization of over 1 month, while mothers reported a wider range of age and hospitalization. This means that fathers were much more likely to know and experience music therapy when their child was young or in an extended hospitalization, but mothers were likely to know throughout. Studies have found a positive correlation between length of services and child’s age (Phares, 1997) for both mothers and fathers; in this study, length of treatment and child’s age were influencing factors primarily for fathers. Mothers were also more likely to participate in sessions. In a similar vein, parents of a child with disabilities have an 80% likelihood of getting divorced, compared to 50% in the general population (Griffin, 2000). The elevated levels of stress and depression that parents experience lead to reduced problem-solving abilities, lower family satisfaction, and lower physical health (Resch, Elliot, & Benz, 2012). However, the majority of studies that discuss “parental depression” focus solely on mothers;


studies that include fathers typically find that they have fewer depressive symptoms. One reason mothers may be experience more distress is that they often take a larger part of the extra duties associated with having a child with disabilities (Bristol, Gallagher, & Schopler, 1988). Furthermore, mothers are typically the parent giving up their job in order to care for the child, leaving mothers feeling unable to pursue their own interests (Breslau, Staruch, & Mortimer, 1982). This can be seen in these results. Just over half of mothers reported no work outside home or work part time, while 90% of fathers reported working full time. Mothers were more likely to be present and knowledgeable of services. Mothers would have preferred more music therapy sessions and were open to the support, while fathers overall were content with the number of sessions. It is possible that this is because without seeing and engaging with the child in music therapy, it may be difficult to understand the value of the service. Further research may be helpful to understand these results; additional research with single parents and same-sex parents may give a more rounded idea of parent perceptions. References Achenbach, T. M., McConaughy S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101(2), 213-232. Brannan, A. M., Sonnichsen, E., & Heflinger, C. A. (1996). Measuring satisfaction with children’s mental health services: Validity and reliability of the satisfaction scales. Evaluation and Program Planning, 19(2), 131-141. Breslau, N., Staruch, K. S., & Mortimer, E. A. (1982). Psychological distress in mothers of disabled children. American Journal of Diseases of Children, 136, 682-686 Bristol M., Gallagher ,J., & Schopler, E. (1988). Mothers and fathers of young developmentally disabled and nondisabled boys: Adaptation and spousal support. Developmental Psychology, 24, 442-451. Cepanec, M., Lice, K., & Simlesa, S. (2012). Motherfather differences in screening for developmental

delay in infants and toddlers. Journal of Communication Disorders, 45, 255-262. Gaston, L., & Sabourin, S. (1992). Client satisfaction and social desirability in psychotherapy. Evaluation and Program Planning, 15(3), 227-231. Griffin, K. L. (2000, February 28). Parental break time. The Milwaukee Journal Sentinel, p. 1G. Loeber, R., Green, S. M., & Lahey, B. B. (1990). Mental health professionals’ perception of the utility of children, mothers, and teachers as informants on childhood psychopathology. Journal of Clinical Child Psychology, 19, 136-143. MacKenzie, E. P., Fite, P. J., & Bates, J. E. (2004). Predicting outcome in behavioral parent training: Expected and unexpected results. Child & Family Behavior Therapy, 26, 37-53. McMahon, R. J., & Forehand, R. (1983). Consumer satisfaction in behavioral treatment of children: Types, issues, and recommendations. Behavior Therapy, 14, 209-225. Phares, V. (1997). Accuracy of informants: Do parents think that mother knows best? Journal of Abnormal Child Psychology, 25, 165-171. Resch, J. A., Elliot, T. R., & Benz, M. R. (2012). Depression among parents of children with disabilities. Families, Systems, & Health, 30(4), 291-301. Tiano, J. D, Grate, R. M., & McNeil, C. B. (2013). Comparison of mothers’ and fathers’ opinions of parent-child interaction therapy. Child & Family Behavior Therapy, 35, 110-131. Webster-Stratton, C. (1988). Mothers’ and fathers’ perceptions of child deviance: Roles of parent and child behaviors with parent adjustment. Journal of Consulting and Clinical Psychology, 56(6), 909-915. About the Author Molly Moses, M.M., MT-BC, is a graduate of Florida State University and practices at Joyful Music Therapy in Orlando, Florida. She provides individual and group music therapy sessions to a diverse population, including young children. Contact:

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Recognized and Researched: An Administrator’s Guide to Music Therapy Elizabeth K. Schwartz, M.A., LCAT, MT-BC Raising Harmony: Music Therapy for Young Children Mount Sinai, New York Elizabeth K. Schwartz, M.A., LCAT, MT-BC specializes in early intervention and preschool treatment and provides staff development in local public schools while lecturing on regulatory issues and music therapy. Contact:

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Educational administrators generally maneuver at the critical intersection between the child and access to services. They daily balance the needs of each child, family and community expectations and available resources with overall system mission, applicable laws and regulations, and stable, sustainable funding sources. Early childhood music therapists working within educational systems can be vital in helping administrators


maintain balance that allows for access to appropriate services for every child in their care while providing efficient, effective programs. By informing administrators in the educational system on how music therapy can fit into administrative requirements (i.e., system mission, laws and regulations, and funding), music therapists can support all parties in collaborating more effectively so that children receive the services they need. How does music therapy support the mission of a preschool program? Every educational system is guided by a mission. Although each district or region might state it differently, the mission of education is generally centered on a common drive toward providing children with opportunities for achievement, development and advancement. For children with disabilities in the United States, the mission of education is explicitly stated in the opening section of the Individuals with Disabilities Education Act of 2004 (Public Law 148-446).


“(1) Disability is a natural part of the human experience and in no way diminishes the right of individuals to participate in or contribute to society. Improving educational results for children with disabilities is an essential element of our national policy of ensuring equality of opportunity, full participation, independent living, and economic selfsufficiency for individuals with disabilities” (Public Law 108-446; Music therapy interventions can support “equality of opportunity” and “full participation” through music experiences. Research demonstrates that music is accessible to all children and can provide support in enhancing communication, social interaction, group functioning, access to pre-academic curriculum and inclusion for children with disabilities. The American Music Therapy Association (AMTA) offers comprehensive research resources, including peer-reviewed journals for educators and administrators, which can be found on the organizational website at AMTA welcomes administrators to contact them with questions and concerns, or to explore possible program development.

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Is music therapy recognized under United States law and in regulations? Yes. The Individuals with Disabilities Act (IDEA) Part B for children ages 3-22 allows for the provision of related services if

“required to assist a child with a disability to benefit from special education in order for the child to receive FAPE [Free Appropriate Public Education]” (Public Law 108-446; Although not explicitly named in the body of the statute, music therapy as a related service has been supported multiple times in both regulation and clarification of regulation and intent. From the Federal Register: August 14, 2006 (Volume 71, Number 156): “Discussion: Section 300.34(a) and section 602(26) of the Act state that related services include other supportive services that are required to assist a child with a disability to benefit from special education. We believe this clearly conveys that the list of services in Sec. 300.34 is not exhaustive and may include other developmental, corrective, or supportive services if they are required to assist a child with a disability to benefit from special education” ( finalregulations.html). Further clarification came from the June 2010 United States Department of Education QUESTIONS AND ANSWERS ON INDIVIDUALIZED EDUCATION PROGRAMS (IEPs), EVALUATIONS, AND REEVALUATIONS: “If a child’s IEP Team determines that an artistic or cultural service such as music therapy is an appropriate related service for the child with a disability, that related service must be included in the child’s IEP under the statement of special education, related services, and supplementary aids and services to be provided to the child or on behalf of the child. 34 CFR §300.320(a)(4)” (https://


In September of 2015 a communication was sent to all State Directors of Special Education from the Office of Special Education Programs, the United States Department of Education reiterating that music therapy could be included as a related service on a child’s Individual Education Plan. Each state’s Department of Education should be able to clarify in writing this federal directive. What about for infants and toddlers under IDEA Part C? Can music therapy be provided? Yes. As with IDEA Part B, music therapy may be included for infants and toddlers under IDEA Part C in early intervention. From Federal Register/Vol. 76, No. 188/Wednesday, September 28, 2011:


“(d) Other services. The services and personnel identified and defined in paragraphs (b) and (c) of this section do not comprise exhaustive lists of the types of services that may constitute early intervention services or the types of qualified personnel that may provide early intervention services. Nothing in this section prohibits the identification in the IFSP of another type of service as an early intervention service provided that the service meets the criteria identified in paragraph (a) of this section or of another type of personnel that may provide early intervention services in accordance with this part, provided such personnel meet the requirements in §303.31 (Authority: 20 U.S.C. 1432(4)” ( FR-2011-09-28/pdf/2011-22783.pdf).


Do I have to hire a music therapist to provide music therapy? Determining who can provide services within an educational setting in the United States is decided by each state. The federal government does suggest guidelines in assuring that all related services, including music therapy, are provided by professionals who are appropriately and adequately prepared and trained. From the June 2010 United States Department of Education QUESTIONS AND ANSWERS ON INDIVIDUALIZED EDUCATION PROGRAMS (IEPs), EVALUATIONS, AND REEVALUATIONS:

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“Part B of IDEA does not prescribe particular qualifications or credentials for personnel providing special education and related services. Under 34 CFR §300.156(a), each SEA must establish and maintain qualifications to ensure that personnel necessary to carry out the purposes of Part B of the IDEA are appropriately and adequately prepared and trained” ( guid/idea/iep-qa-2010.pdf ). The American Music Therapy Association (AMTA) ( and Certification Board for Music Therapy (CBMT) ( offer search engines to find a certified music therapist in each state. A Music Therapist Board Certified (MT-BC) must have attended an accredited university training program and is adequately prepared to provide high-quality services. A list of frequently asked questions about the Board Certification can be found at How can my district pay for music therapy? Music therapy can be paid for out of district operating funds or with grants such as educational enhancement funding through IDEA. Although disbursement of funds is unique to each state and municipality, music therapy funding is supported in the following document from New York State.


“IDEA Part B funds may be used for the following expenditures which are not also included in the tuition rate: … Art and music therapies by part-time staff or contract services” ( specialed/finance/2012-13-DEAapplicationMemo.htm). Can music therapy only be provided as a related service in my schools? No. Many schools and educational programs throughout the United States employ or contract with music therapists to provide group music therapy services for children with disabilities as part of their program offerings.




Healthcare administrators face many challenges, including balancing cost control and value creation while boosting productivity and improving quality of services within their hospitals (Begun, White, & Mosser, 2011). Administrators are responsible for determining which programs will be best for their hospitals and patients and therefore need accurate and concise information on proposed services. Although some healthcare administrators already recognize the value of music therapy services, there is little research on administrators’ perceptions of music therapy within pediatric settings. The suggestions offered in this article are based on the research literature and experiences of the authors (two music therapists and a hospital administrator) with the intention of helping music therapists work with healthcare administrators to develop pediatric music therapy programs. This article will focus on a) research outcomes and neurological foundations, b) cost effectiveness, and c) professional advocacy in music therapy. Research Outcomes and Neurological Foundations Music therapists must be able to communicate to others best practices based on research and clearly and concisely provide basic information about the psychological and neurological effects of music. Compiling a summary of research outcomes can help provide information about potential benefits of music therapy at-a-glance (see Figure 1).

Altering Perceptions: Research, CostEffectiveness, and Advocacy Ashley Miller, MT-BC Olivia Swedberg Yinger, Ph.D., MT-BC University of Kentucky College of Fine Arts Lexington, Kentucky Joseph Zwischenberger, MD University of Kentucky Department of Surgery Lexington, Kentucky

DEPARTMENT General Pediatrics

Neonatal Intensive Care



Reducing pain/anxiety Decreasing respiratory distress • Maintaining developmental milestones (Standley, Gooding, & Yinger, 2014) •

Regulating physiologic measures • Increasing tolerance to stimulation • Reinforcing non-nutritive sucking (Standley, 2014) • •

Increasing positive coping Increasing active engagement (Robb, 2000) •


Facilitating functional movement • Regulating attention/memory/ executive functioning • Improving communication skills (de l’Etoile & LaGasse, 2013)

Surgery and Other Medical Procedures

• Decreasing distress (Gooding, Yinger, & Iocono, 2015)

Table 1. Example Research Summary.

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In their article on the convergence of music therapy and neuroscience, de l’Etoile and LaGasse (2013) discussed two critical discoveries taken from decades of evidence regarding music and the brain. First, the neural networks used for music are not only used for music, but are also used for many routine non-musical functions. Second, learning music alters the brain. Together, these findings support the use of music therapy in pediatric rehabilitation to facilitate functional movement; regulate attention, memory, and executive function; and promote the acquisition and rehabilitation of communication skills (de l’Etoile & LaGasse, 2013). It is important to become familiar with a facility’s mission and services, and present information that communicates how music therapy could help the facility better meet its mission and serve patients and their families. Patient-centered care is a high priority for most healthcare administrators. Providing clear information about research outcomes and neurological foundations of music therapy can help provide evidence supporting music therapy’s inclusion in patient-centered care. Although demonstrating music therapy's effectiveness is crucial, for many administrators who are interested in offering music therapy to their patients the question remains: How do we pay for it?




Decreased length of stay

Walworth et al., 2012

Decreased length of procedure

Walworth, 2005

Reduced need for medication

Walworth, 2005

Improved patient/family satisfaction

Gooding, Yinger, & Iocono, 2015; Yinger & Standley, 2011

Cost Effectiveness Cost-effectiveness is understandably a major concern of hospital administrator, due to the necessity of providing critical care services with limited time, staffing, and funding. Music therapy has been shown to be costeffective in several ways, including a) decreasing length of stay, b) decreasing length of medical procedures, c) reducing the need for medication, and d) improving patient/family satisfaction and perception of medical facilities. Research has shown that premature infants who receive music therapy go home 1 to 2 weeks sooner than infants who receive standard care (Walworth et al., 2012), decreasing length of stay and potentially saving $3,000 a day (Kornhauser & Schneiderman, 2010). Walworth (2005) found that children who received music therapy during echocardiograms had procedure times 40 minutes shorter on average than children who received standard care. By decreasing the lengths of procedures, healthcare facilities are able to schedule more procedures per day, which is cost-effective and allows for provision of services to more people. Children in Walworth’s 2005 study who received music therapy during medical procedures also required pharmacological sedation less often, saving money while decreasing the likelihood of adverse events from medications. Patient satisfaction has become increasingly important to healthcare facilities in recent years, particularly since 2010, when the Affordable Care Act made performance payments to healthcare facilities contingent, in part, on patient satisfaction (Millenson & Macri, 2012). There is evidence that music therapy improves patient/family satisfaction and perception of the healthcare facility (Gooding, Yinger, & Iocono, 2015). One study by Yinger and Standley (2011) showed that patients who received music therapy services had higher overall mean satisfaction scores on the Press Ganey Inpatient Survey than patients who did not receive music therapy. Pediatric patients who received music therapy had particularly high scores in relation to the national average, scoring 6.9 points higher, and those who received music therapy had overall satisfaction scores that were an average of 5.4 points higher than patients from the same hospital who did not receive music therapy (Yinger & Standley, 2011). By improving patient/ family satisfaction, music therapists help healthcare facilities ensure that they will receive funding for the

Table 2. Cost-Effectiveness Evidence.

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services they provide, making music therapy a costeffective treatment. Figure 2 provides a summary of research substantiated ways in which music therapy services have been shown to be cost-effective. Cost-effectiveness benefits are even more impressive when compared to the average cost of a music therapist’s salary, benefits, and equipment (see Walworth, 2005 for an example of a cost-effectiveness analysis) and when considering the fact that some music therapists are able to obtain third-party reimbursement for their services (see Standley and Walworth, 2010 for a cost-effectiveness analysis that factors in third-party reimbursement). In addition, music therapy carries minimal risk to patients. When factoring in its low cost, established benefit, and minimal risk, music therapy can be shown to have a very favorable cost/benefit/risk profile. Beyond communicating the potential benefits of music therapy and its cost-effectiveness, music therapists must be prepared to describe how music therapy is unique from other services. Increasing awareness and understanding of music therapy should be a priority when communicating with administrators. Professional advocacy includes building working relationships with others outside the field of music therapy while providing information. Professional Advocacy In order to educate and advocate, music therapists should be prepared to help administrators understand what makes music therapy unique among other forms of integrative medicine. Music therapy is different in part because of the use of music as the modality and in part because of the individualized treatment clients receive through interactions with a qualified music therapist. Music therapy is more than playing music for patients; the skilled intervention by the music therapist combining music and counseling skills offers a uniquely beneficial service. Although other practitioners use music as a modality, only music therapists have the specialized training necessary to conduct standardized assessments, design treatment plans addressing individualized goals, and document progress. AMTA and the National Standards Board for Therapeutic Musicians (NSBTM) created a guide that can be used to help others

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understand the differences between music therapy and other therapeutic music services (2015). Figure 3 provides a summary of sources of information that can help administrators better understand what music therapists do and what makes music therapy unique.



ADVOCACY INFORMATION Understanding/altering pediatric treatment team members’ perceptions of music therapy

Darsie, 2009

Differences between music therapy and therapeutic music

AMTA & NSBTM, 2015

AMTA fact sheets: Music therapy and young children, Music therapy in medicine

AMTA, 2016

Benchmark hospitals that provide music therapy

Harder, 2015; Truven Health Analytics, 2016

Table 3. Professional Advocacy Resources. In 2015-2016, U.S. News and World Report published a list of the Best Children’s Hospitals in the country in 10 specialties. Twelve hospitals made the Honor Roll, meaning they had high scores in three or more specialties (Harder, 2015). A search of the websites of Honor Roll hospitals revealed that 11 out of 12 of the top children’s hospitals offer music therapy, supporting the notion that leaders in the healthcare field see the value of music therapy in pediatric settings. Additionally, information about whether music therapy is present in hospitals within specific categories is helpful when communicating with administrators. For example, if a music therapist were describing music therapy services


Music therapy is more than playing music for patients; the skilled intervention by the music therapist combining music and counseling skills offers a uniquely beneficial service.–Joseph Zwischenberger, MD, University of Kentucky Department of Surgery

to an administrator within a teaching hospital, it would help to know which other benchmark teaching hospitals employ music therapists. A list of the top hospitals in various categories is easily accessible online (Truven Health Analytics, 2016). Music has universal appeal and affects people in profound ways. Music therapists are trained to select appropriate music and design interventions to meet individualized goals. By communicating to healthcare administrators (a) research on the effectiveness of music therapy, (b) cost-effectiveness information, and (c) what makes music therapy unique, music therapists can help make music therapy part of patient-centered care in more pediatric healthcare facilities. References American Music Therapy Association (2016). Music therapy with specific populations: Fact sheets, resources, & bibliographies. Retrieved from http:// American Music Therapy Association and National Standards Board for Therapeutic Musicians (2015). Therapeutic music services at-a-glance: An overview of music therapy and therapeutic music. Retrieved from TxMusicServicesAtAGlance_15.pdf.pdf Begun, J. W., White, K. R., & Mosser, G. (2011). Interprofessional care teams: The role of the healthcare administrator. Journal of Interprofessional Care, 25, 119-123. Darsie, E. (2009). Interdisciplinary team members’ perceptions of the role of music therapy in a pediatric outpatient clinic. Music Therapy Perspectives, 27, 48-54.

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de l’Etoile, S. K. & LaGasse, A. B. (2013). Music therapy and neuroscience from parallel histories to converging pathways. Music Therapy Perspectives, 31, 6-14. Gooding, L. F., Yinger, O. S., & Iocono, J. (2015). Preoperative music therapy for pediatric ambulatory surgery patients: A retrospective case series. Music Therapy Perspectives. Advance online publication. Harder, B. (2015). Best children’s hospitals 2015-16: Honor roll and overview. Retrieved from http:// Kornhauser, M., & Schneiderman, R. (2010). How plans can improve outcomes and cut costs for preterm infant care. Managed Care Magazine. Retrieved from how-plans-can-improve-outcomes-and-cut-costspreterm-infant-care Millenson, M. L., & Macri, J. (2012). Will the affordable care act move patient-centeredness to center stage? Timely Analysis of Immediate Health Policy Issues. Retrieved from research/2012/03/will-the-affordable-care-act-movepatient-centeredness-to-center.html Robb, S. L. (2000). The effect of therapeutic music interventions on the behavior of hospitalized children in isolation: Developing a contextual support model of music therapy. Journal of Music Therapy, 37, 118-146. Standley, J. M. (2014). NICU music therapy. In L. F. Gooding (Ed.), Medical music therapy: Building a comprehensive program (pp. 103-115), Silver Spring, MD: The American Music Therapy Association. Standley, J. M., Gooding, L. F., & Yinger, O. S. (2014).


Pediatric medical music therapy. In L. F. Gooding (Ed.), Medical music therapy: Building a comprehensive program (pp. 117-133), Silver Spring, MD: The American Music Therapy Association. Standley, J. M., & Walworth, D. (2010). Music therapy with premature infants: Research and developmental interventions (2nd ed.). Silver Spring, MD: American Music Therapy Association. Truven Health Analytics. (2016). Truven Health 100 Top Hospitals ® Study 2016, 23rd edition. Retrieved from TOP_16409_0316_100_Top_Hospitals_Study_WEB.p df Walworth, D. D. (2005). Procedural-support music therapy in the healthcare setting: A costeffectiveness analysis. Journal of Pediatric Nursing, 20, 276-284. Walworth, D. D., Standley, J. M., Robertson, A., Smith, A., Swedberg, O., & Peyton, J. (2012). Effects of neurodevelopmental stimulation on premature infants in neonatal intensive care: Randomized controlled trial. Journal of Neonatal Nursing, 18, 210-216. Yinger, O. S., & Standley, J. M. (2011). The effects of medical music therapy on patient satisfaction: As measured by the Press Ganey Inpatient Survey. Music Therapy Perspectives, 29, 149-156.

Olivia Swedberg Yinger, PhD, MT-BC, is Director of Music Therapy and Assistant Professor of Music Therapy at the University of Kentucky. Her research interests include pediatric procedural support music therapy and music therapy for premature infants. Contact:

Joseph (Jay) B. Zwischenberger MD is a cardiothoracic surgeon and the Johnston-Wright Professor and Chairman of the Department of Surgery at the University of Kentucky. He also serves as the Surgeon-inChief of UK HealthCare.

About the Authors Ashley Miller, MT-BC, is currently pursuing her master's degree in music therapy as a graduate teaching assistant at the University of Kentucky. She has experience working with a variety of clinical populations in private practice and as a music therapy practicum supervisor. Contact:

Dr. Zwischenberger is an advocate for music therapy and frequently makes music alongside music therapy students in the atrium of the University of Kentucky Chandler Hospital.

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Super Star or Behind the Scenes Sleuth: What is Your Advocacy Style? Dena Register, PhD, MT-BC Regulatory Affairs Advisor Certification Board for Music Therapists

The word “advocacy” conjures up many different images for people. Perhaps you think of people standing in front of a government building, in a picket line, holding signs with pithy sayings, and loudly chanting a repetitive phrase. Maybe advocacy makes you think of someone standing at a microphone making a speech in front of a large crowd of people. While these two scenarios could certainly be part of the imagery we associate with advocacy, they are by no means the only options. In fact, there are any number of ways that individuals can contribute to awareness and advocacy efforts. Imagine for a moment that in your work with young children, you valued only ONE particular skill set. Let’s say that ONLY their logical reasoning was important, with little or no value placed on creativity or developmental goal areas. That sounds crazy, right? We would never place sole value on one skill set in children. Likewise, we would never want only ONE kind of advocate. It takes the diversity of skill sets among advocates to effect change and help decision makers understand an issue. With that in mind, let’s have a little fun! This 10-question quiz is designed to help you assess and understand the value of your advocacy strengths. Answer each question quickly and honestly and then add up your total points to see where your advocacy strengths lie for early childhood music therapy and beyond.

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When asked if you know who your current state

senator and/or representative are, your reply is a) “Good question.” b) “I think I know, but let me double-check.” c) “Yes, I know the names but not much about them.” d) “Yes, they’ve already heard from me about an issue.”


