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Florida State University Libraries
Electronic Theses, Treatises and Dissertations The Graduate School
2014
Social Work versus Music TherapyGraduate Students' Perceived Effectivenessof Music Therapy Interventions with anEnd-Stage Dementia PatientErica S. Privett
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FLORIDA STATE UNIVERSITY
COLLEGE OF MUSIC
SOCIAL WORK VERSUS MUSIC THERAPY GRADUATE STUDENTS’ PERCEIVED
EFFECTIVENESS OF MUSIC THERAPY INTERVENTIONS WITH AN END-STAGE
DEMENTIA PATIENT
By
ERICA S. PRIVETT
A Thesis submitted to the Department of Music
in partial fulfillment of the requirements for the degree of
Master of Music
Degree Awarded: Spring Semester, 2014
© 2014 Erica S. Privett
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Erica S. Privett defended this thesis on April 18, 2014
The members of the supervisory committee were:
Jayne M. Standley
Professor Directing Thesis
Dianne Gregory
Committee Member
Kimberly VanWeelden
Committee Member
The graduate school has verified and approved the above-named committee members, and
certifies that the thesis has been approved in accordance with university requirements.
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For Laura Allen.
Grandparents teach the importance of living in moments. Old people understand that we all get
a finite number of harvest moons, sunsets, and walks by the sea. Knowing the number of each of
these events would create unbearable poignancy, but it would force us to pay attention. If we
knew a harvest moon would be our second to last, we would look closely. If we knew a trip to
the sea would be our fourth to last, we would linger a bit longer.
-Mary Pipher, Ph.D.
Another Country: Navigating the Emotional Terrain of Our Elders
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ACKNOWLEDGMENTS
I would first like to thank Janis Long – not only for allowing me the use of the footage of
her mother’s music therapy sessions, but also for the encouraging words, continuous support, and
never ending enthusiasm for music therapy. Special thanks, also, to Aimee Woods who has had
to bear the brunt of and provide support during every single mood change throughout the entirety
of the “theserizing” process; that is, truly, the greatest gift I have ever received. You are as close
to a perfect human being as it gets. Thank you to the other perfect humans in my life, my
parents, Eric and Pamela Privett for the love that has never wavered; it is a debt that I will never
be able to repay. Thank you for always letting me believe that music is a viable option for a
profession. Very special thanks to my “seester” Holly Porcase for never being more than a text
message away, allowing me to rant and rave as needed, and for knowing that, when all else fails,
boba tea cures all ills. Thanks to Peter Berta for always welcoming me into the warm little home
that you and Holly have cultivated. Thank you to Kaitlyn Crocker for always having time for
lunch and for always making me feel heard. Thank you to Susan Droessler and the music
therapy department at Big Bend Hospice for your support of my research, your mentorship and
direction during my internship, and for being just a generally awesome group of people all
around. Thank you to Craig Stanley and Dr. Stephen Tripodi in the Florida State School of
Social Work for being immediately supportive of my research after never even having met me
before. Immense gratitude goes to my thesis chair, Dr. Jayne Standley for her patience and
guidance during this process as well as to my committee members, Dr. Kimberly VanWeelden
and Professor Dianne Gregory for their contribution and expertise. Finally, thank you to the
faculty of the Florida State University Music Therapy Program for changing me from a music
therapy student into someone with a clear understanding of what it means to be a fully realized
professional and human being.
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TABLE OF CONTENTS
List of Tables ………………………………………………………………………………….......vii
Abstract ………………………………………………………………………………………….. viii
1. INTRODUCTION ………………………………………………………………………….......1
A Growing Population of Older Adults …………………………………………………………1
The Rising Disability Rates in the United States ……………………………………………….2
Serving the Needs of the Growing Number of Dementia Patients ……………………………..6
Hospice Care in the United States …………………………………………………………......10
2. REVIEW OF LITERATURE …………………………………………………………………14
The Role of Social Work in Hospice Care …………………………………………………......14
Dementia in the Social Work Literature …...………………………………………………......17
The Role of Music Therapy in Hospice Care ……………………………………………….....20
Dementia in the Music Therapy Literature ……………………………………………………24
Interdisciplinary Collaboration and Referral to Music Therapy ……………………………….26
3. METHOD…..………………………………………………………………………………......31
Participants ……………………………………………………………………………….....31
Materials ……………………………………………………………………………….....31
Procedure ……………………………………………………………………………….....32
4. RESULTS ……………………………………………………………………………….....34
Summary ……………………………………………………………………………….....37
5. DISCUSSION ……………………………………………………………………………….....39
Limitations ……………………………………………………………………………….....40
Suggestions for Future Research ……………………………………………………………...41
Conclusions ……………………………………………………………………………….....42
APPENDICES ……………………………………………………………………………….....43
A Raw Data for Question 6, Part 1: Rating of Overall Effectiveness ……………………..…43
B Raw Data for Question 6, Part 2: Rating of Effectiveness of First Half of Video …………45
C Raw Data for Question 6, Part 3: Rating of Effectiveness of Second Half of Video ……...47
D Raw Data for Question 14: Likelihood of Referral to Music Therapy Services …………...49
E FSU IRB Approval …………………………………………………………………………51
F Proposal to BBH Ethics Committee ………………………………………………………..52
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G BBH Ethics Committee Permission ………………………………………………………..53
H Recruitment Email …...…………………………………………………………………….54
I Informed Consent Form …………………………………………………………….……...55
J Questionnaire ……………………………………………………………………………….56
REFERENCES ……………………………………………………………………………………59
BIOGRAPHICAL SKETCH ……………………………………………………………………...63
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LIST OF TABLES
Table 1: t-Test Results on Mean Overall Effectiveness Ratings ……………………………. 34
Table 2: t-Test Results on Mean 1st Half Effectiveness Ratings ……………………………... 35
Table 3: t-Test Results on Mean 2nd
Half Effectiveness Ratings ……………………………. 35
Table 4: t-Test Results on Mean Likelihood of Referral to MT Services ……………………. 36
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ABSTRACT
The purpose of this investigation was to determine differences in the way music
therapists and social workers discern effectiveness of therapeutic interventions. Participants
(N=71) were graduate students recruited from the Master of Social Work (n=44) and Master of
Music Therapy (n=27) programs at Florida State University. Participants were shown a 20-
minute video containing footage from two music therapy sessions with a 91-year-old end-stage
dementia patient and were asked to complete a brief questionnaire based on their perceptions of
the interventions used in the video. The research design was post-test only and included all
questions from the questionnaire in the analysis. A two-tailed t-test was performed for all
questions requiring participants to provide a rating on