Which best describes the written correspondence

(e.g., email, letter) you have had with your senator and/ or representative. a) I’m on a first-name basis with at least one of


You have been approached by your supervisor

to participate in an advocacy event where you will talk to decision-makers about the benefits of music for young children. Your first thought is

their staff members. b) You’re kidding, right?

a) “That sounds scary but if you give me some guidance I’ll give it a shot.”

c) I’ve considered writing but don’t really know how the process works.

b) “Do you need me to help train others? I’ve done this before.”

d) I’ve made contact on at least one occasion

c) “Isn’t there another committee or task I can

about an issue.

help with?” d) “I’m happy to go as long as I don’t have to do the talking.”


You are just settling into your seat for a 2-hour flight

when the person next to you asks, “What do you do?” After you respond, the questions begin. You think a) “I don’t mind sharing but now I’m ready to listen to the playlist I ceated before this flight. Let’s wrap it up.”


An agency that you work for has asked you to

give a presentation about music therapy to their foundation board. You see this as a) a little bit of a daunting task but doable, as long as you can confer with colleagues for help and practice.

b) “So far, so good. I hope I can answer all their questions.”

b) an ulcer in the making. Is there someone else who can cover this one?

c) “Bring on the questions. I love these

c) no sweat. I love doing this sort of thing and

opportunities for education!” d) “I wish I’d said I was a dental hygienist.”

could do it in my sleep. d) this could be fun. I have little practice with this but welcome the chance to be in front of a new group.

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You get a call from a colleague in the state


As you sit down with the morning newspaper you

association to talk about the association and their advocacy efforts to provide music for all young

notice that the opening of the current legislative session is front page news. The article outlines the major issues

children and what your thoughts are on pursuing

for this session. You

legislation that would help families access these services. You

a) skip past that to find the weather for this week. b) skim through to get a sense of what issues are

a) recall hearing something about this and are glad for the chance to ask questions and talk

going to be “hot topics.” c) m ake a note to see what committees your

about what is happening in the state.

senator and representative are on in case they

b) want to know about being more involved with the advocacy group or how you can help.

might be able to help. d) wonder why the writer of this article didn’t

c) a ren’t sure they have the right number. d) a re part of the team making these calls.

cover the healthcare issues with the same depth as the online coverage that you’ve been following.


You receive an email from an early childhood

music advocacy committee asking you to complete a survey about your work with young children. You a) helped create the survey and look forward to compiling the results to determine what services are being offered in your state (and to whom). What a great advocacy tool! b) hope to get around to it in the next week or so but think, “Haven’t I already answered these questions?” c) complete it right then and sign up to be contacted if they need help with additional advocacy tasks. d) delete. No time for another survey.


At the urging of a friend you agreed to join an

advocacy committee to raise awareness of the benefits of music for the development of young children. As the group is deciding who will take on particular tasks, you are most likely to a) take the lead on writing correspondence to your colleagues as long as you can get some feedback and support from the other committee members. b) v olunteer to be the chair of the advocacy group. You are ready to lead! c) take on a task that can be done by searching the internet and providing information to help the group’s effort. d) p articipate in calls and weigh in with an occasional opinion about what the group should do next.


Your advocacy efforts have paid off and there is a bill moving through the state legislature that would

provide access to music therapy services for children with identified developmental need. This bill is going before the Health and Human Services Committee on the Senate side. Your sponsoring senator has indicated that a few of you should speak at the hearing about the importance of this bill to the families you serve. You a) look forward to hearing how that works out. b) are willing to contact a client’s family that might be willing to share their story. c) a re happy to help organize materials as long as you don’t have to speak in front of anyone. d) h ave had your presentation and remarks ready for weeks. Bring on the committee.

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Tally Your Score






a) 1 b) 2

a) 1 b) 2

a) 1 b) 2

a) 1 b) 2

a) 1 b) 2

c) 3

c) 3

c) 3

c) 3

c) 3

d) 4

d) 4

d) 4

d) 4

d) 4






a) 1 b) 2

a) 1 b) 2

a) 1 b) 2

a) 1 b) 2

a) 1 b) 2

c) 3

c) 3

c) 3

c) 3

c) 3

d) 4

d) 4

d) 4

d) 4

d) 4

34-40 points: Loud and Proud Maybe you should run for office! Your advocacy style is a front-and-center, informed, direct approach. You are not afraid to take any and all opportunities to promote your cause. Whether it is making sure you are up-to-date with the latest “intel,� staying connected to your colleagues and professional happenings, writing e-mails or taking meetings, you make sure that you are well informed and that your voice is heard. 26-33 points: Not Afraid to Take the Lead You are excited about the possibility of working for change and you are not afraid to talk to others or take on a leadership role if you have some support and guidance from others. You enjoy sharing ideas about the profession and how to achieve change. 18-25 points: Behind-the-Scenes Sleuth You are committed to helping out the group in a role that does not require you to be front and center. You work to stay informed and are happy to search the internet, write a letter or e-mail or deal with tasks that allow you time to process and respond. 10-17 points: Supporting Role While you feel invested, you are not necessarily comfortable being front-and-center to answer questions or lead the charge. You prefer a supportive role that helps further the cause. Rest assured that there are many advocacy tasks that would not be accomplished without the support of those who are more comfortable doing the detail or research work that supports the more vocal members of the group. Maintaining membership and boardcertification, responding to surveys and requests from your task force and reading organizational news are ways to be involved without committing a huge amount of time.

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Music Therapy for Hospital Procedures Darcy DeLoach, Ph.D., MT-BC University of Louisville Louisville, Kentucky When family members are approached by hospital staff and given the choice to use music therapy interventions instead of sedation for their child who is undergoing a procedure, oftentimes questions arise. In an environment typically using medications to alleviate symptoms of anxiety and pain, the process of using music interventions can be unknown. How can a music therapist use music during a procedure instead of sedation or anxiety medications? Are there risks involved? How does it work? Music as Therapy Much research has looked into how effective music can be for reducing anxiety and pain in hospital environments, with moderate support being given overall for successful outcomes (Ghetti, 2012; Walworth, 2010; Walworth, 2005; Yinger & Gooding, 2015). One of the leading factors in mixed results being found is the many different types of music that can be implemented in hospital settings by various healthcare providers or volunteers. As musicians take live music into healthcare environments to enhance the hospital experience and improve patient mood states, misperceptions can occur when attempting to understand board-certified music therapists’ interventions and expected patient outcomes.

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Intervention The processes WHAT FAMILY implemented by music MEMBERS SHOULD therapists are not KNOW ABOUT unique to the field of music therapy, per se. HOW MUSIC However, the methods INTERVENTIONS of intervention techniques typically are. WORK FOR When reviewing the CHILDREN flowcharts explaining the process for music UNDERGOING therapy assisted PROCEDURES IN pediatric procedural support developed at HOSPITALS Tallahassee Memorial HealthCare, it is obvious that there is a straightforward and predictable treatment intervention flow. The complexity, however, of what a music therapist is doing in the moment during patient interventions cannot be captured in a flowchart and is where the differences lie between a patient listening to music and receiving a music therapy intervention. Isoprinciple. First let’s look at the term “isoprinciple” displayed in Figures 1 and 2, which illustrates how a music therapist would provide procedural support when a child falls asleep and when a child stays awake during a procedure. This term describes a process of meeting a person where he/she is physiologically or emotionally (Davis, 2003) and matching the musical qualities to that state of being. The human body has an intrinsic ability to change breathing patterns, movement patterns, and emotional responses to music that is heard and attended to. The key here is actually attending to the music being played and processing it. If a person can be engaged with the music he/she is hearing, it is possible to change the musical qualities of the sound and have a resulting change in breathing rate, movement, or emotional state. This process is complex and requires consistent assessment and monitoring of the patient’s behavior and mood state to choose the appropriate musical modifications for eliciting desired changes. This process is also very gradual. Any alerting change in the music can disengage



Figure 1. Pediatric procedures when goal is for patient to be asleep.

the patient from the music listening process. For example, if a person is experiencing heightened anxiety and slow, quiet, unfamiliar music is played, the person will have a hard time engaging with the music and will not respond to the isoprinciple technique being used by the music therapist. However, if the musical properties match the anxiety state with tempo, volume, melodic and harmonic movement, and familiarity, it is highly likely that the person will engage and attend to the music. At that point, the music can gradually change over time to eventually be calmer, quieter, and slower, and the patient will respond similarly.

Figure 2. Pediatric procedures when goal is for patient to be awake and still.

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Theory. One very helpful theory for understanding how this is possible is the Optimal Complexity Theory by Berlyne (North & Hargreaves, 1995; Tan, Spackman, & Peaslee, 2006), which is applied to various aesthetics. The theory states that if the aesthetic quality is not optimal, the experience will be negatively affected. This can be applied to music listening and the aesthetic qualities of the music source. Music that is either too complex or not complex enough will be rated as less enjoyable or disliked. The factors that create complexity in music vary and are personalized. Previous exposure to the song, familiarity with instrumentation, chordal progressions, melodic structure, variance from original song structure, and listening environment are all examples of factors that can contribute to how complex a music experience is rated.


How it Works Music therapists will commonly choose live music to use during procedural support due to their ability to change the music itself in response to the patient experience, behaviors, and mood state. If a song is too familiar or too unfamiliar, it is likely the patient will not engage with the song. If a song is too soft or too loud, it is likely the music listening experience will be negatively affected. If a song is not in its original instrumentation or voicing, it is possible the music listening experience will be negatively affected. In addition to these assessments, music therapists consider the emotional stress of the hospital environment on the patient. If a patient has never been in a hospital before, the emotional stress will impact his/her ability to process new information and remain regulated. This affects the level of music familiarity necessary for a patient to have a positive experience. Meaning, choosing music that is new or novel may not be appropriate during a new stressful medical experience. choosing music that is very familiar but presented with different instrumentation may prove to be optimal due to the novelty of the voicing, but familiarity of the chordal progression and melodic movement.

Figure 3. Complexity of music/attributes.

Any indication that a patient is not optimally engaged in the music therapy intervention will typically result in a change of the music being played. Music therapists are skilled observers who modify musical experiences in the moment to achieve desired outcomes.

Now, when applying points1 and 2 to the experience a child has in a hospital setting during a medical procedure such as a CT scan, MRI, xray, ultrasound, echocardiogram, or IV start, the following points need to be considered: All music is not created equally. The assessment of patient needs is fluid and ongoing. Previous exposure matters.

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Outcomes. For procedural support, these desired outcomes can include reduced anxiety, reduction or elimination of medications or sedatives, and improved perception of the hospital experience. Through the careful and fluid assessment of patient needs and the correct music to use in meeting those needs, music therapists are able to positively impact patient experiences.


References Davis, W. B. (2003). Ira Maximilian Altshuler: Psychiatrist and pioneer music therapist. Journal of Music Therapy, 40(3), 247-263. Ghetti, C. M. (2012). Music therapy as procedural support for invasive medical procedures: Toward the development of music therapy theory. Nordic Journal of Music Therapy, 21(1), 3-35. North, A. C., & Hargreaves, D. J. (1995). Subjective complexity, familiarity, and liking for popular music. Psychomusicology: A Journal for Research in Music Cognition, 14(1-2), 77-93. Tan, S-L., Spackman, M. P., & Peaslee, C. L. (2006). The effects of repeated exposure on liking and

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judgements of musical unity of intact and patchwork compositions. Music Perception: An Interdisciplinary Journal, 23(5), 407-421. Walworth, D. (2010). Effect of live music therapy on anxiety, perception of procedure, repeating procedure, and time for completion for patients undergoing magnetic resonance imaging. Journal of Music Therapy, 47(4), 335-350. Walworth, D. D. (2005). Procedural support music therapy in the healthcare setting: A cost and effectiveness analysis. Journal of Pediatric Nursing, 20, 276-284. Yinger, O. S., & Gooding, L. F. (2015). A systematic review of music-based interventions for procedural support. Journal of Music Therapy, 52(1), 1-77. About the Author Darcy DeLoach, Ph.D., MT-BC, is the Director of Music Therapy at the University of Louisville. She enjoys teaching and researching how music therapy is effective in various patient and client population groups. Contact:



The Use of Parental Singing: Enhancing Neurodevelopment in Premature Infants Michael R. Detmer, M.M.E., MT-BC University of Louisville Norton Women’s & Kosair Children’s Hospital Louisville, Kentucky

Premature birth abruptly interrupts the final, critical phase of neurodevelopment, and life-sustaining medical treatment can inhibit optimal neurodevelopment resulting in long-term intellectual and developmental delays (Hack, 2007). While medical treatment is a top priority, medical care and developmental care needn’t be mutually exclusive. Developmental care is an evidence-based, interdisciplinary professional practice individualized to each infant and his/her family to support healthy growth and development. Standards of developmental care include sleep, positioning, pain and stress management, feeding, swaddled bathing, and family-centered care. Outcomes of developmental care include shorter hospital stays, improved weight gain and feeding ability, and higher developmental scores after discharge (Symington & Pinelli, 2006). One component of developmental care— family interaction, and the parental voice in particular—

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has been documented to improve premature infants’ medical status. Krueger (2010) highlighted important medical benefits of maternal voice for preterm infants including improvements in physiological measures such as heart rate and oxygen saturation as well as weight gain. Parental voice can also be used to offset common developmental challenges. Bozzette (2008) found preterm infants showed improved behavior state regulation and attending skills when listening to their mother’s voice, and in a later study, Caskey, Stephens, Tucker, and Vohr (2011) discovered that parental talk was a significantly stronger predictor for premature infant vocalization when compared to language from other adults. Compared to speaking, parental singing may further enhance a preterm infant’s neurodevelopmental response. First, it is important to recognize that music is different than all other sound, including speaking, as


music is “sound and silence expressively organized in time” (Madsen & Madsen, 1997, p. 24) and the provision of music “consistently has a positive and significant impact in the NICU” (Standley, 2012, p. 314). Key acoustical properties including pitch, melody, tempo, harmony, and rhythm, make music highly organized and predictable, functioning to soothe and stabilize the neurologically immature infant more effectively than speaking (Standley & Whipple, 2003). Furthermore, term infants show a fixed, sustained attention to music (Standley & Walworth, 2010) and longer periods of attention during singing compared to speaking (Nakata & Trehub, 2004), which may also be true in preterm infants, indicating an optimized parent-infant interaction during parental singing. Parental Singing Research on parental singing has revealed a variety of benefits for premature infants. Arnon et al. (2014) found when mothers sang during kangaroo care, their infants exhibited better autonomic stability as evidenced by heart rate variability changes. Chorna, Slaughter, Wang, Stark, and Maitre (2014) revealed that when mother’s voice was played through a pacifier-activated lullaby® during nonnutritive sucking, premature infants demonstrated significantly increased oral feeding rates, volume intake, number of oral feeds per day, and faster time to full oral feeds, as well as shorter hospital stays. Cevasco (2008) also showed a decrease in hospital stay for preterm infants who listened to recordings of their mother’s singing. Benefits of maternal singing also transcend those for the infant. Mothers who sang to their premature infants showed increased parental involvement while reporting improved coping and bonding with their child (Cevasco, 2008) as well as decreased anxiety (Arnon et al., 2014). While singing is more effective than speaking (Nakata & Trehub, 2004; Standley & Whipple, 2003) and the use of live music produces the greatest benefits (Standley, 2012) for premature infants, live parental singing may not always be feasible for a variety of reasons including: Medical needs of the mother post-delivery; Limited resources for transportation or a long commute to and from the hospital; Needs of other children or family members at home; A short or unobtainable maternity/paternity leave; Single parenting; and

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Parental stress, anxiety, or depression related to the infant’s hospitalization or fragility. All of these, and more, may prevent or limit a family’s ability to be at the bedside with consistency and regularity, indicating the need for increased promotion of family-centered care and supportive services, such as NICU music therapy (NICU-MT) in the form of parental lullaby recording. Recording Lullabies NICU music therapists often work with families to create lullaby recordings for use with their infant when they are unavailable or as an activity to improve the family’s coping and adjustment to their child’s hospitalization. NICU parents are encouraged to use recordings of their own singing with their child as it is preferred over unfamiliar voices and important for language stimulation and bonding. Furthermore, commercially available music via tape, CD, or electronic/online platforms rarely complies with evidence-based recommendations on appropriate music for NICU infants consisting of: Voice only or voice with one instrument, Light rhythmic emphasis, Constant rhythm and volume, Melodies in a higher vocal range, Female vocalists, and In the native language of the family (Standley & Walworth, 2010). As well as Three chords or less, Major chords, and Played slowly and softly in a repetitive lullaby style (Nguyen, Jarred, Walworth, Adams, & Procelli, 2005). In compliance with these recommendations, one approach NICU-MTs use for parental lullaby recording is having parents sing familiar lullabies such as “Twinkle Twinkle Little Star” or “You Are My Sunshine,” which could be accompanied by the music therapist on guitar. Another more personalized approach is to have the parents complete a fill-in-the blank songwriting task in which they replace some words or phrases in familiar lullabies with the baby’s name or personalized messages. An additional option would be to use an Orffbased songwriting approach.


Orff-Based Songwriting Orff-based music therapy is grounded in the use of elemental (simple, basic, natural) and culturally relevant music, and provides intrinsic opportunities for autonomy and involvement in the therapeutic process (Colwell, 2009), easily allowing parents to participate musically. Furthermore, the creation of an original Orff-based lullaby with a NICU-MT can easily align with the appropriate NICU music characteristics listed above (Detmer, 2015). The music file below provides an example of an original, Orff-based parental lullaby. This was created by a NICUMT and a premature infant’s mother days before the infant’s discharge. The mother had experienced many personal medical issues during her child’s hospital stay and at the time of the music therapy referral, reported increased anxiety as she faced the prospect of transitioning home with her child. The intended outcome of this project was to increase the mother’s feelings of control and contribution through cognitive processing and emotional expression, thus decreasing her feelings of anxiety. The NICU-MT used the following Orff process outlined in the sidebar to assist the mother in creating her personal lullaby. Miamore Recorded 2016 by Michael Detmer

ORFF PROCESS FOR CREATING A PERSONALIZED LULLABY 1. Introduce music therapy services and the idea of an original lullaby recording project. 2. Prompt mother to write down pleasant thoughts or create a

poem about her child. (a day later…) 3. Work with mom to form thoughts/poem into a chant. 4. Add body percussion to chant (i.e., patting to mimic bordun). 5. Teach mom C-G bordun and play with chant. 6. MT-BC improvises in a pentatonic scale during bordun with chant. 7. MT-BC and mom switch instrument parts and repeat chant.

Playing Recorded Music If parental lullaby recordings are to be played while in the NICU, it is imperative the NICU-MT educate staff and parents on appropriate recorded music provision as well as stress cues or overstimulation of premature infants. Per Standley and Walworth’s (2010) research-based recommendations, music can be played: For infants who have reached at least 28 gestational weeks and are approved by nursing staff; 30 minutes at a time, for a maximum of four hours/ day; No louder than 65-75 db (scale C); With speakers on each side of the infant’s head or feet so music is received binaurally; and Should be discontinued if the infant exhibits persistent overstimulation or physiological instability.

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8. Discuss and create a vocal melody based on common themes present during the improvisation. 9. Mom plays bordun while she sings, choosing how/if she wants MT-BC to participate during recording (e.g., intro, chorus, interlude, outro). 10.Record, burn to CD, and provide to mother along with guidelines for music playing in the NICU.


Conclusion Considering the a) inherent soothing characteristics of a lullaby, b) biological relevance, familiarity, and preference for the parental voice, c) medical and neurodevelopmental benefits of music in the NICU, and d) increased opportunities for language input as a result of increased attention to music, parental lullaby singing is highly recommended as a standard of developmental and family-centered care. Music therapists with the NICU-MT designation are trained to provide music interventions that are matched to the developmental maturation of infants as measured by gestational weeks (Standley & Walworth, 2010). Thus, a NICU-MT should be consulted before music, such as a recorded parental lullaby, is provided to infants in the NICU. References Arnon, S., Diamant, C., Bauer, S., Regev, R., Sirota, G., & Litmanovitz, I. (2014). Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety. Acta Paediatrica, 103(10), 1039-1044. Bozzette, M. (2008). Healthy preterm infant responses to taped maternal voice. Journal of Perinatal & Neonatal Nursing, 22(4), 307-316. Caskey, M., Stephens, B., Tucker, R., & Vohr, B. (2011). Importance of parent talk on the development of preterm infant vocalizations. Pediatrics, 128(5), 910-916. Cevasco, A. M. (2008). The effects of mothers' singing on full-term and preterm infants and maternal emotional responses. Journal of Music Therapy, 45(3), 273-306. Chorna, O. D., Slaughter, J. C., Wang, L., Stark, A. R., & Maitre, N. L. (2014). A pacifier-activated music player with mother's voice improves oral feeding in preterm infants. Pediatrics, 133(3), 462-468. Colwell, C. M. (2009). Orff-based music therapy in the pediatric hospital setting. The Orff Echo, 41, 20-23. Detmer, M. R. (2015, November 13). Orff-based music therapy: Addressing anxiety and beyond. Paper presented at the American Music Therapy Association Conference, Kansas City, MO. Hack, M. (2007). Survival and neurodevelopmental outcomes of preterm infants. Journal of Pediatric Gastroenterology and Nutrition, 45(3), 141-142. Krueger, C. (2010). Exposure to maternal voice in preterm

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infants. Advances in Neonatal Care, 10(1), 13-18. Madsen, C. K., & Madsen, C. H. (1997). Experimental research in music. Raleigh, NC: Contemporary Publishing Company. Nakata, T., & Trehub, S. E. (2004). Infants' responsiveness to maternal speech and singing. Infant Behavior & Development, 27(4), 455-464. Nguyen, J., Jarred, J., Walworth, D., Adams, K., & Procelli, D. (2005). Music therapy clinical services. In J. M. Standley et al. (Eds.), Medical music therapy: A model program for clinical practice, education, training and research (pp. 167-220). Silver Spring, MD: American Music Therapy Association. Standley, J. (2012). Music therapy research in the NICU: An updated meta-analysis. Neonatal Network, 31(5), 311-316. Standley, J. M., & Walworth, D. (2010). Music therapy with premature infants (2nd ed.). Silver Spring, MD: The American Music Therapy Association, Inc. Standley, J. M., & Whipple, J. (2003). Music therapy for premature infants in the neonatal intensive care unit: Health and developmental benefits. In S. L. Robb (Ed.), Music therapy in pediatric healthcare: Research and evidence-based practice (pp. 19-30). Silver Spring, MD: The American Music Therapy Association, Inc. Symington A. & Pinelli J. M. (2006) Developmental care for promoting development and preventing morbidity in preterm infants. Cochrane Database Systematic Reviews 2, CD001814.  About the Author Michael R. Detmer, M.M.E., MT-BC is a music therapist, lecturer, and clinical supervisor at University of Louisville and Norton Women’s and Kosair Children’s Hospital in Louisville, KY.




Sound Play for Preschoolers With Cochlear Implants Kate Gfeller, Ph.D. School of Music, Department of Communication Sciences and Disorders, Iowa Cochlear Implant Clinical Research Center, University of Iowa Hospitals and Clinics The University of Iowa Iowa City, Iowa This article describes music perception and enjoyment of preschool children who use a hearing device called a cochlear implant (CI). Although cochlear implants do not transmit an accurate replica of pitch or timbre, young children using CIs can enjoy many musical experiences if appropriately selected or modified. This article includes descriptions of those aspects of music most and least eectively conveyed by CIs, as well as strategies for facilitating successful participation in preschool music activities.

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As music therapists and educators know, preschool music programs not only expose children to the beauty of music, but also promote development of vocabulary, mental constructs, emotional regulation, and motor and social skills (Campbell & Scott-Kassner, 1995). Music can be an engaging and natural medium through which children learn; this includes youngsters with hearing loss (Gfeller, Driscoll, Kennworthy, & Van Voorst, 2011). The children pictured in this preschool music therapy session have severe to profound

hearing loss, and access the world of music through a bionic inner ear called a cochlear implant (CI). Cochlear Implants and Music Cochlear implants (CIs) are hearing devices used by persons with severe to profound hearing losses who receive little if any benefit from conventional hearing aids (Looi, Gfeller, & Driscoll, 2012). A CI does not cure deafness or convey sound as one hears through a normal ear. Unlike hearing aids, which amplify sound, CIs have an externally-worn microphone and sound processor


which pick up and process the features of sound waves most salient to speech perception. This electrical signal, transmitted to an electrode array implanted in the cochlea, stimulates the auditory nerve. The signal travels via the auditory pathway to the brain, where meaning is assigned to the sound. More detailed information regarding the CI and how it works can be found at the following NIH website: health/cochlear-implants. CIs have been remarkably successful in helping young children with pre- or peri-lingual deafness to acquire spoken language. Unfortunately, CIs are not ideally suited for conveying music, especially pitch and timbre (Looi, Gfeller, & Driscoll, 2012). On average, recipients of CIs have pitch perception significantly poorer than that of persons with normal hearing, which makes melody recognition and singing in tune difficult. However, accuracy of pitch perception does vary from one CI user to the next. For example, some describe musical notes as sounding like a series of ‘thuds’ with no central pitch. Others can hear semblances of melodic contour, though interval sizes may be compressed. Interestingly, a small proportion of children with CIs has achieved surprisingly accurate pitch perception or production within some frequency ranges. This difference among users of CIs is not fully understood, but some children have improved pitch perception in part because of focused music instruction over months or years (Gfeller et al., 2011). How about sound quality? Young CI

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users can discriminate between distinctly different musical instruments (e.g., piano vs. violin). However, differentiating between more similar sounds (e.g., maraca vs. tambourine) or recognizing an instrument from sound alone can be difficult (Hsiao & Gfeller, 2012). Because the fascinating and beautiful sounds of music can draw children into play, it is more problematic that some musical sounds may be harsh, robotic, or shrill when perceived through a CI. Some users of CIs have described music as sounding like a garbage disposal, or like unpleasant electrical chimes. It is likely, however, that some musical instruments do sound pleasant to individuals; this can be determined through exploration and trial and error. Furthermore, the unusual tone quality through the CI is not necessarily an impediment for all children. Children who have grown up using a CI do not have a point of comparison with music as heard through normal hearing (Gfeller, et al., 2011). Music through the CI is music to them. Children using CIs compare quite favorably with children with normal hearing when it comes to rhythm perception (Hsiao & Gfeller, 2012). Children with CIs can readily keep a beat, detect tempo changes, and match or produce rhythm patterns with basic instruction. Thus, rhythm-based movement or instrument playing can be engaging and successful for integration in musical games and instruction.

Cochlear Implants and Early Childhood Music Even though CIs convey a degraded representation of pitch and timbre, young children can enjoy and succeed in early childhood music with a few accommodations. Over two decades of clinical observation in our center confirms the viability of music engagement, including playing instruments, movement, and singing songs (albeit not necessarily in tune). Parents of preschoolers confirm these observations through questionnaires about music in the daily lives of preschoolers with CIs (Driscoll, Gfeller, Tan, See, Cheng, & Kanemitsu, 2015). Daily music involvement by preschoolers with CIs (age 2-5) included listening (78.6%), socializing via music (71.4%), moving to music (64.3%), playing music toys (42.9%), and creating and exploring music (28.5%). Factors that improve music enjoyment include live music with visual input, a quiet listening environment, moderate volume, and simpler music with a clear beat. Interestingly, despite how poorly CIs

To better understand the impact of CI technology on musical sounds, the following link offers interactive sound files that simulate the sound of popular music through a CI: http:// When listening, identify those musical aspects best (e.g., rhythm) and poorly (pitch) conveyed, and keep in mind that beauty is in the brain of the beholder.


convey music, the children with CIs had similar amounts and types of involvement in music as their siblings with normal hearing. Perhaps the most valuable lesson learned from this study is the importance of parental attitudes (Driscoll, et al., 2015). Preschool children with CIs, who have more familial encouragement and exposure to music experiences in the home or in the community, are more likely to enjoy and have successful engagement with music. Fostering Successful Participation Because children with CIs vary on a host of factors (including hearing history, device type, familial environment, and personal interests), early childhood educators and practitioners will need to individualize music experiences for preschoolers with implants. The following four suggestions offer practical tips that may foster successful participation of young children with CIs in music groups. Finding practical resources for understanding and troubleshooting CI use There are three primary manufacturers of cochlear implants. While similarities exist across brands, there are also device-specific details (such as function keys or battery usage) for each brand and model. Each of the companies provides information on rehabilitation, educational concerns, and device maintenance. Find out the type of CI used, and check out that company’s website.


Advanced Bionics Cochlear Corporation MED-EL Establishing goals and objectives for preschool children who use CIs Music in early childhood should encourage playful exploration of music (Campbell & Scott-Kassner, 1995). The goals and objectives for children with CIs tend to be more similar than different from preschoolers who have normal hearing. After all, they are children first, who happen to have hearing loss (Gfeller et al., 2011).


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That being said, there may be a discrepancy between a child’s chronological age and development and his/her hearing age. The extent of the discrepancy depends upon hearing history. Earlier, longer, and more severe auditory deprivation can undermine auditory development, and consequently, speech, language, and music development. Therefore, some milestones may be achieved at a later age or slower rate. Goals, objectives, and types of experiences should take into account the child’s chronological maturation as well as hearing age. As is true for children with normal hearing, children with CIs vary in rate of development within different domains, thus individual and dynamic assessment for each child is advisable. Some musical skills that require precise pitch and timbre perception may be particularly challenging. Set realistic goals for perceptual accuracy and mastery, and emphasize exploration and engagement. For example, many children with CIs may have difficulty singing in tune with an external pitch, yet they may still enjoy using their voices and learning song lyrics. Choosing musical instruments As a point of departure, select musical instruments that are suitable for most any preschooler – those that are sturdy, easy to handle, enticing, and have good sound quality. Instrumental preferences vary from one child to the next. Because CIs are best at conveying rhythm (compared with pitch and timbre), rhythm instruments may be easier than pitch-based instruments. When working on timbre discrimination or recognition, start with instruments that have distinctly different timbral features. For example, the sounds of a maraca and a tambourine may be quite similar for a CI user, in contrast to a maraca vs. a drum.


Keep in mind that audibility (perceptual capability to hear a sound) is not a concern for CIs, as can be the case with hearing aids. Therefore, avoid playing musical instruments too loudly, which can be painful for CI users. A younger child may have difficulty verbalizing responses, but rather may make faces, pull at his/her ears, or cry if a sound is too loud or unpleasant. Through playful exposure to various instruments paired with careful observation, it is possible to ascertain responses to specific instruments and figure out which are most suitable for a given child.


Also, keep in mind that CI users have greater difficulty hearing and understanding speech or musical sounds against background noise. Therefore, make an effort to facilitate music in a non-reverberant and relatively ‘clean’ acoustic environment. Choosing and facilitating songs In general, the music therapist, teacher, or parent can draw from the same rich repertoire of children’s songs used in most any preschool. However, because of possible speech and language delays, some songs with more sophisticated grammar, vocabulary, or concepts may require more pedagogical support such as breaking down the song, using visual aids, or demonstrating concepts with actions. A slower rate of singing and repetition can help children to understand and learn the lyrics.


Many beloved songs in early childhood repertoire (e.g., “Itsy Bitsy Spider,” “The Wheels on the Bus,” “Five Little Ducks”) present numerous opportunities to listen to and produce speech sounds and demonstrate concepts such as spatial (up and down, in and out) and temporal (1st, 2nd, last, etc.) relationships. A conversation with a child’s teacher or speech-language therapist can help with the selection of songs that reinforce important and developmentally appropriate concepts and speech sounds. Encouraging participation in music Therapists and teachers should select developmentally appropriate musical experiences and facilitate them to engage children of various capabilities. Concepts introduced in the classroom can be further consolidated if parents are provided with songs or activities to use as part of play in the home environment. As noted previously, the children most likely to enjoy music in daily life are those encouraged by their parents.


In conclusion, even though CIs do not convey musical sounds as does typical hearing, thoughtful accommodations that take into account the technical features of the CI as well as the auditory development of the children can support satisfactory participation in early childhood music. Perhaps the most important advice is

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to keep things playful. Early childhood music that focuses on playful exploration of musical sounds can bring youngsters who use CIs into the wonderful world of music. References Campbell, P. S., & Scott-Kassner, C. (1995). Music in childhood. NY: Schirmer Books. Driscoll, V., Gfeller, K., Tan, X., See, R., Cheng, H., & Kanemitsu, M. (2015). Family involvement in music impacts participation of children with cochlear implants in music education and music activities. Cochlear Implants International, 16(3), 137-146. Gfeller, K., Driscoll, V., Kennworthy, M., & Van Voorst, T. (2011). Music therapy for preschool cochlear implant recipients. Music Therapy Perspectives, 29(1), 39-49. Hsiao, F-L., & Gfeller, K. E. (2012). Music perception of cochlear implant recipients with implications for music instruction: A review of literature. UPDATE, 30(2), 5-10. Looi, V., Gfeller, K., & Driscoll, V. (2012). Music appreciation and training for cochlear implant recipients: A review. Seminars in Hearing, 33(4), 307-334. Note: This study was supported by grant 2 P50 DC00242, RO1 DC012082-10, and 2 RO1 DC003698-06 from the NIDCD, NIH; grant RR00059 from the General Clinical Research Centers Program, NCRR, NIH; and the Iowa Lions Foundation. About the Author Kate Gfeller, Ph.D., is Russell and Florence Day Chair of Liberal Arts and Sciences, and holds appointments in the School of Music, the Department of Communication Sciences and Disorders and the Iowa Cochlear Implant Clinical Research Center in Otolaryngology at the University of Iowa. Her research on music perception, enjoyment, and rehabilitation has been supported by the National Institutes of Health since 1990. Contact:



Selecting Songs for Language and Cognitive Development of Preschoolers: Suggestions From the Research Literature


Alisha Luymes, BME University of Iowa Iowa City, Iowa

Have you ever thought, “I do not know what songs to use for my session/circle time tomorrow… I wish I had more time for planning! What am I going to do?” Well, you are not alone! Starting with a summary of the rationale and systematic process of the author’s song selection project, this article provides a quick and easy resource and examples to support music therapists and early childhood educators in identifying and applying familiar songs that can be used for specific learning goals for young children with various ability levels.

Developing Specific Song Lists for Preschoolers Identifying a Pool of Familiar Songs. Using familiar children's songs may have multiple advantages. Familiar songs can be easily generalized across settings and implemented by a variety of individuals caring for young children. Common song repertoire for young children has been described in the literature for more than two decades by authors like Humpal (1998), Connors and Wright (2004), and Kulich and Suzuki (2006). The author analyzed the content of these publications and identified 81 songs that were included in a resource list.

Alisha Luymes completed her BME at Northern State University in South Dakota. This project has been completed in partial fulfillment of her MA degree in music therapy at the University of Iowa. Contact:

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Determining Familiarity. To determine if songs included on the list represent current, familiar children's songs, three groups were contacted to rank the 81 songs from most to least familiar: a) parents of young children who were non-music experts, b) three music therapists who have had clinical experience working with young children, and c) three early childhood music experts. A composite list was then created from all rankings. Songs included in the top two-thirds of the composite list were considered sufficiently familiar.


Categorizing Songs. Songs can provide a natural opportunity for children to learn pre-academic concepts and vocabulary. The early childhood music experts were asked to analyze the lyrics and classify the songs under the following four operationally defined categories: a) classification, b) seriation, c) spatial relations, and d) temporal relations. Their responses were then analyzed for inter-rater reliability. The categories chosen were all associated with a cognitive-linguistic approach to language development for preschoolers (Gfeller, 1990). Selecting the Final Song List. To create a ‘top ten’ list of items for each category, songs were ranked according to the composite familiarity score and the category results with greatest inter-rater reliability. This method provided a systematic way of selecting the most familiar songs. The final lists for each of the categories are displayed in the four boxes along with an example. Songs that fit into multiple categories are marked with an asterisk. Modifications in Facilitation While the song lists offer a good starting point, music therapists or early childhood educators must also consider the unique abilities, interests, preferences, and needs or background (e.g., culture) of each child and select the songs accordingly. Additionally, modifications can be made to songs to help facilitate each child’s specific goals and objectives. Changes may include adaptations of the lyrics, simplifying the

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1 Classification Classification is the mental task of grouping objects or events by shared qualities or characteristics (e.g., shapes, colors, categories of animals or food). 1.

Apples and Bananas

2. 3.

Head and Shoulders, Knees and Toes* Old MacDonald


Down by the Bay

5. 6.

Make New Friends (But Keep the Old) The More We Get Together

7. 8.

Hokey Pokey* Baa Baa Black Sheep


You are My Sunshine


Pease Porridge*

Example: “Old MacDonald” has many animals on his farm (e.g., cows, pigs, ducks). As the song progresses, more animals are added. These are all farm animals that are being grouped together.

2 Seriation Seriation is the mental task of ordering objects based on quantity, magnitude, or quality (e.g., numbers/counting, big/little, rough/ smooth). 1.


2. 3.

Ants Go Marching Bingo


Five Little Monkeys*

5. 6.

Head and Shoulders, Knees and Toes* The Wheels on the Bus*

7. 8.

This Old Man Hickory Dickory Dock*


If You’re Happy and You Know It


She’ll be Comin’ ‘Round the Mountain*

Example: “Ants Go Marching”starts off with one ant and keeps adding another in, which can help address counting. The concept of more/less could also be addressed by comparing and contrasting groups of ants.


3 Spatial Relations Spatial relations is the concept of understanding one’s own orientation in space, such as in/out, up/down, near/far, etc. 1.

Hokey Pokey*

2. 3.

Itsy Bitsy Spider Twinkle, Twinkle, Little Star


Here We Go Looby Loo

5. 6.

My Bonnie Lies Over the Ocean Over the River and Through the Woods

7. 8.

Where is Thumbkin? Five Little Monkeys*


Row, Row, Row Your Boat


The Wheels on the Bus*

Example: In “Itsy Bitsy Spider,” the spider goes up the spout, rain comes down, and the sun comes out. Up/down, high/low, and in/out are all concepts of spatial relations that can be addressed within this song.

4 Temporal Relations Temporal relations is the mental task of chronologically ordering events or routines such as first, second, third, last. It can also include seasons, beginning/end, day/night, etc. 1.

Humpty Dumpty

2. 3.

It’s Raining, It’s Pouring Hickory Dickory Dock*


Hush Little Baby

5. 6.

Rain, Rain, Go Away She’ll be Comin’ ‘Round the Mountain *

7. 8.

Skip to my Lou The Farmer in the Dell


Baby Bumblebee


On Top of Spaghetti

structure, slowing the tempo, simplifying the accompaniment, or even singing a capella. When working with children who have intellectual disabilities, hearing impairments, or speech and language delays, slowing the tempo of the song may be important in setting them up for success. Lyrics may be changed to provide more repetition of certain vocabulary or concepts. If a child has difficulty producing certain phonemes, a song could be altered to offer additional practice opportunities. Conclusion Many well-known children’s songs can be used to work on pre-academic concepts and vocabulary with young children. While this song list is not all inclusive, it is a quick and easy resource that can be utilized when planning music therapy sessions or circle time. References Connors, A. F., & Wright, D. C. (2004). 101 rhythm instrument activities for young children. Beltsville, MD: Gryphon House. Gfeller, K. (1990). A cognitive-linguistic approach to language development for the preschool child with hearing impairment: Implications for music therapy practice. Music Therapy Perspectives, 8, 47-51. Humpal, M. E. (1998). Song repertoire of young children. Music Therapy Perspectives, 16, 37-42. Kulich, B., & Suzuki, L. (2006). Growing with music: Friendly bear's song book. Vancouver: Empire Music. Acknowledgments The author wishes to thank the following individuals for supporting this project: Dr. Kate Gfeller, Virginia Driscoll, Alaine Reschke-Hernandez, Meghan Ross, Dr. Mary Adamek, Marcia Humpal, and Amy Furman.

Example: “The Farmer in the Dell” presents items in chronological order. First comes the farmer, second comes his wife, next comes the child, etc.

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Steady Beat: Laying a Foundation for Literacy Kathy Schumacher Music Therapy Services, LLC Oshkosh, Wisconsin Phonological Awareness. Phonological awareness includes the foundational literacy skills that emerge long before a child starts to learn the name and sound of each letter. Developing phonological awareness includes the ability to detect and manipulate individual sounds of language rather than focusing on meaning. Phonological skills include blending and segmenting sounds in words, rhyming words, and dividing words into syllables. Many studies have demonstrated that phonological awareness is

strongly related to the development of reading skills (Anthony & Frances, 2005; Gillon, 2004). Additional skills that develop earlier and aid in the development of phonological awareness include directional concepts, sequencing environmental sounds, and synchronizing body movements to an external beat. Beat Synchronization. This term means a child can move his or her body in sync with an external rhythm. Recent research suggests that there is a connection between a child’s ability to tap to a beat and cognitive skills, including reading readiness (Tierney & Kraus, 2013; Woodruff Carr, White-Schwoch, Tierney, Straight, & Kraus, 2014). This skill can be developed by bouncing a baby in a lap or banging on pots and pans with a wooden spoon in time with parents’ singing. Nursery Rhymes. Practice keeping a steady beat by tapping on body parts, clapping hands, or playing

The gift of reading is what we want for every child. However, when a person is given the opportunity to parent a child with special needs, life gets busier than ever thought possible. How do we squeeze in the development of literacy skills amidst everything else that needs to happen daily? What can even be done to develop literacy skills at such a young age? Don’t we have to wait until children are ready to learn the alphabet? This article gives examples of how to use music to address key components of early literary during daily activities and family routines.

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instruments while reciting traditional nursery rhymes. Research has long established that a significant relationship exists between the knowledge of nursery rhymes at three years of age and success in reading and spelling at later ages (Maclean, Bryant, & Bradley, 1987). Call and Response. Tapping body parts and moving to a steady beat with a parent helps a child learn to imitate and take turns. The rhythmic component improves focus. The following chant also improves working memory, a skill that includes remembering and planning and helps with the development of phonological awareness (Alloway et al., 2005).

“My turn

(point to self)

your turn

(point to child)

Parent: “nose—nose” Parent: “nose—tummy” Parent: “knees—jump!”

I’ll - go - first.” (point to self 3 times)

Child: “nose—nose” Child: “nose—tummy” Child: “knees—jump!”

Rhyme While You Eat. …and when in a carseat, and while you are walking down the street focus on playing with the sounds of language. Use your child’s name and turn Sammie into Lammie, Zammie, and Hammie! Recite those nursery rhymes over and over again, and have fun changing parts of a word to make a new word. Keep It Upbeat. …when you read, read, read, and read some more. What if children will not sit still to listen to a book that is read to them? Look for books that are visually uncluttered. Books with rhythmic text, like a chant or rap, helps maintain attention in young children. Using singable books—fitting the text to a familiar or new melody—is also very effective. Here are five suggestions: Silly Sally by Audrey Wood—The text works well with the tune of “London Bridge.” What a Wonderful World illustrated by Tim Hopgood —Text and illustrations accompany “What a Wonderful World” as recorded by Louis Armstrong. Pete the Cat: I Love My White Shoes by James Dean & Eric Litwin—While there is a recording available for this song, the following melody is an option as well:

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Rhyming Dust Bunnies by Jan Thomas— This book offers opportunities to create specific rhymes with text that provides a visual cue. Do Cows Meow? by Salina Yoon— The pictures in this book work well with this simple melody:

Repeat, Repeat, Repeat! It is okay to use the same book over, and over, and over again! Once the book is familiar, stop before the last word of a familiar phrase, and let children fill in the missing word. It is tempting to do this too soon; be sure they have heard the book ten or more times before trying. Focusing on Words Once a foundation of beat synchronization, working memory, and rhyming has been established, children are ready to focus on words. In early stages, children learn to manipulate larger chunks, gradually moving toward the smallest unit of sound, a phoneme. At all levels of learning to read, we are segmenting (taking apart) and blending (putting together). This happens at four levels. Table 1 displays an example using the sentence “Music is fun!” Playing with language in this way can spontaneously happen throughout the day. Although it is helpful to provide a visual prompt, especially at the phoneme level, it is not necessary at all times. Think of this as just playing with the sounds of language while separating larger chunks into smaller chunks. Words. Point to words in a book. Write a simple sentence, with each word on a separate sticky note. After placing the sticky notes in a series, simply point to each one with a steady beat, and read the sentence. Syllables. Clap the syllables in family members’ names. Count the number of syllables and create a column for names that have one, two, or three syllables. Tap out the syllables on a drum to add variety.


Larger Chunk

Smaller Chunk





Music is fun! = music + is + fun

music + is + fun = Music is fun!



music = mu + sic

mu + sic = music

Words & Syllables


fun = /f/ + un

/f/ + un = fun

Words & Syllables


fun = /f/ + /u/ + /n/

/f/ + /u/ + /n/ = fun

Table 1: Example for Phonological Awareness. Onset-Rime. By separating mop, hop, and top into /m/op, /h/-op, and /t/-op, a child learns to recognize smaller chunks. Blending an onset (the initial consonant) with the rime (the vowel and consonant after the onset)—also called a “word family”—is easier than jumping right into blending three sounds (/m/-/o/-/p/). Playing with onsets and rimes helps children further develop their ability to produce rhymes and to recognize patterns when they are reading. Phonemes. This is often called “sounding it out” which is segmenting while remembering the sound for each letter and then blending those sounds together. At this stage, it is critical that a connection is made with a visual representation of letters. Using music, including rhythm, to address these skills can be a motivating way to give children the gift of literacy. References Alloway, T. P., Gathercole, S. E., Adams, A., Willis, C., Eaglen, R., & Lamont, E. (2005). Working memory and phonological awareness as predictors of progress towards early learning goals at school entry. British Journal of Developmental Psychology, 23, 417-426. Anthony, J. L., & Francis, D. J. (2005). Development of phonological awareness. Current Directions in Psychological Science, 14(5), 255-259.

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Gillon, G. T. (2004). Phonological awareness: From research to practice. New York, NY: The Guilford Press. Maclean, M., Bryant, P., & Bradley, L. (1987). Rhymes, nursery rhymes, and reading in early childhood. Merrill-Palmer Quarterly, 33(3), 255-281. Tierney, A. T., & Kraus, N. (2013). The ability to tap to a beat relates to cognitive, linguistic, and perceptual skills. Brain & Language, 124, 225-231. Woodruff Carr, K., White-Schwoch, T., Tierney, A. T., Strait, D. L., & Kraus, N. (2014). Beat synchronization predicts neural speech encoding and reading readiness in preschoolers. Proceedings of the National Academy of Sciences of the U.S.A., 111, 14559-14564. About the Author Kathy Schumacher, MT-BC is a music therapist in private practice near Oshkosh, Wisconsin, where she focuses on reaching and teaching children with diverse learning styles. Kathy blogs at and is passionate about improving literacy for all children. Contact:


Talk less. Use fewer words that can be more readily processed by the children. Also use quick transition songs to move between interventions or to redirect.

Tips Marcia Humpal, M.Ed., MT-BC Cleveland State University Associate Editor, imagine

Limit your choices. This will keep the session moving and will be less daunting for the children when trying to come to a decision.

Be in proximity. Sit close to the children so that you can get better eye contact and move directly into their space when you are addressing them.

When reinforcing, be specific. “Good job” doesn’t really reinforce the skill itself. Vary your descriptors, too – e.g., “Super singing!”

What Music Therapy Students Should Know About Working With Young Children Use more, but shorter, songs/interventions. When having the children take turns, make the turns brief. Go quickly back and forth between children. This keeps the song and the pace moving. “Down time” can be lethal!

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About the Author Marcia Humpal is Associate Editor of imagine and was co-founder of AMTA's Early Childhood Network. She was the 2013 recipient of AMTA's Lifetime Achievement Award. Currently an adjunct faculty member at Cleveland State University, she also continues her clinical work at the Toddler Rock program at Cleveland's Rock and Roll Hall of Fame.

Use statements, not questions. If you ask children if they want to do something, they may justifiably refuse! Instead of “Can you choose a farm animal?” simply say, “Choose a farm animal.”


EIGHT WAYS MUSIC MAKES A DIFFERENCE Infographic by Christopher R. Millett, M.M., MT-BC Created for imagine 2016, the early childhood online magazine published by de la vista publisher.

Music engages many aspects of human functioning at various developmental levels. Music therapists are trained to use music interventions to achieve individualized goals.

MUSIC & PLAY Children learn through play. Musical play is motivating, supportive, and engaging.

RELAXATION Slow, repetitive, and simple songs like lullabies can have a calming effect.

PAIN & STRESS Music can help children cope with pain and stressful situations. It can also be used to teach positive coping skills.

MOTOR SKILLS Music can be used to structure or motivate movement. It can be used to promote rehabilitation or to develop motor skills.

SOCIAL SKILLS Group music-making provides opportunities for social interaction. Music can also be used to teach important social skills.

COMMUNICATION SKILLS Music is a form of communication that can be used to teach or enhance speech and language skills.

BONDING FOR FAMILIES Because music can be social, pleasurable, and engaging families can use music to create or strengthen bonds from infancy onward.

COGNITIVE SKILLS Music is a highly effective teaching tool. Participating in music has also been shown to enhance cognitive functioning in a number of areas like listening skills and memory.

Board-certified music therapists (MT-BC) have a degree in music therapy, completed over 1200 hours of clinical training, and passed a national board certification exam. To find a board-certified music therapist in your area or to learn more visit Source: Humpal, M. (2015). Music therapy for developmental issues in early childhood. In B. L. Wheeler (Ed.), Music Therapy Handbook (pp. 265-276). New York: Guilford Press. Image statement: Icons made by from and are licensed by creative commons license

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Early Childhood Development, Music, and the Grief Process Lorna E. Segall, Ph.D., MT-BC University of Kentucky Lexington, Kentucky

What is Grief? Grief is a normal, natural reaction to a loss of any kind. Grief may accompany the end of or change in familiar patterns of behavior (Lyle, 2010). It can occur in response to a) expected events like moving to a new home or going through a divorce, b) unexpected, traumatic events like witnessing school violence, acquiring a disability, surviving a natural disaster, or the death of a loved one (Hooyman and Kiyak, 2008). Adults often find the

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grief process to be complex, unfamiliar, and challenging. They may find that contrasting feelings of guilt, regret, lack of closure, and depression can make verbalizing the grief process frustrating, and even something the most skillful adults may find it diďŹƒcult to navigate (Hilliard, 2015; Hooyman & Kiyak, 2008). For children, a limited or non-existent understanding of loss, limited vocabulary, and developing emotional literacy make grieving even more challenging and

confusing (Hilliard, 2015; Register & Hilliard, 2008). Understanding how children exhibit grief is important in order to assist them with learning coping skills and making the grief process a meaningful and useful experience. Parents, teachers, counselors, and therapists play a critical role in helping children handle these complex emotions in a meaningful, healthy, and productive manner.


What Does Grieving Look like in Children? Like adults, children express their grief in unique and varying ways. No child is too young to experience grief. Research states that infants about the age of six to eight months have the associative cognitive ability to experience a sense of loss. At this developmental stage, infants are able to identify specific relationships with individuals. This concept, known as stranger anxiety, indicates that an infant has identified a connection with its caretaker (Osterweis, M., Solomon, F., & Green, M., 1984). Absence of this caretaker’s presence results in depressive and discontented behavior on behalf of the infant (Okun & Kantrowitz, 2015). Additionally, children at this age are sensitive to the environment in which they exist and perceive the stress, fear, and anxiety portrayed by those surrounding them. Too much emphasis on processing these mature emotions can cause delays in other areas of growth such as motor development (Hopkins, 2002). Pre-school or school age children are capable of experiencing grief psychosomatically (Lyle, 2010). Although children 18 months to three years may not internalize the concept of loss, they can exhibit feelings of distress, anxiety, sadness, anger, or confusion (Hilliard, 2015). They are familiar with the idea of something missing and are able to experience feelings of anguish and anxiety (James, 2008). Children ages three to five are able to attempt verbal communication of their feelings regarding fear,

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sadness, and anger (Lyle, 2010; Osterweis, Solomon, & Green, 1984). Their inability to understand the concept of ‘never’ conflicts with their developmental expectation that something will return and that they will regain what has been lost. Children at this stage do not yet have a clear understanding of death and might consider it “as punishment for bad behavior, and may have a fear of separation” (Hilliard, 2015, p. 78). Children may present with fatigue, appetite fluctuations, low energy, or headaches. Behaviorally, they may exhibit behaviors of isolation, crying, or avoidance of familiar places associated with their loss and seek reassurance that the loss has actually occurred by repeatedly asking questions (Lyles, 2010; Stuber, Hovsepian, & Merskhani, 2001). Taking a proactive approach in anticipating these questions may calm the needs of the child and ease the frustrations of a grieving caregiver. In a study exploring the loss of a parent in early childhood, researchers found that children who were grieving experienced higher levels of sadness and fear than children who were not grieving (Kranzler, Shaffer, Wasserman, & Davies, 1990). Interestingly, differences were also noted between males and females. Females reported higher levels of sadness when thinking about their deceased parent. It is also important to note that those children who were able to report their feelings were more likely to demonstrate higher levels of functioning (Kranzler et al., 1990). This type of information can help parents, teachers, and counselors

respond appropriately to a child’s experience of loss and presents valuable opportunities for child growth, development, and wellbeing. How Should We Respond to a Child’s Grief? With respect to a child’s developmental level, cognitive ability, and cultural framework, parents, teachers, and therapists are encouraged to be honest when discussing grief and loss with a child (McGlauflin, 1998). Children should have access to an environment of complete acceptance, an open invitation to ask questions, and an opportunity to express their grief in any way they see fit (Milton, 2004; Wolfelt, 1983). Most importantly, it is imperative that they be given the opportunity to process their emotions at their own pace and in their own way (James, 2008; Milton, 2004). Today’s children represent a variety of traditions, cultures, and religions, making it necessary for caregivers to become familiar with and considerate of the backgrounds from which their clients come. Events happening on a national and global scale have resulted in dramatic shifts in the composition of the United States population. Issues relating to migration, birth rates, and civil rights have contributed to this evolving tapestry of our population (Milton, 2004; Okun & Kantrowitz, 2015). This diversity is perhaps one of the greatest and most exciting challenges facing today’s therapists (Okun & Kantrowitz, 2015). Music therapists must make it a priority to familiarize themselves with various


traditions, music, and customs. A thorough understanding of this information ensures a therapists’ ability to create healthy grieving opportunities. What is Healthy Grieving and How Do We Do That? Unaddressed grief can result in the development of behavioral and cognitive processing problems (McGlauflin, 1998). Difficulties can be seen in lack of concentration, irregular sleep, digestive issues, physical aggression, and learning challenges (Osterweis, Solomon, & Green, 1984). Though not conclusive, the research literature suggests that unattended grief experiences in early childhood can largely increase a child’s likelihood of suffering from depression, educational challenges, and delinquent behavior (Osterweis, Solomon, & Green, 1984). Prevalence of this outcome has resulted in the creation and identification of a personality disorder labeled Prolonged Grief Disorder or PGD. This has been identified in many adults and in a growing number of children (Spuij, 2015). Healthy introductions to the grieving process can positively impact future experiences with grief across the lifespan. Unhealthy associations with grief and loss and deficits in coping skills impact how we relate to each other, how we view ourselves, and how we interact with our world (Wolfelt, 1983). Introductions to concepts of grief need not wait until a loss has occurred. Research supports and encourages proactively working

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with children regarding these concepts (McGlauflin, 1998). This can be difficult for adults as it may require facing their own unresolved grief issues, but it is essential that children feel validated in their feelings and understand that their reactions are natural, normal, and healthy (Milton, 2004). Children benefit from having expressive outlets for their grief (Hilliard, 2015; McGlauflin, 1998). What Grief Support Can Music Therapy Offer? Music therapy provides an evidence-based, developmentally appropriate opportunity for children to engage in and process their grief (Register & Hilliard, 2008). Its ability to address multiple objectives simultaneously, offer an inclusive nature, provide flexibility, and allow for adaptive implementation make it an ideal treatment modality for children at all levels of development. Whether on an individual or group basis, music therapy sessions allow not only for children to receive support from their peers but also to meaningfully interact with family members who might also be working through their grieving experience. Goals of music therapy and grief work may include: emotional identification, cognitive re-framing, behavior modification, coping skills, identifying peer/family support, and cultivating a deeper understanding of what it means to grieve (Hilliard, 2015). One of the most important aspects of the grieving process for children is to tell their story (Roberts, 2006). This activity is thought to accelerate acceptance, process the loss, and propel an individual to move in a

forward direction in a healthy manner. Interventions may include songwriting, lyric analysis, drumming, or creating memorial CDs. Children benefit from activities that are fun, familiar, and relevant to age-related milestones (Hilliard, 2015; Roberts, 2006). Conclusion Grief is a healthy and natural response to loss in life. It should be encouraged, explored, and utilized to teach current and future coping skills (Milton, 2004; Osterweis, Solomon, & Green, 1984; Spuij, 2015; Wolfet, 1983). Adults are not the only ones who grieve. Children as young as six months are capable of experiencing feelings of loss within the parameters of their developmental stage. Grief education for children is valuable for overall psycho-social well-being and laying the groundwork for future encounters with grief and loss. Music therapy provides unique and meaningful opportunities for processing grief during early childhood development (Hilliard, 2015; Register & Hilliard, 2008). References Hilliard, R. (2015). Music and grief work with children and adolescents. In C. A. Malchiodi (Ed.), Creative interventions with traumatized children (2nd ed., pp. 75-93). New York, NY: Guilford Press. Hooyman, N. R., & Kiyak, H. A. (2008). Social gerontology: A multidisciplinary perspective. (8th ed.). New York, NY: Pearson Education, Inc. Hopkins, A. R. (2002). Children and grief: The role of the early


childhood educator. Young Children, 57(1), 40-47. James, R. K. (2008). Crisis intervention strategies (6th ed.). Belmont, CA: Thomson Brooks/Cole. Kranzler, E. M., Shaffer, D., Wasserman, G., & Davies, M. A. (1990). Early childhood bereavement. Journal of the American Academy of Child and Adolescent Psychiatry, 29(4), 513-520. Lyles, M. M. (2010). Children’s grief responses. Children’s Grief Education Association: Navigating Children’s Grief. Retrieved from https:// /blog/2013/06/best-griefdefinition-you-will-find McGlauflin, H. (1998). Helping children grieve at school. Professional School Counseling, 1(5), 46-49. Milton, J. (2004). Helping primary school children manage loss and grief: Ways the classroom teacher can help. Education and Health, 22(4), 58-60. Okun, B. F., & Kantrowitz, R. E. (2015). Effective helping,

interviewing and counseling techniques, (8th ed.). Stanford, CT: Cengage Learning. Osterweis, M., Solomon, F., & Green, M. (Eds.). (1984). Bereavement: Reactions, consequences, and care. Institute of Medicine (US) Committee for the study of health consequences of the stress of bereavement. Washington, DC: National Academic Press. Retrieved from http:// NBK217849/ Register, D., & Hilliard, R. E. (2008). Using Off-based techniques in children’s bereavement groups: A cognitive-behavioral music therapy approach. The Arts in Psychotherapy, 35(2), 162-170. Roberts, M. (2006). “I want to play and sing my story.” Homebased songwriting for bereaved children and adolescents. Australian Journal of Music Therapy, 17, 18-34. Spuij, M., Dekovic, M., & Boelen, P. A. (2015). An open trial of ‘Grief-Help’: A cognitive-

behavioral treatment for prolonged grief in children and adolescents. Clinical Psychology and Psychotherapy, 22(2), 185-192. Stuber, M. L., & Merskhani, V. H. (2001). What do we tell the children? Western Journal of Medicine, 174(3), 187-191. Wolfet, A. (1983). Helping children cope with grief. New York, NY: Routledge Taylor & Francis Group. About the Author Lorna E. Segall, Ph.D., MT-BC is an assistant professor of music therapy at the University of Kentucky. Her research interests include hospice care, older adults, and the inmate population. Contact:

Music taught me that I’m not alone. There are other kids out there going through the same stuff I am." –Abbey, 6 years old, grief camp participant, Fort Myers, Florida

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What Happens in Music Therapy? A Coloring Worksheet


Madeleine Walworth Louisville, Kentucky



I meet new friends.



We sing and dance together.

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We say “Hello.”

Making music with instruments is fun.



We read books, too.



Playing the drum is my favorite.

Making up songs is awesome. About the Artist Madeleine Walworth is an aspiring artist and illustrator in the 8th grade. She loves reading, creating stories and art, and playing guitar.

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Letter From a Child Dana Bolton, M.Ed., MMT, MT-BC Bolton Music Therapy, Murfreesboro, Tennessee

: p U n w o r G y Special

To M

h fun! I s so muc i t I ! y p ra ’t feel usic the re doesn me to m su g t i n i t k u a b t re there, at you a ke it a when I’m g cited th n i x e k r t will ma o so a w h t e b I’m u l o ’l y e that I ould tell u tell m ings I sh h t w know yo fe There’s a t to me. like tha f us. erapy. I for all o e m i t music th r e n i s g n happi i h ! y to do t t is okay rong wa and tha w , o ld n u s o i eone at there hink I sh mber th ay you t lf or som e w se m y e e h r m t , t g st n n e Fir , how or hurti instrum therwise rument play an O st t . n o i n n e w t o h t h y mig roying if I gs on m not dest uck call out thin d ’m k I c a s e e h a k c g li d n As lon n sound xplore a block ca let me e d , o t i o w h t c i i else w a plast out that d n fi r e v will I e an, ill be cle w m e ! t h i t f blow on th. All o in my my mou n i s t n fe to put e sa m t u o r n st ’s their to put in ing that dings in y for me ’s anyth n e a e r k e e o v h t o r e f ls i n s It’s a ill tell u ith more ith their e born w erapist w r h t a s y e ything w i m r b e v a e b t and t u a o , know th ey check or rough Did you s why th smooth i t s i i s h i T – mouth. y s? s this wa mouth eir hand of thing ies who than th b s s d a h t b n i u st k o o m all r than m ey learn I’m olde f first! Th i s n h t e v u E o m or cold? ft, warm so r o d har be ight still m I s, g n thi ental evelopm in the d ed ere I ne TS stage wh WHAT PAREN heck it c I e c n that. O OW th a SHOULD KN my mou h t i w t ou ady USIC more re e b l ’l I ABOUT A M , lot ith it to play w THERAPY . ly e t a i r p appro N


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,I . At first ’t like it n o d I because t used ed to ge ably not e b n o r I p , n ’s e t c, i place. Th e a lot ng musi will hav o a new t set duri st p d i p u se a t u r e t e g If I e to ge music th rst, just some tim ions. My d e ss e se n e ing at fi st h k t r f o o w e ’s n may ju t i i t t and rou t upset i look like ructure t, if I ge doesn’t t a st i h e f t I h r t e s. o i ft t w sound t now. A e with th t be a ne eed righ o help m h t n g s i I k t m c i a e r r h t w he of . It’s od. Or t stency is ble with e. Consi ’t feel go a n t m i r o t d fo t i r m o e giv ork to get co ’m tired ist will w nd need ecause I p b a a e r o t b e t h e t v h i c t mig y my musi I’m sensi t to be m nt that ely, and e t m le p u r m st turn ou o c t h se g e or in i h t m ow – it t avoid never kn nt to no u o Y . t i importa o et used t elp me g h o t w o sl vel ental le m ment! p u r lo e st v n e i d favorite ge and myself eep my a k s, d i stick by k l r ’l e I h , t st o r h ar ds. At fi rapy wit other ki l play ne usic the ’l h t I i m e w r n i e y h la w p If I’m ce I llel play hing me play! On en watc nto para i o h t e w v lf d o se n y m i in m r off by m hen I’ll great fo y own. T ry if I go r m o n w o ’t y erapy is n h o t D c s. si y u o and pla M e same t s more. s with th ther kid o d i h k t i r e w h g ot rt playin r, I’ll sta e ld o t e g ill! d YOU! n that sk r a le at I nee e h t m s i g r n i e b help o remem if you for you t g n i me. Even h t h t t i n w a c t r si o njoy mu imp how to e ipate in he most c e t i t m e r b h a y c p a a o e But m er at o do is t sic will t o togeth for you t njoy mu d e g n n u i a o h c y t e g The best things w al, seein . Of ’t music ideas on at home n e u h r t o a i y w u e v y o i think y e can pla ist can g c therap ts that w si n e u m m u y r safe inst it, too! M as well! ou some y w o sh orks just d w n n a o o e sp hom u keep wooden When yo t and a . o e p m a , sh se u cour and aid to p to grow n’t be afr o m o d o , r n e r fu ’t e me mo erapy is do! Can , you giv music th le h b g a u n o at I can i h h a t w t a h t t i Even t u w s high, b rise you I’ll surp ectation p t x a e h t r t u e o b y ntial. I full pote y m h c rea week! me next i t c si u m wait for About the Author Dana Bolton, MEd, MMT, MT-BC is a music therapist and mother of Jack, who loves to attend music therapy sessions as a peer model. Contact:

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Institutional Culture: Considering the Impact on Early Childhood Music Therapy


Nicole R. Rivera, Ed.D., MT-BC North Central College Naperville, Illinois


Early childhood music therapists provide services in a variety of settings including preschools, daycare centers and homes. Therefore, music therapists should be aware of the culture of the institution where services are being provided. This article will explore the question of institutional culture and the potential impact on early childhood music therapy.

Institutional Culture and Early Childhood Music Therapy Culture is defined on both a macro and micro level. The macro level culture reflects broader national and fieldwide beliefs and practices while micro level culture is based on the unique aspects of the individual organization. According to Kalyanpur and Harry (2012), “It would be expected that the special education system will reflect the ‘beliefs, values, and ideas’ regarding both the ends and the means of education, which in turn reflect those of the national macroculture” (p. 6). This demonstrates the reciprocal nature of how larger systems reflect cultural practices. Similarly, there are accepted structures and early childhood practices which reflect beliefs about young children and the nature of supporting learning and development. When describing culture at a more local level, Bruner (1996) stated that cultures are “composed of institutions that specify more concretely what roles people play and what status and respect these are accorded” (p. 29). Furthermore, cultures are exchange systems. Within the systems, microsystems operate to do “culture’s serious business” (Bruner, 1996, p. 30). Organizations are

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facilitating the day-to-day activities that perpetuate cultural beliefs. Therefore, it is critical to understand and examine institutions as microcultures that are informed by broader cultural structures in order to understand the impact on clinical music therapy. Nadesen (2005) emphasized that every early childhood setting has a unique culture that is informed by both macro and micro culture practices and “workers who lack understanding of organizational culture, its influences, and how to use these forces, will be weakened in their ability to serve children and youth” (p. 16). Blank (2014) described clinical decision-making as a process of discrete choices that are made throughout the clinical process. These decisions are informed by music therapy constructs and the therapist’s understanding of the needs of the client and progress in therapy. Ongoing assessment of the client’s responses to interventions inform in-the-moment decisions. When providing services within an institutional setting, the therapist must also consider the impact of the orientation and culture of the institution on the music therapy process. Baker (2013) examined this impact through interviews with 43 music therapists. The interviews revealed that the institutional culture either supported or restricted the therapeutic process. Clinicians reported having to be thoughtful about how environment was impacting process.


Focus Group Study A focus group study was conducted to further explore the impact of institutional culture on music therapy practices. The participants included ten music therapists who worked in a major metropolitan area with a variety of client populations and settings. In addition to general definitions of culture, the focus group study explored how music therapists described the influence of institutional culture on music therapy practices. Although this study was not specific to early childhood settings, several of the participants did have experience working with young children in private homes, hospitals, and schools. The participants described how the structure of the institutions in which they worked guided how services were delivered. For example, one participant worked for an agency that provided services for several schools. Music therapy was included on the Individualized Education Program (IEP) at some schools, but not others. She further shared that “sometimes if felt like music therapy had to fit the model versus the [client].” Classrooms that were driven by specific practices appeared more regimented. The participant stated, “The philosophy of the institution or the school really affects how much we can do and how we practice in those environments.” In early childhood settings, policy and philosophy shape factors such as class size, childcentered practices, and the value of playful learning – all of which can dramatically impact music therapy experiences.

The perception of different levels of trust created a sharp contrast between the two work environments. One participant reflected her experience on shifting from working in early childhood schools to providing homebased services. She stated, “Maybe it’s about the classroom being predictable and sort of normative and controlled or directed by a teacher and set of class members. There’s an agenda.” However, in the home environment, “maybe mom is there or mom and dad, or mom, dad, grandma, and every other extended family member there looking at you. It’s a different sort of feel.” Another participant also commented on how fluid and unpredictable home or family-based services can be based on who is present for the session. The participant explained, “There’s going to be a different environment, a different culture, a different community depending if there are additional family members who have come in.”

Institutional practices were sometimes seen as slow to change. A therapist shared that the setting she worked in was “very resistant to change.” She explained that the organizational leadership did not identify a need for change and “stepping into that culture and trying to change that culture…. just gets to be very difficult.”

A music therapist who provided contractual services discussed having to navigate multiple environments and alter his approach accordingly. He shared an incident where an approach that he used in one environment was “alarming to the staff,” and he had to be “a lot more laid back” to move between structured and more improvisatory approaches. Finally, another participant described that even within one school, each classroom can have a different set of practices. He stated, “You don’t know all of these schools so you go and you can see how the culture inside the classrooms because some teachers, they are more hands on so they will have more stuff sitting in the circle. Some of them they will have them do random things and really trust the therapist that you’re going to handle all of the situations.” Both of these examples stress the importance of flexibility as a clinician to assess and conform to the structure of the environments in which music therapy services are delivered.

Another participant who worked in two school environments shared examples of how the building level administration created differences in the institutional culture. He commented that, “My private school and my public school are extremely different even though the populations are very similar, but in the private school it seems to be for the staff…it’s a much stricter environment.” He shared differences in monitoring his practices, integration of related services, and curriculum.

Findings from the focus groups demonstrated that the participants did perceive that environment shaped clinical process. As in the Baker (2013) study, different settings supported and constrained the process. Change was perceived to be slow at the institutional level. Music therapists who worked in multiple settings recognized the need to adjust to the setting. Further adjustments were required as clinicians described moving from room to room or family to family. Collectively, the experiences

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of the music therapists demonstrated the need for ongoing assessment of the environment and flexibility as a clinician to adjust practices in a meaningful way to best meet client needs within any setting. Conclusion What should early childhood music therapists know about institutional culture? Institutions are a reflection of larger cultural structures. Within the institution, individual leadership and collective practices further define the microculture. Both the macroculture and microculture shape music therapy practices. Music therapists should be cognizant of how institutional culture is either supporting or constraining the therapeutic process and clinical decision-making in order to be intentional in clinical practice. References Baker, F. A. (2013). The environmental conditions that support or constrain the therapeutic songwriting process. The Arts in Psychotherapy, 40(2), 230-238. Blank, C. A. (Author). (2014, September 15). Clinical decision making in music therapy. Retrieved from podcasts.html Bruner, J. (1996). The culture of education. Cambridge, MA: Harvard University Press. Kalyanpur, M., & Harry, B. (2012). Cultural reciprocity in special education. Baltimore, MD: Paul H. Brookes Publishing Co. Nadesan, V. (2005). The impact of organizational culture in child and youth care agencies. Child and Youth Care, 23(5), 16-17.


• Take time to understand the beliefs and practices of the early childhood settings in which you work. • Be familiar with the organization’s mission and vision statements. • Monitor the organization’s policies and procedures. • Consider how you want to support music as an important part of the organization’s cultural practices. • Advocate for young children within the organization.

About the Author Nicole R. Rivera, Ed.D., MT-BC, is a psychology professor at North Central College. Prior to working in academia, she worked for 15 years as a music therapist with children and their families. Contact:

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Music Therapy for Children With Autism Spectrum Disorder: Developing and Sustaining Professional Relationships With Pediatricians Edward Todd Schwartzberg University of Minnesota Minneapolis, Minnesota

According to the Autism Society (Autism Society, 2016) a physician most frequently determines the medical diagnosis of ASD using various standardized diagnostic tools while considering the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5™). Symptoms are typically identified during the second year of life, but may be observed earlier than 12 months if developmental delays are severe (American Psychiatric Association, 2013). Because pediatricians are often the first professionals to provide a medical diagnosis of ASD, music therapists need to be prepared to provide written and oral information that demonstrates the efficacy of music therapy for young children with ASD. It is also paramount for health care providers, caregivers, and care receivers to be informed of and have access to evidence-based and cost-effective educational and therapeutic interventions early on. The intention of this article is threefold: 1) to inform pediatricians about when to refer to music therapy, 2) to provide music therapists with a rationale to support referrals for clients with ASD, and 3) to offer healthcare providers, caregivers, and care receivers a list of resources to share with pediatricians when seeking music therapy services.

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Referral Criteria for Music Therapy Services Child demonstrates an interest in and positive response to sound and music; Music is observed as a learning modality of the child; Child is capable of grasping new information and concepts through music; There is evidence that the child’s goal areas can be functionally supported by a music therapy intervention; Child’s communication is limited or seems to demonstrate difficulty interacting with others; Child demonstrates a limited cognitive capacity or low physical activity/responsiveness; Other treatments plateau or may be contraindicated (Hanser, 1999; Kern, 2012).


Rationale for Selecting Music Therapy as an Intervention

Music therapy is a long-standing intervention option for young children with ASD and researchers have continued to investigate the eects of music on individuals with ASD over six decades (ReschkeHernandez, 2011). Neural under-connectivity has been demonstrated in individuals with ASD and, while not specific to those with ASD, music promotes neural plasticity and cortical stimulation in three key ways: a) increased neural connections, b) increased level of dopamine, and c) clear channel (Roth & Rezaie, 2011). According to the National Autism Center, music therapy is considered an emerging practice. Music therapists integrate many of the recognized evidence-based practices into their sessions (NAC, 2009). Researchers describe positive outcomes of music therapy interventions for improving communication, interpersonal skills, personal responsibility, and play as well as behavior/psychosocial, communication, intellectual skills, and body regulation of children with ASD (Whipple, 2012). According to researchers, the three primary treatment goal areas addressed with young children with ASD include communication skills, social skills, and emotional skills. These goals are addressed by utilizing singing and vocalization, instrument play, movement and dance, and free and thematic improvisation (Kern, Rivera, Chandler, & Humpal, 2013). Researchers have investigated the use of familycentered music therapy sessions, which may increase social engagement in the home environment and community (Thompson, McFerran, & Gold, 2013).

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Researchers have also investigated parent perspectives of music therapy, conducted by music therapy students in an on-campus clinic that 1) music therapy is a unique and enjoyable multisensory approach that engages and motivates children, 2) working with music therapy students is beneficial for children with ASD as it provides a change of routine and fosters flexibility, 3) the collaborative approach benefits all aspects of treatment and promotes rapport and alliance, 4) gains and progress from music therapy generalize to other settings, and 5) parents independently implement techniques used in music therapy in other settings (Schwartzberg & Silverman, 2016).

Approaching and Collaborating with Pediatricians Identify local pediatric agencies, pediatricians working in hospitals, and pediatricians in private practice. Regularly provide presentations and sta development opportunities to medical personnel. Use published information materials such as fact sheets, brochures, and annotated bibliographies about music therapy and ASD or create your own. Oer presentations and marketing materials to local and state autism advocacy organizations in order to market your services to the medical professionals in their databases. Provide workshops and marketing materials to parent support groups and early childhood and elementary programs. Conclusion Developing professional relationships with pediatricians is paramount to increasing accessibility to evidencebased music therapy services for young children with ASD. Moreover, by being prepared with current published research and professional resources, music



Fact Sheet: Music Therapy and Autism Spectrum Disorder (October 2015) Brochure: Music Therapy and Persons with ASD Short Report: Autism Spectrum Disorder Survey Study Outcomes (2015) Annotated Bibliography: Articles from the Journals of the American Music Therapy Association that Pertain to Music Therapy and ASD, 2000-2015 therapists can create sustainable professional relationships with both pediatricians and other health care providers. While pediatricians should feel confident in collaborating with and referring young patients with ASD to music therapists, researchers and clinicians need to continue to demonstrate and determine the effectiveness of music therapy interventions in addressing various goal areas. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C: Author. Autism Society (2016). About autism: Diagnosis. Retrieved from Hanser, S. B. (1999). The new music therapist’s handbook (2nd ed.). Boston, MA: Berklee Press. Kern, P., & Humpal, M. (2012). Early childhood music therapy and autism spectrum disorders: Developing potential in young children and their families. London: UK: Jessica Kingsley Publishers. Kern, P., Rivera, N. R., Chandler, A., & Humpal, M. (2013). Music therapy services for individuals with autism spectrum disorder: A survey of clinical practices and training needs. Journal of Music Therapy, 50, 274-303. National Autism Center. (2009). National standards project: Findings and conclusions. Randolph, MA: National Autism Center. Reschke-Hernandez, A. E. (2011). History of music therapy treatment interventions for children with autism. Journal of Music Therapy, 48, 169-207.

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Roth, I., & Rezaie, P. (Eds.). (2011). Researching the autism spectrum: Contemporary perspectives. Cambridge, UK: Cambridge University Press. Schwartzberg, E. T., & Silverman, M. J. (2016). Parent perceptions of music therapy in an on-campus clinic for children with autism spectrum disorder. Musicae Scientiae, 1, 1-15. Thompson, G. A, McFerran K. S., & Gold, C. (2013). Family-centred music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomized controlled study. Child Care Health Development, 40(6), 840-852. Whipple, J. (2012). Music therapy as an effective treatment for young children with autism spectrum disorders: A meta-analysis. In Kern, P., & Humpal, M. (Eds.), Music therapy and autism spectrum disorders: Developing potential in young children and their families (pp. 58-76). London and Philadelphia: Jessica Kingsley Publishers. About the Author Edward Todd Schwartzberg, M.Ed., MT-BC, is professor and music therapy clinic coordinator at the University of Minnesota. He served as the President for the Autism Society of Minnesota and is currently on the Assembly Delegate for the Great Lakes Region of AMTA. Contact:


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Video by Julie Guy, M.M., MT-BC and Angela Neve, M.M., MT-BC with the Music Therapy Center of California Team San Diego, California

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Skill Generalization: Intentional Use of Apps in Music Therapy Sessions and Beyond ULD WHAT SHO ERAPISTS MUSIC TH NTS AND PARE OUT KNOW AB PS AND MUSIC AP SKILL



Nowadays, the use of technology and interactive media has become part of everyone’s daily routines. Therefore, it is essential to effectively engage and empower young children with and without disabilities in actively using digital tools for enhancing learning and development in the early years. Assuring equitable access to safe, developmentally-appropriate, individualized, and interactive technology and media experiences prepares young children to thrive as digital citizens in an everchanging world (NAEYC/Fred Rogers Center, 2012). This article is based on the Key Messages of the NAEYC/ Fred Rogers Center Position Statement on Technology and Interactive Media in Early Childhood Programs (NAEYC/Fred Rogers Center, 2012). It outlines how the intentional use of technology and interactive media tools such as iPads and applications (apps) can maximize children’s learning outcomes in music therapy sessions and beyond. An example illustrates how to a) explore accessibility, content, and individualization of music

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Petra Kern, Ph.D., MT-BC, MTA, DMtG Music Therapy Consulting Santa Barbara, California Bonnie Hayhurst, MT-BC Groovy Garfoose Music Therapy Services Hudson, Ohio

apps, b) embed them systematically in a session plan for goal achievement, and c) coach parents to continue using them across time for skill generalization. Use of iPads and Apps in Music Therapy Practice Over the past six years, music therapists have discovered that the iPad (or other tablets) can be a useful tool in music therapy practice. An iPad can turn into various digital instruments that are easily accessible for clients, a mobile multitrack recording studio, a portable library of songs and sheet music, or a tool for transposing music into different keys (Knight, 2013). Many music therapists use a wide variety of apps to support young children’s therapeutic goals (i.e., social skills, communication, academic concepts, fine motor skills, and emotional expression), document progress, exchange information with team members, engage parents and families, or illustrate their work in presentations and meetings (Kern, 2013a, 2013b). However, when using technology and digital media with young children, it is essential to consider the content, context, and child (Donohue, 2015). Which app best matches the child’s interests, abilities, needs, and developmental stage? What constitutes a high-quality app, and in which context should it be used to support the therapeutic process and generalization of skills?


Selecting Music Apps for Learning and Development Today, there are numerous music apps on the market which target young children who have different ability levels. Unfortunately, several lack essential design features of high-quality apps. Thus, music therapists and parents must critically appraise music apps by using existing guidelines or by considering professional reviews before embedding them as learning tools into music therapy sessions and into daily schedules and routines (Kern, 2011, 2013b).


When used intentionally and appropriately, technology and interactive media are effective tools to support learning and

In general, a well-designed educational app should support children's engagement, expression, imagination, and exploration (Donohue, 2015). Several published checklists offer users evaluation rubrics for selecting suitable apps for young children with disabilities. For example, More & Travers (2013) recommend rating apps for accessibility, content, and relevance. Accessibility criteria focus on the following universal design for learning (UDL) principles: Equitable use, flexibility in use, simple and intuitive, perceptible information, tolerance for error, low physical effort, and size and space for approach and use. The Content area emphasizes developmentally appropriate practice criteria including the child’s interest, choice, and specific learning needs while addressing specific Individual Family Service Plan (IFSP) and Individual Education Program (IEP) goals and outcomes. Relevance refers to features that allow customization of the app to match the unique learning objectives of each child. Figure 1 offers an example of applying the three suggested rating rubrics to an app. Embedding Music Apps in Sessions and Family Routines When using music apps to support goal achievement in young children with disabilities, music therapists need to plan ahead and systematically embed the selected highquality apps in session plans and family routines (More & Travers, 2013). In other words, music therapists should consider why, when, and how to use each app with individual clients. After identifying the right app for a given task, music therapists should decide during which section of the session plan the app makes the most sense. Active, hands-on engagement and empowerment of the child as well as adjusting the level of difficulty to the child’s ability are vital for successful implementation of the app. Additionally, the music therapist should

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Intentional use requires professionals to have information and resources regarding the nature of these tools and their implications of their use with children.

Limitations on the use of technology and media are important.

Special considerations must be given to the use of technology with infants and toddlers.

Attention to digital citizenship and equitable access is essential.

Ongoing research and professional development are needed.

From the 2012 NAEYC/Fred Rogers Center Joint Position Statement.


monitor whether the app supports the desired learning outcomes and make suggestions on how to effectively integrate the app during daily routines for enhanced learning opportunities and generalization of skills (Donohue, 2015). Apps can be easily embedded into various settings, during different times, and across subjects and persons. Therefore, they are ideal tools for supporting skill generalization in young children with disabilities. When coaching parents and caregivers to use music apps during family routines, music therapists may guide them through the following five steps: a) provide a rationale for the selected apps, b) demonstrate how to apply the apps, c) practice using the apps with everyone involved, d) schedule days/times to practice the apps, and e) check in to see if the specific apps in use are effective in achieving the child’s set goals. The following video vignette provides an example of how to embed an app into the home environment for skill generalization. Video Vignette Sally is a two-year-old girl with Down Syndrome. She recently learned how to walk but still relies heavily on her parents’ and teachers’ support for simple tasks such as gripping utensils firmly enough to feed herself and playing with toys independently. Children’s songs, animal sounds, and musical instruments capture Sally’s interest and motivate her to engage in interactive relationships with her music therapist and mother. Her intervention team identified two IFSP goals for her to work on: 1. Enhance fine-motor skills (i.e., finger isolation), and 2. Increase independence (i.e., self-directed exploration). To support Sally’s learning goals, the music therapist evaluated and selected the following two apps respectively: Peekaboo Barn by Night & Day Studios (Cost: US$1.99) and Lullaby Planet by Francois Walter (Cost: US$1.99). Figure 1 displays the evaluation of the first app using the Preschool App Evaluation Guide (More & Travers, 2013, p. 24). Both apps were embedded into Sally’s home environment. The music therapist coached Sally’s mother to continue using the apps during scheduled times during the week.

Figure 1. Evaluation of the Peekaboo Barn app. Source: More, C. M., & Travers, J. C. (2013). What’s app with that? Selecting educational apps for young children with disabilities. Young Exceptional Children, 16(2), 24. Reprinted with permission.

The Peekaboo Barn app gave Sally the opportunity to practice finger isolation by swiping the barn door while the Lullaby Planet music app allowed her to extend selfdirected exploration by engaging with hand-drawn characters illustrating well-known lullabies. The video demonstrates the five steps to skill generalization implemented by Sally’s music therapist.

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Conclusion Music apps are one of many options that can support learning and development of young children with disabilities. However, digital tools cannot replace human relationships, attend to each child’s unique abilities and needs, or provide personal interactive and physical play. Still, embedding technology and interactive media into music therapy sessions offers an essential aspect of early learning in today’s digital age.

P REVIEWS MUSIC AP s vorites: app imagine fa usic eview for M R d n a s n o mendati App Recom Therapists m MusiciansW eds Special Ne h it w n re d hil Apps for C

Music therapists need to continue increasing their digital fluency and coach families in using digital media in effective, appropriate and intentional ways. Promoting young children's digital wellness as well as positive media ecology in therapeutic settings and at home is part of a music therapist’s responsibility. References Donohue, C. (Ed.) (2015). Technology and digital media in the early years: Tools for teaching and learning. New York, NY: Routledge. Kern, P. (2013a). Resources within reason: Technology applications to support your work, Part 3. Young Exceptional Children, 16(3), 39-40. Kern, P. (2013b). Apps Starter Kit für Musiktherapeuten. [Apps starter kit for music therapists]. Musiktherapeutische Umschau, 34(4), 370-376. Kern, P. (2011). Cool music apps for little ones. imagine 2(1), 91. Knight, A. (2013). Use of iPad applications in music therapy. Music Therapy Perspectives 31(2), 189-196. More, C. M., & Travers, J. C. (2013). What’s app with that? Selecting educational apps for young children with disabilities. Young Exceptional Children,16(2), 15-32. NAEYC/Fred Rogers Center (2012). Technology and interactive media tools in early childhood programs serving children from birth through age 8: A joint position statement of the National Association for the Education of Young Children and the Fred Rogers Center for Early Learning and Children’s Media at Saint Vincent College. Washington, DC: Author.

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About the Authors Petra Kern, Ph.D., MT-BC, MTA, DMtG, business owner of Music Therapy Consulting, is adjunct Associate Professor at the University of Louisville, serves as editor-in-chief of imagine and on CBMT’s Board of Directors. She is an app enthusiast and has presented and published about the use of technology and interactive media in therapy since the iPad became a household tool. Contact:

Bonnie Hayhurst, MT-BC, business owner and director of The Groovy Garfoose, LLC, provides music therapy and music classes to children through adults of all abilities. Bonnie is a self-proclaimed technology geek who has been blogging and presenting about embedding the iPad and apps into music therapy sessions early on. She shares monthly app reviews through her newsletter at  Contact:


Let’s Stay Together: Collaboration in Inclusive Early Childhood Music Therapy Settings Ellary Draper, PhD, MT-BC University of Alabama Tuscaloosa, Alabama Laura Brown, PhD, MT-BC Ohio University Athens, Ohio

Collaboration is at the heart of service delivery for music therapists working in early childhood settings. In 2012, most (54.6%) of the over 750,000 children ages 3 through 5 with disabilities were educated in regular early childhood programs (e.g., Head Start, preschool classes) for at least 10 hours per week (U.S. Department of Education, 2014). With more than half of the children in inclusive classrooms, it is likely that many of the 13% of music therapists working with infants and children (AMTA, 2015) provide services to children in those inclusive early childhood classrooms. The role of the music therapist in inclusive early childhood education settings requires not only knowledge of regular and special education practices, but importantly, skills that lead to successful collaboration with classroom teachers, including music teachers and other therapists who may be working with children in inclusive settings. Even in inclusive settings, music therapists continue to face barriers to collaboration. For example, professionals can have high caseloads which result in tight schedules that do not allow time to collaborate in meaningful ways. Also, although there are fewer separate preschools, there continue to be separate classrooms in many early childhood settings. Separate classrooms may nurture the mistaken idea of separate territories and may keep some professionals from collaboration to avoid “overstepping

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their bounds.” Despite these barriers to collaboration in educational settings, some districts are moving to a fullinclusion model; related services are being delivered in regular classrooms as part of a “push-in” model, and there is an increased need for effective, efficient, and meaningful collaboration to provide high quality services for our clients. In addition to the increased quality of services, collaborating with other professionals provides opportunities for children to practice the important goal of generalization of skills. Collaboration on key principles of successful inclusive teaching practices (e.g., Jellison, 2015) can lead to the design of meaningful transfer activities for inclusive settings, and ultimately positive outcomes related to long-term goals. With careful consideration, music therapists providing services in classroom settings may maximize the numerous opportunities to support students practicing IEP goals in music classrooms (Draper, 2016) and other inclusive classrooms (Obiakor, Harris, Mutua, Rotatori, & Algiozzine, 2012; Odom, et al., 1999) when they use a team approach. The American Music Therapy Association’s professional competencies list interdisciplinary collaboration as a skill for entry level music therapists, including developing


working relationships with other disciplines, communicating with other departments, and collaborating with team members in designing and implementing interdisciplinary treatment programs. Practicing music therapists often collaborate with parents and caregivers, occupational therapists, medical personnel, speech therapists, and educators, among others (Register, 2002). Successful collaboration requires commitment, knowledge of each every team member’s goals and classroom practices, and strategies that work.

existing sessions and supplemented with electronic communication. This model is extremely efficient and maximizes the use of electronic communication while still having some face-to-face time. A parent has a new communication system using an iPad for their child and wants to incorporate the system into music therapy sessions. The parent emails the music therapist information about the system and requests to meet a few minutes before the session to orient the music therapist to the new device. The music therapist e-mails the parent a list of items to add to the device prior to the music therapy session. The parent, music therapist, and client meet prior to the session to work with the new device. The music therapist is able to incorporate the system into sessions because items used in the session plan are already on the device.

Approaches for Collaboration Sharing Collaboration can require varied amounts of time depending upon the desired outcome. Many people may be hesitant to collaborate because of the perceived time commitment. Some collaborative projects may involve intensive planning and time, while others can take place with brief communication. The following scenarios show three different approaches to Electronic Communication. Electronic communication collaboration. A strong collaborative environment often is an efficient and effective way for everyone to get uses all three approaches. information quickly, share ideas, and get on the same page when co-treating. Even the briefest interaction can Lengthy Meetings. Some collaborative processes result in improved services. require a significant time commitment. Professionals may



need to schedule separate meetings for sharing expertise, document review, and planning. While this model is the most time consuming, it can have a strong impact on service delivery.


A special education teacher is working on a science unit in his classroom. He e-mails the music therapist the theme for the week, and she replies with some ideas for activities. They communicate back and forth briefly about specific topics to include in the music therapy session. At the session, the music therapist is prepared with a recording of some of the songs from the session that the teacher can use throughout the week.

A music therapist and special educator are working together on a project to demonstrate service delivery to a special education administrator from the state department of instruction. The music therapist and special educator review each student’s IEP and determine common goals to address in the sessions Inter-Strategies for Collaboration that will be observed by the administrator. Both dependency With a few simple strategies for collaboration, music professionals bring ideas for experiences and therapists can increase the efficacy and efficiency of our activities and work together in the meeting to develop services. Jellison (2015) presents and describes several the session plan based on their mutual expertise. important ideas to consider when participating in the Materials are shared back and forth via e-mail prior to collaborative process. The main ideas are presented the session. The administrator attends the sessions below: where the music therapist and special educator are working together to address the IEP goals and objectives of the students. Short Meetings. Many collaborative experiences can take place via shorter meetings that are added on to

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1. Request notification of meetings and documentation. 2. Prioritize problems and needs. 3. Attend meetings.


4. 5. 6. 7. 8.

Build rapport as soon as possible. Collaborate on assessment. Identify and request support. Set a positive tone. Persevere in building relationships.

Jellison (2015) emphasizes the importance of the collaborative relationship in that professionals must communicate with each other openly and respectfully in order to provide clients with the best services possible. All three approaches described above (lengthy meetings, short meetings, and electronic communication) hinge on effective communication and respect. Jellison also references four key words commonly found in the interprofessional collaboration literature: sharing, partnership, interdependency, and power. These ideas center on a strong relationship. Professionals can be aware of their own strengths while still being open to learning from others. Collaboration involves a shift of power from one person to another (often many, many times) while keeping the clients’ best interests at heart. The three different collaborative approaches described above require different time commitments, but when professionals engage in any or all of them frequently, they can develop strong relationships with one other, provide effective services to clients, and enhance the opportunities for transfer and generalization of skills. Ultimately, it is when music therapists work with others as members of a cohesive team that clients will receive the highest quality of services. References AMTA. (2015). 2015 AMTA member survey and workforce analysis: A descriptive, statistical profile of the AMTA membership. Retrieved from http:// Draper, E. A. (2016). Observations of children with disabilities in four elementary music classrooms. Update. Advance online publication. doi: 10.1177/8755123316660594 Jellison, J. A. (2015). Including everyone: Creating music classrooms where all children learn. New York, Oxford University Press. Obiakor, F. E., Harris, M., Mutua, K., Rotatori, A., & Algiozzine, B. (2012). Making inclusion work in general education classrooms. Education and

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Treatment of Children, 35, 477-490. doi: 10.1353/ etc.2012.0020 Odom, S. L., Horn, E. M., Marquart, J. M., Hanson, M. J., Wolfberg, P., Beckman, P., … Sandall, S. (1999). On the forms of inclusion: Organizational context and service models. Journal of Early Intervention, 22, 185-199. doi: 10.1177/105381519902200301 Register, D. (2002). Collaboration and consultation: A survey of board certified music therapists. Journal of Music Therapy, 39, 305-321. U.S. Department of Education (2014). 36th annual report to Congress on the implementation of the Individuals With Disabilities Education Act, 2013. Retrieved from annual/osep' About the Authors Ellary Draper teaches music therapy courses at The University of Alabama and has experiences as a music teacher and music therapist. She specializes in inclusion in her research. Contact:

Laura Brown teaches music therapy courses at Ohio University and has experiences as a music therapist in public schools. She specializes in children and Autism Spectrum Disorder in her research. Contact:


Will I work with children individually or in groups? Both! Music therapists provide group sessions in early childhood centers and individual sessions to address individual needs of young children.

Q&A Darcy DeLoach, Ph.D., MT-BC Petra Kern, Ph.D., MT-BC, MTA, DMtG University of Louisville Louisville, Kentucky

Will I work with young children? While music therapists serve clients across the lifespan, 13% work with young children (AMTA, 2015).

Which problems do these children have? Children might be at-risk, developmentally delayed, or have a disability such as Autism Spectrum Disorder or Down Syndrome.

How long do sessions last? Most sessions last around 30 minutes, but sessions can last longer depending on the needs of the individual or group.

What Prospective Students Should Know About Music Therapy and Early Childhood Do I use all original songs? Most music therapists use a mixture of original and pre-existing songs that young children already know and can join in singing.

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About the Authors Dr. Darcy DeLoach and Dr. Petra Kern teach at the University of Louisville. They are contacted by over 100 perspective students each year with questions about the process of becoming a music therapist. Resource AMTA (2015). 2015 AMTA member survey and workforce analysis: A descriptive statistical profile of the AMTA membership. Silver Spring, MD: Author.

What salary can I expect? The average salary of music therapists working in early childhood settings is $52,107 (AMTA, 2015).



Empowering Immigrant Latino Parents to Support Their Children’s Developing Literacy Skills Through Music


Ilene Berger Morris, MM, LCAT, MT-BC Alternatives for Children East Setauket, New York

Preschool and early intervention programs offer enriching opportunities for children to explore language and communication interactions in their many facets. But parents and other family members have a critical role in helping their child form early literacy skills (Villarreal, 1995), primarily because the home environment is where the child spends the bulk of his/ her early years, and where the framework for learning is built and reinforced. The parent-child shared reading experience, utilizing developmentally appropriate books, is an especially powerful literacy development strategy and helps to create positive associations with reading (Gest, Freeman, Domitrovich, & Welsh, 2004). Parents can maximize learning by describing illustrations, summarizing the plot, encouraging predictions and inferences, identifying letter-sound relationships, and promoting book handling concepts (Roberts, Jurgens, & Burchinal, 2005; Wessels & Trainin, 2014). A study by Festa, Loftus, Cullen and Mendoza (2014) compared the frequency of early childhood book reading in immigrant families with native-born families in California. The study found that whereas 75.8% of native-born parents reported daily book sharing activities, the figure in immigrant families was 57.5%. Daily book sharing had the lowest incidence in Latin American families with two foreign-born parents, at 47.1%. Although cultural, social and linguistic practices of Latin American immigrant families may stress other activities and behaviors over book sharing, these family traditions, community activities, and daily interactions are important ways parents foster the cognitive and language development of their children (Ortiz & Ordoñez-Jasis, 2005; Wessels & Trainin, 2014). Educational professionals should demonstrate a validation of cultural differences in the families of the children they serve.

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Accommodations to access and participation may be needed to facilitate the contribution of new immigrant or monolingual Spanish-speaking parents. In tandem, families can be encouraged to increase their involvement in literacy building activities such as book reading, resulting in positive outcomes for children, families, and schools (O’Donnell & Kirkner, 2014).

Musical Books to Enhance Learning Book sharing and engaging in music activities are mutually reinforcing, providing excitement, enjoyment and increased confidence as literacy skills emerge (Kolb, 1997; Register, 2004). Books that feature a song, poem, nursery rhyme, or contain strong rhythmic patterning and repetition often lend themselves to elaboration and exploration through music. The use of Spanish language or bilingual children’s books enable parents with limited English skills to become literacy guides and models for their children at home (Wessels & Trainin, 2014). Spanish language and bilingual children’s books that spotlight songs are available commercially and many can be borrowed from the library. Options include popular English language children’s songs translated into Spanish, often with both versions printed on the page. Children socialized in English-based preschools or enrichment programs will likely recognize the tunes and

Music to Promote Literacy Music is central to Latino life and culture (Schechter, 1999), and music may play a part in stimulating and supporting home literacy involvement. Family celebrations and activities typically involve music-making and/or playing (Castro, 2001; Rilinger, 2011). Music is also an appealing and powerful medium through which children can experience the interwoven facets of literacy: listening, speaking, reading, and writing (Kolb, 1996; Register, 2001). Music stresses the tonality, rhythms and patterns inherent in expressive language. This can enable music to function as a bridge, linking the pleasure and familiarity of family traditions and natural interactions with the strengthening of North American phonological awareness, phonemic awareness, Songs sight identification, orthographic awareness, fluency, and word recognition/word decoding skills The The Wheels On (Bolduc & Fleuret, 2009; Register, 2004). Music s en Bus (Las Rueda activities that focus on building these skills el Autobús) encourage children to focus their attention on the And mechanisms of language, helping them improve If You’re Happy Te i their listening skills and develop metacognitive and You Know It (S n ie B Sientes metalinguistic skills (Bolduc & Fleuret, 2009). Contento) Through singing, moving to music, and musical word play at home, parents can help children distinguish important aspects of sound structure – rhymes, syllables and phonemes (Bolduc & Fleuret, 2009). Opportunities to enhance print concepts and prewriting skills can be tapped through music as well (Standley & Hughes, 1997), and musical improvisation is a form of creative writing. Since metacognitive skills achieved through learning in the home language serve as a foundation for the development of similar skills in a child’s second language (Cummins, 1991; Morris, 2014), Latino immigrant parents should be encouraged to use their primary language in songs and other literacy development activities.

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Latin American Songs he Los Pollitos (T Little Chicks) e Arroz Con Lech ) (Rice With Milk

rhymes of songs such as “The Wheels on the Bus,” “If You’re Happy and You Know It,” “Twinkle Twinkle Little Star,” and “The Itsy Bitsy Spider.” Familiarity contributes to a learning environment where predictions are successful and preferences and choices can be expressed. A drawback of translated song lyrics is that differences in word length and linguistic rhythm between English and Spanish can sometimes result in rhythmically awkward phrases with rushed syllables and offset accents in the translation.


Spanish Language Musical Books Spanish language children’s and folk songs may be more familiar to Latino parents, making the shared singing and reading of books based on such songs easier to facilitate. In addition to addressing literacy skills, these experiences have the potential to convey aspects of cultural and individual family traditions and history. There are picture books featuring songs such as Los Pollitos (The Little Chicks) and Arroz Con Leche (Rice With Milk), as well as other songs that are well-known in much of Latin America. Adding Music to Non-Musical Books It is not necessary to use a book specifically based on a song to enhance book reading with music. Many good children’s books employ engaging spoken meters, rhythmic patterns, repetition, alliteration, pitch and emotional inflections and other linguistically interesting devices that can be explored and expanded upon through music. For instance, I Like It When/Me Gusta Cuando is a bilingual board book for preschoolers by Mary Murphy (2008). Each page features the book’s penguin adult and child interacting in various playful and affectionate ways. The text describing the 10 scenes begins with the English and Spanish phrases “I Like It When” and “Me Gusta Cuando” followed by a description of the activities in both languages. The simple concept and repetitive nature of this book’s structure make it a good choice for optimizing the experience of shared reading through music.

Parents, teachers, and therapists can develop songs or rhythmic patterns to accompany non-musical books. The song “I Like it When”/”Me Gusta Cuando” is an example of how salient patterns and phrases in children’s literature can be extracted and developed within a musical structure to reinforce the reading experience with an additional sensory and attentional layer. The author developed this song designed to accompany the book with lyrics consisting solely of the words of the title plus the repeated musical syllable “la.” It can be used as a way to introduce the book, to break up the reading of multiple pages into smaller chunks without losing focus of the book’s concept, and/or to conclude the book, recapping what transpired. Singing, hand clapping or the playing of simple percussion instruments can be added to articulate rhythms, integrate the child’s body, and channel energy. Immigrant parents have much to offer their children, guiding their skill development through interactions, activities, play and education that create the foundation for literacy. Educators should continue to encourage all parents regarding the value of book sharing experiences as an important form of literacy development. Music therapists can dialogue with the family members of the

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children with whom they work with, welcoming input and information about their home music practices. Through such exchanges, the music therapist can promote awareness of how music and early reading work together not only to emphasize things like languagemusic parallels, tonality variations and pattern recognition, but also to increase confidence, incorporate familiar traditions, and deepen emotional value and meaningfulness. References Bolduc, J., & Fleuret, C. (2009). Placing music at the centre of literacy instruction [Monograph]. What Works? Research into Practice, 19, 1-4. Castro, R. G. (2001). Chicano folklore. New York: Oxford University Press. Cummins, J. (1991). Interdependence of first- and second-language proficiency in bilingual children. In E. Bialystok (Ed.), Language processing in bilingual children (pp. 70-89). Cambridge, UK: Cambridge University Press. Festa, N., Loftus, P., Cullen, M., & Mendoza, F. (2014). Pediatrics, 134(1), 162-168. Gest, S., Freeman, N., Domitrovich, C., & Welsh, J. (2004). Shared book reading and children’s language comprehension skills: The moderating role of parental discipline practices. Early Childhood Research Quarterly 19(2), 319–336. Kolb, G. (1996). Read with a beat: Developing literacy through music and song. The Reading Teacher, 50(1), 76-77. Morris, I. B. (2014). Music therapy to support a preschool transitional bilingual education program. imagine, 5(1), 90-94. Murphy, M. (2008). I like it when/me gusta cuando. San Diego, CA: Libros Viajeros. O’Donnell, J., & Kirkner, S. (2014). The impact of a collaborative family involvement program on Latino families and children’s educational performance. School Community Journal, 24(1), 211-234. Ortiz R., & Ordoñez-Jasis R. (2005). Leyendo juntos (reading together): New directions for Latino parents' early literacy involvement. Reading Teacher, 59, 110-121. Register, D. (2001). The effects of an early intervention music curriculum on prereading/writing. Journal of Music Therapy, 38, 239-248.

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Register, D. (2004). The effects of live music groups versus an educational children's television program on the emergent literacy of young children. Journal of Music Therapy, 41(1), 2-27. Rilinger, R. (2011). Music therapy for Mexican American children: Cultural implications and practice. Music Therapy Perspectives, 29(1), 78-85. Roberts, J., Jurgens, J., & Burchinal, M. (2005). The role of home literacy practices in preschool children's language and emergent literacy skills. Journal of Speech, Language, and Hearing Research, 48, 345-359. Schechter, J. (1999). Music in Latin American culture. New York: Schirmer Books. Standley, J., & Hughes, J. (1997). Evaluation of an early intervention music curriculum for enhancing prereading/writing skills. Music Therapy Perspectives, 15(2), 79-86. Tabors, P. (2008). One child, two languages: A guide for early childhood educators of children learning English as a second language (2nd ed.). Baltimore, MD: Paul H. Brookes Publishing. Villarreal, A. (1995). Parents as first teachers: Creating an enriched home environment. IDRA Newsletter, April 1995. Wessels, S., & Trainin, G. (2014). Bringing literacy home: Latino families supporting children’s literacy learning. Young Children, 69(3), 40-46. About the Author A music therapy clinician for over 30 years, Ilene "Lee" B. Morris lives and works in Suffolk County, Long Island, NY. Lee provides music therapy to young children and adolescents in special education settings and to patients of all ages in a community hospital and rehabilitation center. Contact:



Quality of Early Childhood Music Programs in the Community: A Guide for Parents Carol Ann Blank, LCAT, LPC, MMT, MT-BC Music Together®LLC Robbinsville, New Jersey Early childhood music programs offer opportunities for parents and children to have a dedicated time to learn, play, and make music. Most communities have a variety of music programs for families from free/lowcost offerings at public libraries to tuition-based, semester long experiences offered by businesses in town. These community offerings differ from the clinical work that music therapists do with children who have disabilities and their families. This article addresses key considerations for identifying highquality early childhood programs that meet the needs of families.

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Making Informed Choices Early childhood music classes take many forms, which may make a difference to parents. The infographic in this issue of imagine provides an overview of featured early childhood music therapy programs during 2013-2015 (pp. 114-115). The following is a summary of five key aspects (i.e., accessibility, class offerings, philosophical and educational match, communication, community support) parents might want to consider when choosing musicmaking opportunities for their family.

Building Accessibility Evaluate the building’s accessibility. Does the building need to be wheelchair accessible? Does your family need handrails or large restroom stalls? Many publically owned or high-traffic buildings will likely have these. If issues regarding accessibility that are important to you are not obvious from the program’s website, contact the program to ask questions.



Class Offerings Most early childhood music programs serve children birth through 5 years old. Some early childhood music programs offer classes for children in specific age groups. For example, there might be classes for infants (generally birth through 18 months), toddlers (18 months through 3 years), and preschoolers (3 to 5 years). Other programs offer family classes where children of all ages can attend together. Several early childhood music programs offer a class for children with special needs or children who need more support. The instructor of a class designed specifically to include learners with special needs should have some education and training in working with families and children with special needs. Information about the instructor’s qualifications should be readily apparent on the program’s webpage. Providers of early childhood music programs often offer a variety of services ranging from semester-based classes using a pre-designed curriculum, birthday parties, and open-to-the-public family music nights, to clinical services provided by a qualified professional.


Philosophical and Educational Match Look for statements in the class descriptions that point to the program’s philosophy and approach to music-making. Some programs may have a more educational focus while others may be focused on family music-making as a way of spending time with


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Questions to Ask

Importance of Question

Are children with special needs and disabilities welcome in your classes? Some of my children don’t have special needs. Can we all attend the same class?

This question allows you to determine whether all the children in your family will be able to attend a class together.

Do you have instructors on your staff with experience and expertise in including children with special needs?

A gifted teacher’s bio may not reflect his or her successful track record of accommodating children with special needs.

How do you handle [insert a specific behavior like running, or loud vocalizations]?

You are interested in learning about the center’s approach to classroom management and how they balance safety with accommodating children’s unique learning preferences.

May we attend a class for free to see if this is the right fit for us?

Don’t underestimate the importance of the teacher-family fit! Investing the time to determine whether the teacher is the right person for your family prior to registering for a class is well worth the effort.

Does your center have access to additional training and resources to help instructors accommodate families like ours?

Centers that exhibit a commitment to professional development will often have access to a mentor with expertise in this area.

If we have to miss class for a doctor’s appointment, can we make up the class?

Center policies are important. An open dialog with the center director will let you know if there is flexibility to accommodate your family’s needs.

Table 1. Questions for Early Childhood Music Program Providers.


other families and building strong relationships. Also consider the importance of a developmentally appropriate approach to learning for your child. A developmentally appropriate approach in early childhood music-making accepts and includes all members of the community and creates necessary access points into music-making through teaching practices that incorporate children (and adults) in community music-making. Communication There are several ways that early childhood music providers communicate information. While it may seem to go without saying, checking a program’s online presence is a great first step to get a feel for how they welcome families with children with special needs. Keep in mind that centers that offer pre-designed curricula often have links to the national (or international) organization that authored the program. Taking a look at the national site allows you to determine the company’s depth of commitment to serving families of children who have special needs. Speaking directly with the owner of the early childhood music program in which you are considering enrolling your child is the best way


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to determine if that program is a good fit for your family. The provider’s responses to your questions should be considered an invitation to continue the conversation. Table 1 list some questions that you might want to ask. Community Support A family music class should be a supportive community that honors the musical journey of each child and adult. Early childhood music therapists and music educators understand the importance of creating community. Each center director will have his/ her own way of doing this. (S)he might use email or social media. Whatever the means, you should feel like your family is part of a community of music makers that focuses on family engagement and child development.


Conclusion Accessing community activities can be challenging for families with children who have special needs or disabilities. Your community’s early childhood music program may be a good choice for a welcoming and inclusive experience. Music therapists are uniquely qualified to

provide music interventions for addressing individualized goals, which can occur in an individual or group setting. Early childhood music educators are uniquely qualified to provide a welcoming, multisensory, and musically rich environment in which to experience the joy of music-making with others as well. The information presented may help you decide what your family needs from a music-making experience and how to get the information you require in order to make the best decision for your family. About the Author Carol Ann Blank, LCAT, LPC, MMT, MTBC is the Manager of Special Needs Services at Music Together LLC where she also oversees the Music Together Within Therapy program. Carol is currently completing her dissertation research on clinical decisionmaking at Drexel University. Contact:


Integrate Music Together® into Your Music Therapy Practice

Bring the internationally recognized, research-based Music Together curriculum into your work with individual clients through the Music Together Within Therapy® program. Participating clinicians have access to Music Together family and educator materials as well as tools specifically designed to facilitate the therapeutic process. Your clients will receive their own professionally produced songbook and CD set, and you’ll join an active online community of other practitioners with whom to share ideas and resources. You’ll also be eligible for marketing support, mentoring from a board-certified music therapist, and a variety of CBMT-approved professional development opportunities.

Visit our website or call us to learn more about how Music Together can enhance your music therapy work.

(800) 728-2692 x332 •

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Summary of Featured Early Childhood Music Programs in imagine 2013-2015 Infographic by Rose Fienman, MSW, MT-BC & Christopher R. Millett, MM, MT-BC. Created for imagine 2016, the early childhood online magazine published by de la vista publisher.

Kodรกly is an experience-based philosophy of music education that focuses on developing musical skills.

Folk Music


High Quality

Music Together is an internationally recognized early childhood music and movement program for children birth through age seven--and the grown-ups who love them.

Serves 2500 communities in 40 countries


Development of the complete musician

Classes focus on active music making Promotes cognitive, language, and physical growth

Hello Everybody app provides activities outside of group sessions

Sing & Grow is an evidence-based international music therapy project that provides services within the community for young children and their families who present with complex needs. Sprouting Melodies is an early childhood program created and offered exclusively by board-certified music therapists with specialized curriculum training.

Uses developmentally appropriate live music

Musical approach is researchbased

Focuses on healthy early development

Sing & Grow: Quick Facts

Evidence-based interventions promote long-term outcomes

Results show significant increases in participants' use of music to support parenting Hosts stated that the program strengthened their interactions with the community Traditional/Non-traditional music is used to support parenting & child development

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Dalcroze is an approach to music education that focuses on rhythmic movement (Eurhythmics), aural training, and improvisation. The continued study of Dalcroze eurhythmics, solfège, and improvisation can:

Kindermusik offers developmentally-specific educational music programs for children ranging from newborn to seven. The curriculum is based on the principals of Kodaly, Suzuki, and Orff.

Promotes whole child development

Heighten concentration and focus

Fosters life-long love of music Improve coordination and balance Research-based program Participants gained 32% greater early language/literacy skills than those who did not participate in Kindermusik

Enrich hearing

Orff Schulwerk Orff Schulwerk is an approach to music and movement education based in play. It uses speech, singing, movement, instruments, improvisation, and drama to promote music literacy in all children.

Musikgarten is a holistic and integrated approach to music education that gives children a total musical experience. Whether listening, moving, vocalizing, playing an instrument, or creating music the focus in on the process, not on a performance.

Experience first, then intellectualize. - Carl Orff

North American and International programs Focus on participation Incorporates family materials and resources Developmental, sequential approach

For more information on each program visit the following links:

Image statement: All images reprinted with permission from respective program representatives. Icons made by from and are licensed by creative commons license

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parentscan The 2016 parentscan series is oered by parents for parents. Each of them participates in familycentered music therapy services provided by Bolton Music Therapy, Therabeat,Inc., and the Music Therapy Clinic at the University of Louisville, respectively.

It’s for


Engaged parents of three young children with disabilities provide ideas that can support other parents in seeking out music therapy services, addressing developmental goals, attending sessions, maximizing outcomes at home, and finding reimbursement. Learn about the benefits and joy of participating in music therapy sessions with your child and family! imagine 7(1), 2016


parentscan Ideas for Parents From Parents 1. Have Realistic Expectations

2. Continue at Home

Recognize where your child is at developmentally and have attainable goals in mind. We spent the first several months of music therapy simply working on staying in the room for the duration, and then eventually progressed to joint attention, and years later to an interactive session with more advanced goals.

Be involved in the sessions (even just a couple). If you can’t, learn a few of the songs so you can use them at home throughout the week. Most therapists will record the session for you to see progress and learn songs. Repeating songs and movements over and over and over helped with transitions, initiating communication, creating patterns, etc.

3. Get on the Floor and Have Fun 4. Keep Trying Sing the songs, do the movements and have fun yourself! Your child will feed off your enjoyment – even if it takes them time. My son started interacting through music therapy long before he did in any other therapies primarily because of the open and fun environment, and that still took months! We now have a song for everything – even the grandparents know several of the familiar tunes now. 

When seeking out music therapists, do your research and talk with other parents. It’s important to find a therapist that your child is comfortable with so they can actually open up and have fun. You can find a lot of therapists out there, and regardless of their abilities, music therapy works best when your child is relaxed and having fun.  

5. Ask Questions Always keep an open line of communication with the therapist. If you don't understand what or why something is being done, just ask! Your therapists are invaluable resources and can help with understanding particular goals or even help troubleshoot issues at home or school. We've requested our therapist create new songs not just for therapy, but to use in school, transitions, and new things.

Written by Rachel, mother of Daniel, receiving services at Bolton Music Therapy since 2010. imagine 7(1), 2016


parentscan Ideas for Parents From Parents

1. There are No Dumb Questions Ask any questions that you may have to help you understand the music therapy process. For example “How can music support SLP, OT and PT goals?” “What does a typical session look like?” “What are the differences between music therapy and a music lesson?”

2. Know the Difference Between Music Lessons and Music Therapy Sessions A music lesson is typically when a child plays a specific instrument and is learning to read music. Music therapy is the use of music to help a child meet specific goals. A music therapist could be using rhythmic patterns to help a child learn or remember certain phrases, using a drum to teach them the difference between loud and soft, or teaching positional words in a song. Knowing the difference is very helpful when thinking about the benefits of music therapy.

3. Go to a Session to See What it is All About Attend a music therapy session with your child. Observe what and how your child is learning, and make use of the great resources provided.

4. Talk with the Music Therapist after the Session Ask for anything that really worked during the session and try to find ways to apply it at home. Generalization is always something for our children to be working on.

5. Do your Research As far as the benefits of music therapy goes, there are so many studies and resources out there that show the importance of music therapy and the impact it is having.

Written by Elizabeth, parent of Dex who has Down Syndrome receiving services at Therabeat since 2012. imagine 7(1), 2016


parentscan Ideas for Parents From Parents 2. Be Organized

1. Be Yes-Parents As long as it seems potentially helpful and makes sense for your family, give things a try. Take other peoples’ recommendations and then decide what is right for your child.

Be organized, specific, calm and goaloriented. Use binders and storage tubs to divide things out into medical, education and insurance sections. If you are not methodical in keeping track of your child’s needs then how will you know what has been accomplished?

4. Be Resourceful

3. Believe in your Child Presume competency in your child! Assume they understand you even if they don’t show signs of engagement. Treat them with respect and not pity. When people see that you treat your child this way, they will do the same.

There are a plethora of resources available. Seek as many out as possible including advocacy groups, local social services organization and state insurance advocates. Use your child’s music therapist as a resource.

Written by Leslie and Justin, parents of Alexander, receiving services at the UofL Music Therapy Clinic since 2014.

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Come and Sing With Me: Call and Response Layne Guyer, MT Student University of Louisville Louisville, Kentucky

Adaptations Change the lyrics to address children by name. For example, “Come and sing with me” could become “Anna, sing with me.” Ask children for other body movements and create a dance.

Description The purpose of this welcome song is to gather children and orient them to the music therapy session. Goals to transition to music time to imitate body movements to distinguish left from right Behavior Observation The child will: follow the leader to the music center clap, step, and turn around step to the left and right Materials Accompanying instrument (e.g., guitar) Directions 1. Sing the first line of the song and round up the children in the room. Repeat until everyone has joined you. 2. Invite children to clap along to the song. 3. Demonstrate stepping to the left/right and turning around while singing the song. 4. Invite all children to imitate your movements.

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Come and Sing With Me Recorded 2015 by Layne Guyer

About the Author Layne Guyer is a sophomore music therapy student at the University of Louisville in Kentucky, USA.




name, and have the children listen for their names to be called while engaging in stomping and clapping at appropriate times. 3. Invite children to say hello and be recognized by the class. 4. After each child had a turn to be featured in the sing, facilitate group discussion about the theme. Adaptations Ask children for other motor activities to include in the song (e.g., jumping). Coordinate with other members of the interdisciplinary team to address similar themes for skill generalization.

Hey! Hello!: Introducing a Theme Scott Sams, MT Student University of Louisville Louisville, Kentucky Description The purpose of this song intervention is to greet children by name while introducing a theme. Goals to promote name recognition to practice impulse control to recognize a curricular theme Behavior Observation The child will: say, “Hello,” when hearing her/his name clap and stomp when prompted respond to questions about the theme Materials Accompanying instrument (e.g., guitar or ukulele) Directions 1. Gather children in a circle around you. 2. Sing the song, individually inserting each child’s

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Hey! Hello! Recorded 2015 by Scott Sams

About the Author Scott Sams is a music therapy major at the University of Louisville, Kentucky. He successfully implemented this song with toddlers and preschoolers at the Early Learning Campus.




children to name the four seasons. 2. Sing the first line of the song and ask children to name the season during which the leaves change color. 3. Display the leaves and have children identify the colors while placing them in order (i.e., green, yellow, orange, red, and brown). 4. Sing the song from the beginning, holding up different colored leaves during the repeated section and asking the children to call out their colors. Adaptations Have children choose a leaf and dance when their color is sung. Use the interactive “Lucy Ladybird” story app for continued discussion on seasons and colors.

The Leaves Are Changing: Learning About Autumn Colors Bethany Wilker, MT Student University of Louisville Louisville, Kentucky Description The purpose of this song intervention is to facilitate exploration of the changing leaves in autumn. Goals to learn about seasonal change to identify various colors Behavior Observation The child will: name the four seasons differentiate between five colors Materials Accompanying instrument (e.g., guitar or ukulele) Different shapes and shades of green, yellow, orange, red, and brown leaves. Directions 1. Introduce the topic of seasonal change and ask

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The Leaves Are Changing Recorded 2015 by Bethany Wilker

About the Author


Bethany Wilker is a sophomore music therapy student at the University of Louisville. She is excited to use music for learning with young children at the Early Learning Campus. Contact:


Directions 1. Ask children what reminds them of Halloween. 2. Show the children the props and ask them about the sizes, shapes, and patterns. 3. Have children count backwards within the song. Adaptations Add movements to the backwards counting (e.g., jumping up and down to the correct number). Adapt song and materials to a different season (e.g., “I See Winter Time”). Bring in the number of each prop specified in the song and mix up the order of the song so that the children have to physically count the props for each line instead of counting backwards in oder.

I See Autumn Time: Learning About Early Math Concepts A’Marie Rust, MT Student University of Louisville Louisville, Kentucky Description The purpose of this fall song intervention is to develop early math skills. Goals to understand size, shapes, and patterns to enhance the ability to count backwards

I See Autumn Time Recorded 2015 by A’Marie Rust

About the Author A’Marie Rust is a junior music therapy student at the University of Louisville. This song was implemented successfully during a music therapy event at the Early Learning Campus.

Behavior Observation The child will: classify fall items according to size, shape, and pattern verbally count backwards Materials Accompanying instrument (e.g., guitar or piano) Objects mentioned in the song lyrics (i.e., jack-olanterns, trick or treaters, scarecrows, witches, pair of eyes).

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2. 3. 4. 5.

favorite animals. Hold up animal pictures/puppets and ask children to name them. Invite children to create a sound for each animal (e.g., “What does the kangaroo sound like?”) Ask children how each animal moves. Sing the song for each animal and prompt children to move to the music accordingly (e.g., jump like a kangaroo).

Adaptations Offer animal sound examples if the children are struggling to come up with them on their own. Act out a movement and have children guess the corresponding animal.

How Does It Move?: Identifying Sounds and Movements Anna Lazeski, MT Student Shenandoah University Winchester, Virginia Description The purpose of this song intervention is to promote the recognition of animal sounds and movements. Goals to identify animal sounds to move like different animals Behavior Observation The child will: vocalize animal sounds imitate animal movements Materials Pictures or puppets of various animals (e.g., a kangaroo) Directions 1. Invite children to the circle and ask them about their

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How Does It Move? Recorded 2016 by Anna Lazeski

About the Author Anna Lazeski is a junior music therapy student at Shenandoah University. During her studies, she has worked with young children in multiple daycare settings. In her spare time, Anna volunteers at an animal shelter. Contact:


volume (e.g., shh, finger in front of mouth, tiptoeing) and loud volume (e.g., roar, big arm movement, fast steps). 3. Sing the song and invite children to use their indoor and outdoor voices accordingly. Adaptations Have children take turns leading the activity as the dragon or the person who wakes the dragon. Practice the song in dierent environments (e.g., during the transition time from the classroom to the playground).

Mr. Dragon Is Sleeping, Shh!: Practicing Indoor and Outdoor Voice Caroline Seitzinger, MT Student Shenandoah University Winchester, Virginia Description The purpose of this song intervention is to teach the concept of appropriate voice volume for dierent environments. Goals to improve voice volume control to use appropriate voice volume indoors and outdoors Behavior Observation The child will: lower and raise the volume of his/her voice as prompted demonstrate a soft indoor voice and a loud outdoor voice. Materials Accompanying instrument (e.g., guitar) Directions 1. Gather children in a circle and introduce the content of the song. 2. Give verbal, gestural, and model prompts for quiet

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Mr. Dragon Is Sleeping, Shh! Recorded 2016 by Caroline Seitzinger

About the Author Caroline Seitzinger is a music therapy student at Shenandoah University. Currently she is involved in the university’s music therapy clinic while giving private piano lessons to children with Autism Spectrum Disorder. Contact:


normal). 2. Invite children to sing along with the chorus. 3. Prompt children musically (i.e., “What is it? What could it be?”) and pause to give them time to respond to the question. Adaptations Replace the animals with different sized objects (e.g., instruments). Hold up animals two at a time and have children identify which one is bigger or smaller than the other.

What Could It Be?: Learning About Early Math Concepts Danielle Coffinbarger, MT Student Shenandoah University Winchester, Virginia Description The purpose of this song intervention is teach children about size. Goals to develop early math skills to improve categorization skills Behavior Observation The child will: distinguish between big, small, and medium sizes categorize animals according to sizes

What Could It Be? Recorded 2016 by Danielle Coffinbarger

About the Author Danielle Coffinbarger is a music therapy major at Shenandoah University. She is the president-elect (2016-2017) of the Shenandoah University Music Therapy Association (SUMTA) and a member of Kappa Kappa Psi and Alpha Lambda Delta. Contact:

Materials Images or puppets of a bee and elephant. Directions 1. Display different sized animals (i.e., bee and elephant) and label their sizes (i.e., big, small,

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Gather the children in a circle, sing the song and introduce the days of the week by showing a flash card when each day is named. 2. Sing the song, pause to give children a chance to fill in the days of the week. 3. Have children put the flash cards in order. 1.

Adaptations Talk with children about the activities they do on different days of the week. Have children create personalized weekly schedules, using pictures to represent each activity. Ask children about what they did on a specific day during the previous week or about what they plan to do the following day.

Know Your Days: Learning About the Concept of Sequencing Faith Wright, MT Student Shenandoah University Winchester, Virginia Description The purpose of this song intervention is to introduce the concept of sequencing by teaching the days of the week. Goals to learn the concept of sequencing to memorize the order of the days of the week Behavior Observation The child will: put the days of the week in the correct order name the seven days of the week Materials A flash card for each day of the week


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Know Your Days Recorded 2016 by Faith Wright

About the Author Faith Wright is a music therapy undergraduate student at Shenandoah University. “Know Your Days” was written for children in a early childhood program in the community. Contact:


Directions 1. Gather children in a circle and introduce the colors of the rainbow. 2. Have each child pick an object (see materials) and label its color. 3. Sing the song and have each child fill in the color and name of his/her object. Adaptations Identify colors of clothing that the children are wearing. Ask each child to bring in his/her favorite colored object for next time.

Colors of the Rainbow: Recognizing Colors Everywhere Grace Wines, MT Student Shenandoah University Winchester, Virginia Description Color recognition is a building block in children's cognitive development. The purpose of this song intervention is to engage children in learning about colors and attributing them to objects. Goals to learn the names of basic colors to identify similarities and dierences Behavior Observation The child will: name colors label the colors of various objects

Colors of the Rainbow Recorded 2016 by Grace Wines

About the Author Grace Wines is a sophomore music therapy student at Shenandoah University. She is a member of the Shenandoah University Music Therapy Association and plays in the pit for the NW Works Adult Chimers Group. Contact:

Materials Image of a rainbow Dierent colored objects (e.g., apple, basketball, sun, pet frog, sky, grapes).

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Directions 1. Ask children why hand washing is important and what situations during the day require it. 2. Introduce the hand washing procedure by singing the song and pointing to the corresponding pictures. 3. Invite children to fill in the blanks with situations requiring hand washing, and repeat the steps of hand washing in call and response style. Adaptations Encourage children to generalize the hand washing steps in dierent situations and places.

Wash Your Hands: Practicing Proper Hand Washing Procedures Karissa Rhodes, MT Student Shenandoah University Winchester, Virginia Description Good hand washing routines protect children from germs that cause infections. The purpose of this song intervention is to teach children about proper hand washing procedures during daily routines. Goals to identify the steps of hand washing to learn when it is appropriate to wash hands Behavior Observation The child will: act out each step of hand washing in sequence identify when to wash hands during the day Materials Picture schedule outlining the steps of hand washing

Wash Your Hands Recorded 2016 by Karissa Rhodes

About the Author Karissa Rhodes is a music therapy undergraduate student at Shenandoah University. This song was inspired by her volunteering experience in a life skills room. Contact:

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Directions 1. Invite children to gather around the piano and introduce the song. 2. Ask children, “Who has ever had to wait for a turn?” followed by, “What is something we can do while we are waiting?” 3. Display children’s answers on the board using picture symbols and embed them into the lyrics of the song. Adaptations Introduce various waiting scenarios and build in appropriate strategies and activities using the song. Practice waiting skills in real live situations and generalize across people, settings, and time.

Waiting My Turn: Preparing Children With Waiting Strategies Nathan Chuba, MT Student Shenandoah University Winchester, Virginia Description The purpose of this song intervention is to give children appropriate strategies and for learning to wait. Goals to improve self-control to utilize appropriate waiting strategies Behavior Observation The child will: listen and wait patiently identify appropriate waiting activities Materials Accompanying instrument (e.g., piano) Board with picture symbols reflecting activities

Waiting My Turn Recorded 2016 by Nathan Chuba

About the Author Nathan Chuba is a music therapy student at Shenandoah University. He works as support staff at A Place To Be, a music therapy clinic in Middleburg, Virginia and at Learning Integrations, an occupational therapy clinic in Herndon, Virginia. Contact:

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Label different body parts and model what the body parts can do. 4. Have children identify various body parts and let them come up with gross motor movements to build into the lyrics of the song. 3.

Adaptations Use a table drum with the song to practice upperbody movements. Embed props, such as a flash cards, showing different body parts and movements.

Moving Our Bodies: Enhancing Mobility Skills Elizabeth Sharp, MT Student California State University, Northridge Los Angeles, California Description The purpose of this song intervention is to encourage gross motor skills and body awareness in children with limited range of motion. Goals to increase gross motor skills to understand the function of body parts Behavior Observation The child will: imitate basic gross-motor movements identify and control specific body parts Materials Accompanying instrument (e.g., guitar)

Move Our Bodies Recorded 2016 by Elizabeth Sharp

About the Author Elizabeth Sharp is a senior music therapy student at California State University, Northridge. She implemented this intervention successfully in a preschool setting with children aged in Los Angeles, California. Contact:

Directions 1. Gather children around you and start singing the song while modeling the first gross motor movement (e.g., walking or jumping). 2. Raise your arms for “Hip, hip, hip, hurray!”

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Directions 1. Invite children to sit in a circle and sing the song with guitar accompaniment. 2. Ask a child to strum the guitar along with the song. 3. Adjust tempo of the song to the child’s strumming. 4. Observe the child’s sensory response to the guitar strings and adjust accordingly. 5. Give every child a chance to have a turn strumming the guitar. Adaptations Use other instruments such as a monochord, harp, or thumb piano.

Strum Song: Enhancing Fine Motor Skills Brandon Wright, Amy Calderon, and Elizabeth Sharp MT Students California State University, Northridge Los Angeles, California Description Many of a child’s daily activities require control of small muscles in the hands. The purpose of this song intervention is to provide an opportunity for practicing fine motor skills within a sensory experience. Goals to increase fine motor skills such as digit isolation to tolerate sensory input Behavior Observation The child will: strum the guitar strings with single finger(s) tolerate sensory stimulation from vibrating guitar strings Materials Guitar

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Strum Song Recorded 2016 by Brandon Wright

About the Authors Brandon Wright, Amy Calderon, and Elizabeth Sharp are senior music therapy students at California State University, Northridge. They successfully implemented this song with children at the Lokrantz School for Special Education in Los Angeles, CA. Contact:


tour with you where they will see a mountain, rivers, and a canyon. 2. Sing the song and act out “touching the sky,” “flowing rivers,” and “deep canyons.” 3. Use a map with the geographical features, allowing children to visually experience the places as well. 4. Invite children to come up with other places, people, animals, or events to visit in their imagination, and embed their ideas into the song lyrics. Adaptations Encourage children to share their vacation experiences within the song. Take children on a field trip to experience the places, people, animals, or events live.

Riding on a Motorbike: Fostering Imagination Tracey Elliott, MT Student Cleveland State University Cleveland, Ohio Description Imaginative play is necessary for children to learn about nature, people, animals, and events they may not directly experience. The purpose of this song intervention is to help children discover the world that surrounds them through a imaginative motorbike ride. Goals to foster imagination to enhance sharing of ideas with a large group Behavior Observation The child will: participate in imaginative play share ideas for other adventure trips Materials Accompanying instrument (e.g., piano) Map representing mountains, rivers, and canyons Directions 1. Gather children and invite them to go on a discovery

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Riding on a Motorbike Recorded 2016 by Tracey Elliott

About the Author Tracey Elliott is a senior music therapy student at Cleveland State University and wrote this song for the preschool class at Olmsted Early Childhood Center in Olmsted Falls, Ohio. Contact:



Make sure that each child has a turn playing the instrument before concluding with the last verse.

Adaptations Allow children to pass the instrument around. Use sign language for “My turn, please!”

My Turn, Please: Encouraging Communicative Interaction Jonathan Tang, MT-BC Florida Hospital Orlando Orlando, Florida Description The simple action of taking turns develops children’s ability to shift attention and engage in a shared moment. The purpose of this song intervention is to facilitate turntaking. Goals to listen and wait quietly for a turn to verbally request a turn Behavior Observation The child will: wait for his/her turn by raising his/her hand say, “my turn, please!” Materials An instrument to be shared (e.g., a drum) Directions 1. Invite children to play a shared instrument. 2. Introduce the song and model appropriate turntaking responses (i.e., raising hands and asking “My turn, please!”).

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My Turn, Please Recorded 2016 by Jonathan Tang

About the Author Jonathan Tang, MT-BC, graduated from Berklee College of Music. He is currently part of the music therapy team at Florida Hospital Orlando. Contact:


Model deep breathing by pretending to blow up an imaginary balloon. Practice inhaling and exhaling a few times with the child. 3. Start singing the song, using the child’s favorite color to describe the balloon. 4. Model inhaling after the words “breathe in” and exhaling after “blow it up so big.” Praise child for breathing deeply when he/she is able to do so. 5. Repeat and match tempo of song to child’s respiration rate as necessary. 2.

Adaptations If child is extremely agitated, match his/her affect with a faster tempo, gradually slowing down as child becomes more relaxed.

My Magic Balloon: Deep Breathing and Relaxation Erin Aubrey Batkiewicz, M.M., MT-BC Universal Health Services Nashville, Tennessee Description The purpose of this intervention is to decrease distress by encouraging deep breathing and relaxation. Goals to encourage deep breathing to increase relaxation and stress management to decrease anxiety, distress, and/or pain perception Behavior Observation The child will: breathe deeply when prompted to do so by lyrics decrease restless movements focus on song rather than stressful stimuli Materials Accompanying instrument (e.g., guitar or piano) Directions 1. Introduce activity by asking the child his/her favorite color.

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The Magic Balloon Recorded 2016 by Erin A. Batkiewicz

About the Author Erin Aubrey Batkiewicz, M.M., MTBC, is a graduate of the University of Kentucky. She currently works at an inpatient psychiatric facility in Nashville, Tennessee. Contact:


Directions Section 1: Calm Infant 1. Pick up child and hold in a chest-to-chest “C” position (see image to the left). 2. Add gentle, vertical rocking. 3. In synchrony with rocking, add lullaby-style humming. 4. Add words (if infant has not calmed). 5. Add gentle pat on bottom (if infant has not calmed). 6. Once infant maintains quiet sleep, move to section 2.

It’s Time to Sleep: Behavioral Regulation in Infants With NAS

Section 2: Restful Sleep 7. Slowly reposition your hands and transition infant to supine over crib. 8. Transition vertical rocking to slight side-to-side rolling. 9. Progressively lower infant’s bottom, then back, to bed. 10. Slowly fade rocking and release hands. 11. Fade singing to humming, then fade to silence. Adaptations If infant becomes fussy at any point during section 2, return to last stimulus used in section 1 and continue.

Michael R. Detmer M.M.E, MT-BC University of Louisville Louisville, Kentucky Description Infants with Neonatal Abstinence Syndrome (NAS) experience withdrawal symptoms from in-utero drug exposure, which affects their ability to self-soothe and maintain quiet sleep. The purpose of this intervention is to promote restful sleep. Goals to improve/stabilize behavioral state to increase sleeping behavior in crib Behavior Observation The child will: maintain an organized, calm behavior state maintain a quiet sleep state supine in crib Materials None!

It’s Time to Sleep Recorded 2016 by Michael Detmer

About the Author Michael Detmer, MME, MT-BC, is a NICU music therapist, lecturer, and clinical supervisor at the University of Louisville, and Norton Women’s, and Kosair Children’s Hospital in Louisville, KY.


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beats. 4. Reward the child immediately afterwards by giving the child your full attention for the next joint activity. Adaptations Fade out the melody and prompt the child verbally by saying “You have to wait!” Extend the waiting beats and count silently.

Wait!: Building Patience Petra Kern, Ph.D., MT-BC, MTA, DMtG University of Louisville Louisville, Kentucky Description During daily routines, children spend much time waiting, which can be frustrating and trigger meltdowns in young children. The purpose of this song intervention is to teach children how to be patient in various daily situations through singing, sign language, and counting. Goals to delay gratification to build self-control Behavior Observation The child will: resist a temptation and wait for later adult attention respond without acting on impulse Materials None! Directions 1. Approach the child in the natural environment. 2. Sing the song while signing “Wait!” (i.e., palms facing up while wiggling all fingers). 3. Engage the child in singing and counting the waiting

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Wait! Recorded 2002 by Petra Kern

About the Author Petra Kern, Ph.D., MT-BC, MTA, DMtG, business owner of Music Therapy Consulting, is adjunct Associate Professor at the University of Louisville, serves as editor-in-chief of imagine and is on CBMT’s Board of Directors. This song was written for children with various abilities at UNC’s FPG Child Development Institute in Chapel Hill, NC. Contact:


While singing the song, embed direction, by singing the verse “pop, pop, pop” and pointing out bubbles for to pop. 3. Use exaggerated facial expression to encourage child to shift gaze between you and the bubbles. 2.

Adaptations Include different directions (e.g., high in the air, low to the ground). Ask child to follow bubbles in a specific order (e.g., big to small).

Bubbles in the Air: Working on Shifting Gaze Adrienne Steiner, M.M., MT-BC University of Louisville Louisville, Kentucky Description The purpose of this song intervention is to encourage children to shift gaze between person and object, and between two objects. Goals to promote shared attention through shifting gaze to increase ability in following distal and contact point Behavior Observation The child will: visually track bubbles moving around the room follow a bubble pointed out by the therapist Materials Accompaniment instrument (e.g., guitar) Bubble bottles

Bubbles in the Air Recorded 2016 by Adrienne Steiner

About the Author Adrienne C. Steiner, M.M., MT-BC is the clinical coordinator and primary therapist at the University of Louisville’s music therapy clinic. She supervises practicum students and interns while teaching courses in music therapy. Starting Fall 2016, Ms. Steiner will be pursuing her doctorate at the Florida State University, Tallahassee, Florida. Contact:

Directions 1. Blow into bubble wand to produce a large number of bubbles to circulate through the air.

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Directions 1. Find a comfortable position for the children to remain in during the session. This may be sitting with legs crossed, seated in a chair, or lying down. 2. Begin playing music that is engaging and holds the attention of the children. 3. Spend several minutes modeling and a steady pattern of breathing in and out. 4. If comfortable and rapport has been established, invite the children to close their eyes. 5. Ask the children to think about one thing that is “happy” and picture that one thing in their mind. 6. Ask them to describe what they see with as much detail as possible. 7. Continue cueing steady, deep breathing. 8. Ask the children to see the image again in their minds and notice what feeling they have when they see it.

Mindful Me: Engaging Children in Mindfulness Practices Darcy DeLoach, Ph.D., MT-BC University of Louisville Louisville, Kentucky Description The purpose of this music-listening intervention is to provide practice in calming and self-regulation techniques. Goals to enhance focused attention to improve self-regulation to increase relaxation response Behavior Observation The child will: remain still and quiet while attending to the music engage in deep breathing and mindfulness techniques relax muscles and breath steadily Materials Live or recorded music without lyrics A space to sit comfortably with limited distractions

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Continue cueing steady, deep breathing. 10. When the exercise is completed, ask the children to notice the support of what they are sitting/lying on and notice the sounds in the room around them before they open their eyes. 9.

Adaptations Discuss the process of noticing feelings and have children imagine that what they are feeling is their whole body. Depending on the children’s needs, another word/ image can be processed. Three Song Recommendations: Yoga Nidra by Meditation Spa Stars and Butterflies by Dario Marianelli Nuvole Bianche by Ludovico Einaudi About the Author Darcy DeLoach, Ph.D., MT-BC, is the Director of Music Therapy at the University of Louisville where she teaches, writes and advocates for the use of music therapy interventions across the lifespan.




DATE: 11/10/2016 TIME: 6-7 PM

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A note to [...] from Music Therapists Around the World Idea and Design by Petra Kern, Ph.D., MT-BC, MTA, DMtG imagine editor-in-chief Compiled by Rose Fienman, MSW, MT-BC imagine editorial assistant The imagine Color of Us series features international voices of early childhood music therapists. This year, 12 authors have each been invited to write an essay about a topic that is highly relevant in their respective countries. A range of fundamental questions are addressed, including the following: What should early childhood educators know about collaboration? What should parents know about the benefits of music therapy interventions? What should professionals know about where music therapists work? What should communities know about music in the home? What should students know about service projects abroad? While there are many similarities in how music therapists practice and provide services worldwide, each country has its own nuances based on federal policies, socio-economic status, and cultural norms. That said, the benefits of music therapy interventions remain the same for young children and their families.

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Early Childhood Educators about Collaboration

Dr. Petra Kern, USA

In the U.S., a music therapist may collaborate with an early childhood educator as contracting partner or as part of an interdisciplinary team. The music therapist may offer environmental modifications (e.g., musical playgrounds), musical curriculum adaptations (e.g., circle time activities), or systematic music-based strategies (e.g., peer-mediated song interventions) to support children with disabilities as they participate in a broad range of activities and contexts. Based on the child’s abilities, preferences, and interest, and identified needs, a music therapist may also offer direct services within a childcare program. In collaboration with all team members, the music therapist then focuses on functional and measurable goals (e.g., pre-academic concepts, self-regulation, or social competence) and engages the child in active learning through music. Often early childhood educators collaborate during the music therapy sessions by providing support to the child with disabilities. Maximizing learning for the target child, the music therapist may also coach the early childhood educator to providing music-based learning opportunities within and across activities and routines.

Parents about the Benefits of Music Therapy Interventions


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In Japan, parents of children with disabilities put forth great effort towards finding the best available educational and therapeutic services for their child. However, they may not have heard about music therapy as a viable treatment option or don’t have a clear understanding of what it is and how it can benefit their child. Parents should know that music therapists strive to create a natural and motivating learning environment, which differs from traditional therapies where children might be pulled out in a special room and feel separated or even stressed. In music therapy sessions, children are able to learn outside the constraints of a typical therapy setting. That said, parents should be aware that music therapy goes beyond offering fun music experiences for their child. Music therapists conduct assessments to determine the abilities and needs of each child, set therapeutic goals accordingly, and plan sessions to address the identified goals. Hence, music therapy is a valuable treatment option for children with disabilities – something parents in Japan should consider.

Kumi Sato, Japan


The music therapist gathers all relevant information, assesses the child’s abilities and needs, develops an individualized treatment plan, and focuses on functional client goals. Developmental goal areas may address communication, physical, cognitive, social, and emotional skills. Music therapy sessions also may support a child in learning new pre-academic concepts and provide an enjoyable environment for learning through music.

Aksana KavaliovaMoussi, Bahrain

The music therapist may attend Individualized Education Program (IEP) meetings at the child’s school and provide reports to parents and school administrators on a regular basis.

Parents about the Music Therapy Process

In Bahrain, a music therapist collaborates with speech and language therapists, occupational therapists, physical therapists, behavioral therapists, and psychometrists when working with private clients in school settings. This collaboration is necessary for providing individual assessment of each child.

Professionals About Where Music Therapists Work


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In Poland, a music therapist may collaborate with special education teachers during eurhythmics classes to address the child’s needs by a) adjusting the course of action to the child’s development, b) developing child-specific pre-academic concepts, or c) assisting the child with self-regulation. In regular schools, music therapists may support teachers in making the curriculum more developmentally appropriate and enhancing teacher-student communication. A music therapist can support children in their emotional development, creativity, and group involvement. The most famous approach applied is Moblina Rekreacja Muzyczna (Mobile Musical Recreation). In a hospital setting, a music therapist may be part of a multidisciplinary team including social workers and physiotherapists. Typically, a music therapist supports children during anxiety-evoking situations such as medical procedures by keeping them relaxed and calm.

Kris Stachyra, Poland


Decision-makers should know that music therapy interventions for young children and their caregivers have positive outcomes on child development and behavior. Music therapy interventions can also improve parenting skills, parental well-being, and the parent-child relationship. Music therapy interventions support attachment, which is crucial for both physical and mental health.

Barbara Krantz, The Netherlands

Local policy makers should know that parent-child music therapy interventions, offered at an early stage in the child’s development, will empower young families and may avoid higher costs for health interventions later on.

Policy Makers About the Benefits of Music Therapy

In the Netherlands, the municipalities recently became responsible for the healthcare of all children in their communities. Civil servants now decide whether or not other interventions for children with disabilities and other health issues will be funded. Therefore, officials need to be informed about the benefits of music therapy as a valuable intervention for early childhood development.

Community About Music Therapy in the Home


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In Spain, an increasing number of music therapists offer their services to infants (0-12 months) and their parents in childcare centers and music schools, as well as through the education departments of major symphony orchestras. One of the primary objectives of programs offered by these facilities is to teach parents how to use music in their daily routines to soothe their infants, foster bonding, communication, and meaningful interactions, and promote child development in the physical, cognitive, emotional, and social domains. This is accomplished through active music experiences. Music therapists share with parents the importance of music in their child’s life, particularly in the first phases of development. Maximizing learning for children involves coaching parents in the diverse ways they can use music at home. Music therapists show parents how to carry out appropriate music-based activities with their children and how to stimulate them through music. Dr. Melissa Broton, Spain


Community About Music Therapy Goals

Fu-Nien Hsieh, Taiwan

In Taiwan, music therapists provide services for children with disabilities through hospital physical medicine and rehabilitation departments and through social welfare organizations (e.g., Taiwan Fund for Children and Families and ROC Down Syndrome Foundation). After assessing the strengths and needs of each child, a music therapist utilizes music to accomplish individualized goals. Music therapy interventions can improve speech and language through singing; facilitate improvement in fine and gross motor skills through instrument play; encourage communication and socialization through various music experiences; and assist with pre-academic skills through activities incorporating songs or instruments. Music therapists often collaborate with other professionals, such as physical therapists, occupational therapists, speech therapists, and special education teachers to maximize the outcomes of music therapy services. Services are delivered using fun and successoriented music experiences to motivate children’s participation and to increase the effectiveness of music interventions.

Multidisciplinary Teams about Medical Music Therapy


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In Chile, a music therapist may be part of a multidisciplinary team in health care settings and centers for children with various challenges. The music therapist may offer support during and after uncomfortable procedures, or for pain management by engaging the child so that the medical staff can carry out the procedure. Depending on the needs of the child, their capabilities, and interests, the music therapist designs an intervention in alignment with the team’s objectives. Taking into account the child´s previous experiences, nature of the intervention and participation of the parents, the music therapist creates a comfortable and soothing environment. Instruments, musical activities, and stories may become an emotional support and intermediary object to provide a contained and safe space for the child. Considering the parents´ role in the child’s healing process, the music therapist may also provide musical ideas to embed in the child´s rehabilitation process.

Mireya Gonzalez, Chile


Often these pregnancies interrupt the young girls’ life plans. It is very common for pregnant teens in Argentina to drop out of school. The shift from puberty to adulthood is forced and can be dangerous, particularly for girls as young as 11 or 12.

Gabriel Federico, Argentina

Music therapists in Argentina frequently work with pregnant teens. One of their main goals is to promote links between the families and society to aid the young mothers in their new roles. Music therapy programs focus on meeting the needs of teen mothers at all levels of pregnancy. Music therapists work to offer support to new and expectant mothers, facilitate bonding between mother and newborn, and offer education on healthy child development.

Music Therapists About Pregnant Teens

In Argentina, 1 out of every 6 infants are born to teen mothers, which causes three major issues: a) physical strains on underdeveloped female bodies, b) identity crises as teens abruptly transition from childhood to motherhood, and c) adjustments related to the responsibilities of raising a child.

Students About Service Projects Abroad


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As a music therapy student traveling to Guatemala to facilitate early childhood music, one might wonder about having a translator for music groups. While this can be helpful, it is important to go a step further. Activities should be planned with as few words needing translation as possible. Children learn well through activities emphasizing rhythm and repetition. While it is wonderful to try to find local songs that children know, it is not always feasible. It is also not always necessary considering children learn through imitation. University students can be taught to engage children in these ways. At one local school, the children were able to fully engage in student-led activities with only minimal translation needed although it was their first time experiencing music therapy. In the Mayan highland region of Xela, music paired with nonverbal techniques was able to cross the language barrier and facilitate communication with Guatemalan children.

Hakeem Leonard, Guatemala


Specialists About Music Therapy Techniques

Olga Blauzde, Latvia

In Latvia, many music therapists provide services for children with speech disorders. Researchers and specialists from a variety of disciplines have begun to take interest in the benefits of music therapy for these children. Music gives children a means for self-expression and stress relief, while simultaneously accessing areas of the brain responsible for speech and language development. Music therapists working with children with language disorders utilize rhythm, dynamics, and tempo to offer musical support and create a space where the children feel free and able to express their creative abilities. Techniques commonly used by music therapists include therapeutic singing, instrument play, movement to music, vocal and instrumental improvisation, and music games. Goals commonly addressed include increased attention, motor planning, breath support, verbal and nonverbal communication, and expression of emotions. Music provides an engaging and effective context for addressing the specific components of speech and language development.

School Personnel About Music Therapy Services


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In Australia, music therapists frequently work in schools that cater to children and adolescents with Autism Spectrum Disorder. They draw on the positive and engaging aspects of music to build a sense of health and wellbeing within entire school communities. This is accomplished both through implementing direct music therapy services and through working alongside teachers, speech therapists, occupational therapists and support staff. Music therapists assist other professionals in building music into their programs so that the mood and motivation of students may be maintained at a high level across the day. They develop dances to address social and motor goals, songs to address articulation and vocal expression, and instrumental play activities to address group music-making and turn-taking. Music therapists identify specific and measurable goals for each child through team assessments and in consultation with the family. Success at school is celebrated with families and encouragement is given so that families might help with generalization of newly developed skills across environments and with different people.

Bronte Arns, Australia



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Dena Register, Ph.D., MT-BC West Virginia University Morgantown, West Virginia

Amy Rodgers Smith, MMT, MT-BC On A Better Note Music Therapy Morgantown, West Virginia

Creating Capacity: What Music Therapist Need to Know About Advocacy for Music in Early Childhood

What Music Therapists Need to Know About Engaging in Advocacy

This podcast focuses on advocating for music and the arts in early childhood as a way for all children to interact, communicate, and grow.Â

This podcast discusses practical steps to engage in advocacy at every level with a variety of parents, professionals, and administrators.


Kimberly Sena Moore Ph.D., MT-BC University of Miami Miami, Florida

Adrienne C. Steiner, M.M., MT-BC University of Louisville, Louisville, Kentucky

What Music Therapists Need to Know About Starting a Private Practice

What Administrators Need to Know About Early Childhood Programming Budgets

This podcast offers seven core principles underlying a successful private music therapy practice.

Rachel Rambach, M.M., MT-BC Listen & Learn Springfield, Illinois Beyond the Clinic: What Music Therapists Need to Know About Extending Their Services Into the Home This podcast provides several ways music therapists can extend their services outside of the clinic, giving parents the opportunity to continue reinforcing skills learned in music therapy at home.

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This podcast addresses consideration for preparing and proposing a budget for a music therapy program to administrators.

Beth McLaughlin, MSE, LCAT, MTBC Wildwood School Schenectady, New York Pay Attention!: What Interns Should Know About Early Childhood Music Therapy and Autism Spectrum Disorder In this podcast, the author has composed a letter to prospective interns sharing her thoughts about what she’s learned from the young children with ASD with whom she has worked over the past 39 years.

Patricia E. Altieri Ramírez M.A., B.A. Benemérito Instituto Normal del Estado. Gral. Juan Crisóstomo Bonilla Puebla, Mexico What Educators in Mexico Need to Know About Music Therapy and Early Childhood This podcast discusses the status of professionals using music as a tool for learning and development with young children in Mexico.

Hakeem Leonard Ph.D., MT-BC Shenandoah University Winchester, Virginia What Music Therapy Students Need to Know When Conducting Service Projects in Latin American Countries This podcasts features key information and strategies to prepare activities that maximize engagement, overcoming any perceived language barriers when offering student service projects abroad.



Organizations: At Your Service Petra Kern, Ph.D., MT-BC, MTA, DMtG Music Therapy Consulting Santa Barbara, California Where do I find a certified music therapist in my area? Which evidence-based practices are available for my child with disabilities? Where can I get reliable information about child development? Who advocates for children, sets guidelines, and makes policies statewide and globally? Where can I meet and network with professionals? Which peer-reviewed

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publications are available? Who is offering professional development opportunities? The following selection of prominent U.S.based and global music therapy and early childhood organizations provide answers to these questions. Parents, professionals, administrators, and policy makers are encouraged to visit the organizational websites to learn more about available services. The World Federation of Music Therapy (WFMT) is an international umbrella organization dedicated to developing and promoting music therapy throughout the world. The Publication Center listed on the menu of the Federations’ website offers WFMT Guidelines and Policies, Fact Pages and Videos from WFMT’s eight regions, an International Library of Music, the Soundboard capturing therapeutic moments of clinical work, and the free online journal Music Therapy Today. To learn more about the forthcoming World Congress of

Music Therapy in Tsukuba, Japan, visit The American Music Therapy Association (AMTA) is a member organization that promotes public awareness of the benefits of music therapy and access to music therapy services. Besides facts about music therapy, qualifications of music therapists, and universitybased training opportunities, the organization also publishes the Journal of Music Therapy, Music Therapy Perspectives, and various books. A wealth of populationspecific information can be found on the organizational website and at its annual national and regional conferences. The Certification Board for Music Therapy (CBMT) is the only organization certifying music therapists to practice music therapy in the U.S. The organization ensures a standard of excellence for safe and competent music therapy practices and requires all certificates to stay current through continuing education requirements. Board-certified music therapists


located in specific states can be found at certificant_search. The European Confederation of Music Therapy (ECMT) fosters exchange and collaboration between European member countries to promote the profession. Specific country information, including a short history, training courses, and research activities can be found at ECMT also hosts a conference every three years. The International Society on Early Intervention (ISEI) provides a framework and forum for professionals from around the world to communicate about advances in the field of early intervention. The organization hosts an international conference every five years to bring together specialists from various disciplines to discuss effective early intervention programs for children at-risk and their families. Membership in this organization is free and can be obtained at http:// membership/memberapp.php. The Council for Exceptional Children (CEC), with over 40,000 members, is the largest professional association dedicated to advancing the success of children with exceptionalities. As the “voice and vision of special education” CEC supports professionals to obtain knowledge and resources needed for effective practice. The major publications of CEC are Exceptional Children and Teaching Exceptional Children. Features for members

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include the Topic Workshops, Webinars, Professional Development Hour, and Professional Training. CEC advocates on behalf of children with exceptionalities on a local, state, and federal level by responding to issues and making policy recommendations. CEC also develops standards, ethics, and practice guidelines for special education professionals, which can be found on the organization’s website. To learn more about CEC, view a short introduction video at v=QA4wwIyXT74. The Division of Early Childhood (DEC) is a special interest division of CEC with an international membership who works with or on behalf of children with special needs birth through age eight and their families. The organization developed sound Recommended Practices and Position Statements for families, emerging and practicing professionals, researchers, and administrators. The Journal of Early Intervention and Young Exceptional Children, Monographs, Learning Decks, and an annual conference keep members informed about policies and evidence-based practices. Visit the newly released website at http:// Division of International Special Education and Services (DISES) is also a division of CEC that focuses on special education programs and services in other countries. DISES promotes collaboration and exchange of research and practice while hosting international

roundtables. Members have access to the Journal of International Special Needs Education and the DISES Newsletter. Follow DISES on Twitter @DISES_CEC. ZERO TO THREE is a global nonprofit organization reaching millions of parents, professionals and policymakers each year. Leading private and public initiatives in partnership with other leaders, ZERO TO THREE ensures “that all babies and toddlers have a strong start in life.” Besides resources and services for parents, professionals, and policymakers, ZERO TO THREE provides free, reader-friendly, and multimedia enriched information on a variety of topics including early development and well-being, early learning, parents, policy and advocacy. To access all categories and corresponding products visit About the Author Petra Kern, Ph.D., MT-BC, MTA, DMtG, business owner of Music Therapy Consulting is adjunct Associate Professor at the University of Louisville, serves as editor-in-chief of imagine and on CBMT’s Board of Directors. She is a member of WFMT, AMTA, ISEI, CEC, and DEC and supports the work of the organizations. Contact:



New Publications 2015-2016 Compiled by Christopher R. Millett, M.M., MT-BC Florida Hospital Orlando, Florida This list features a selection of articles related to early childhood music therapy released after launching imagine 2015. Bond, V. L. (2015). Sounds to share: The state of music education in three Reggio Emilia-inspired North American preschools. Journal of Research in Music Education, 62(4), 462-484. Driscoll, V., Gfeller, K., Tan, X., See, R. L., Cheng, H., &

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Kanemitsu, M. (2015). Family involvement in music impacts participation of children with cochlear implants in music education and music activities. Cochlear Implants International: An Interdisciplinary Journal, 16(3), 137-146. Edwards, J. & Abad, V. (2016). Music therapy and parentinfant programmes. In J. Edwards (Ed.), The Oxford handbook of music therapy (pp. 135-157). New York, NY: Oxford University Press. Edwards, J. & Kennelly, J. (2016). Music therapy for hospitalized children. In J. Edwards (Ed.), The Oxford handbook of music therapy (pp. 53-65). New York, NY: Oxford University Press. Geretsegger, M., Holck, U., Bieleninik, L., & Gold, C. (2016). Feasibility of a trial on improvisational music therapy for children with autism spectrum disorder. Journal of Music Therapy, 53(2), 93-120. Geretsegger, M., Holck, U., Carpente, J. A., Elefant, C., Kim, J., & Gold, C. (2015). Common characteristics of improvisational approaches in music therapy for children with autism spectrum disorder: Developing treatment guidelines. Journal of Music Therapy, 52(2), 258-281. Gooding, L. F., Yinger, O. S., & Iocono, J. (2015). Preoperative music therapy for pediatric ambulatory surgery patients: A retrospective case series. Music Therapy Perspectives. Advance online publication. doi:10.1093/mtp/miv031 Gouzouasis, P., & Ryu, J. Y. (2015). A pedagogical tale from the piano studio: Autoethnography in early childhood music education research. Music Education Research, 17(4), 397-420.


Kim, S. J., Kim, E. Y., & Yoo, G. E. (2016). Music perception training for pediatric cochlear implant recipients ages 3 to 5 years: A pilot study. Music Therapy Perspectives. Advance online publication. doi:10.1093/mtp/miw009 Lee, L., & Lin, S. (2015). The impact of music activities on foreign language, English learning for young children. Journal of the European Teacher Education Network, 10, 13-23. Liao, M., & Campbell, P. S. (2016). Teaching children’s songs: A Taiwan-US comparison of approaches by kindergarten teachers. Music Education Research, 18(1), 20-38. Longhi, E., Pickett, N., & Hargreaves, D. J. (2015). Wellbeing and hospitalized children: Can music help? Psychology of Music, 43(2), 188-196. McPherson, G. E. (2016). The child as musician: A handbook of musical development (2nd ed.). Oxford, United Kingdom: Oxford University Press. Metell, M., & Stige, B. (2016). Blind spots in music therapy. Toward a critical notion of participation in context of children with visual impairment. Nordic Journal of Music Therapy. Advance online publication. doi:10.1080/08098131.2015.1081265 Oldfield, A. (2016). Family approaches in music therapy practice with young children. In J. Edwards (Ed.), The Oxford handbook of music therapy (pp. 158-175). New York, NY: Oxford University Press. Park, G., Weiss, S. J., & Repar, P. (2015). Randomized single-blinded clinical trial on effects of nursey songs for infants and young children’s anxiety before and during head computed tomography. The American Journal of Emergency Medicine, 33(10), 1477-1482. Pitt, J., & Hargreaves, D. J. (2016). Attitudes towards and perceptions of the rationale for parent-child group music making with young children. Music Education Research. Advance online publication. doi: 10.1080/14613808.2016.1145644 Preis, J., Arnon, R., Silbert, D., & Rozegar, A. (2015). Does music matter? The effects of background music on verbal expression and engagement in children with autism spectrum disorders. Music Therapy Perspectives, 34(1), 106-115. Shoemark, H., & Dearn, T. (2016). Music therapy in the medical care of infants. In J. Edwards (Ed.), The Oxford handbook of music therapy (pp. 24-52). New York, NY: Oxford University Press.

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Sundar, S., Ramesh, B., Dixit, P. B., Venkatesh, S., Das, P., & Gunasekaran, D. (2016). Live music therapy as an active focus of attention for pain and behavioral symptoms of distress during pediatric immunization. Clinical Pediatrics, 55(8), 745-748. Tan, E. Y. P., & Shoemark, H. (2015). Case study: The feasibility of using song to cue expressive language in children with specific language impairment. Music Therapy Perspectives. Advance online publication. doi:10.1093/mtp/miv039 Thompson, G., & McFerran, K. S. (2015). “We’ve got a special connection”: Qualitative analysis of descriptions of change in the parent-child relationship by mothers of young children with autism spectrum disorder. Nordic Journal of Music Therapy, 24(1), 3-26. Ullsten, A., Eriksson, M., Klässbo, M., & Volgsten, A. (2016). Live music therapy with lullaby singing as affective support during painful procedures: A case study with microanalysis. Nordic Journal of Music Therapy. Advance online publication. doi: 10.1080/08098131.2015.1131187 Waldon, E. G., Lesser, A., Weeden, L., & Messick, E. (2016). The music attentiveness screening assessment, revised (MASA-R): A study of technical adequacy. Journal of Music Therapy, 53(1), 75-92. Whipple, C. M., Gfeller, K., Driscoll, V., Oleson, J., & McGregor, K. (2015). Do communication disorders extend to musical messages? An answer from children with hearing loss or autism spectrum disorders. Journal of Music Therapy, 52(1), 78-116. Winter, P. (2015). Perspectives on the practice of community music therapy in rural primary schools of Malawi. Nordic Journal of Music Therapy, 24(3), 276-287. Van der Heijden, M. J. E., Oliai Araghi, S., van Dijk, M., Jeekel, J., & Hununk, M. G. M. (2015). The effects of perioperative music interventions in pediatric surgery: A systematic review and meta-analysis of randomized controlled trials. PLoS ONE, 10(8), e0133608. 0133608 Yang, Y. (2016). Parents and young children with disabilities: The effects of a home-based music therapy program on parent-child interactions. Journal of Music Therapy, 53(1), 27-54.



Teaching Young Children (2015). Expressing Creativity in Preschool. Washington, DC: National Association for the Education of Young Children. 128 pages. ISBN: 978-1-938113-08-6. $18.00 Expressing Creativity in Preschool, published by the National Association for the Education of Young Children, is a beneficial resource for early childhood educators looking for ways to support their students’ learning while fostering their creativity. In this book, authors from various disciplines offer strategies and suggestions for activities while stressing the importance of the expressive arts in the education and development of young children. The book is organized into three sections: Art, Music and Movement, and Dramatic Play. Each section contains a piece about expressive arts-infused learning centers, complete with lists of suggested setup tips, activities, and learning goals. Each section also contains suggested “budget stretchers” and extensions which include field trips, arts appreciation activities, and ways to involve students’ families. Additionally, strategies for reaching

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dual language learners and learners with special needs can be found throughout each section. Each section is concluded with a Learning Center Checklist to help educators evaluate how well the centers they have set up promote creative learning processes for their students. The art section of this book opens with a piece that outlines the importance of open-ended art. The author notes that reducing the structure of an art lesson and allowing children to have more control over their creative processes provides increased opportunities for them to explore and interact with the materials in a way that offers outlets for emotional expression and supports the development of executive functioning and motor skills. This message is carried throughout the section, which includes suggestions for an art-based learning center that allows children to explore art materials and engage in open-ended and self-directed art experiences. Strategies for collage, weaving, and splatter paint projects, as well as a list of books that can stimulate artbased discussions, are provided. This section also provides a list of open-ended questions for asking children about their artwork in a way that engages them in conversations about the creative thought processes behind their work.


Listen to my audio bookmarks

The music and movement section outlines ways to use music and movement to help young children learn to follow directions, listen for cues, and gain awareness and control of their bodies in a shared space. Suggestions for a music and movement learning center include setting up in a large and open area where students can freely explore musical instruments and movement props. This section oers ideas on how to promote music play and creative movement with preschoolers, including suggestions for dance stories, an example of an outdoor music play center, tips for attending live performances, examples of low-cost music activities, and a list of books that feature song lyrics. The dramatic play section of this book begins by outlining the importance of dramatic play and oral storytelling in the development of children’s social awareness and ability to problem solve and independently and collaboratively make decisions. This section also highlights the benefits of using improvisational play as a creative way to foster the development of social skills and collaboration in young children. Suggestions for a dramatic play learning center include making puppets, prop boxes, and various play materials available to students. Examples of DIY puppet crafts, a list of books about folktales, and suggestions for a Three Little Pigs building activity are provided.

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The book concludes with biographies about the numerous contributing authors. With pieces from preschool and kindergarten teachers, professors, editors, movement analysts, music therapists, service coordinators, and art teachers, Expressing Creativity in Preschool provides a rich presentation of engaging strategies and activities for early childhood educators to use as tools in promoting student growth and development through art, music and movement, and dramatic play. About the Author Amy L. Myers, MT-BC is a music therapist at Wildwood School. She provides individual and group music therapy services to students with special needs in the Albany, NY area.



Division for Early Childhood (2015). DEC Recommended Practices: Enhancing Services for Young Children with Disabilities and Their Families (DEC Recommended Practices Monograph Series No. 1). Los Angeles, CA: Author. 138 pages. ISBN 978-0-9819327-9-8. $30.00 Published in 2015 by the Division for Early Childhood, DEC Recommended Practices: Enhancing Services for Young Children With Disabilities and Their Families is dedicated to translating research into practice. The book offers comprehensive recommendations on evidencebased practices to aid various professions in providing effective services for improving and promoting the development of young children (ages 0-5) who are at-risk for developmental delays and disabilities. Starting with the history of the DEC Recommended Practices and its revision process, the book consists of the following chapters addressing 66 updated recommended practices, which are organized into eight topic areas: Leadership, Assessment, Environment, Family, Instruction, Interaction, Teaming, and Collaboration, and Transition. Each section includes a research-based literature review providing a strong rationale for the outlined recommended practices. Clinical case scenarios and practical suggestions make the recommended practices accessible for families, professional development providers, faculty, and practitioners such as music therapists. Music therapists working with young children with disabilities and their families should be familiar with the DEC Recommended Practices and implement them as part of their services and supports. For example, the recommended practices in the chapter on instruction are designed to improve learning outcomes for young children with disabilities. These practices allow practitioners “to help children […] learn new skills, achieve meaningful outcomes, and participate as full members of their communities” (p. 85). One such practice recommends that “practitioners embed

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instruction within and across routines, activities, and environments to provide contextually relevant learning opportunities,” which can be addressed in music therapy sessions by creating instructional lyrics to reinforce the learning of routines across multiple settings. Within the original recommended practices published in 2014 (see recommendedpractices), the five recommended practices in the topic area Interaction can also provide effective strategies to use in the context of a music therapy session. One of these practices (Interaction 2) focuses on social development by “encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support” (p. 13). This can be fully addressed in an inclusive music therapy session by pairing a child with a disability with a typically developing child when singing and dancing. In summary, the DEC Recommended Practices should be on every early childhood music therapist’s desk. The practices provide a guide for implementing effective services for young children and their families. By applying the complete list of practices in music therapy sessions, music therapists can demonstrate that they are competent partners in improving child Listen to my audio outcomes. bookmarks

About the Author Anne Parsons is an intern at the University of Louisville’s Music Therapy Clinic. Her current work involves a wide range of populations including young children with disabilities in various community settings. Contact:


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imagine 2016  

In this issue, over 70 authors from 12 countries share their dedication and passion for early childhood music therapy with imagine readers....

imagine 2016  

In this issue, over 70 authors from 12 countries share their dedication and passion for early childhood music therapy with imagine readers....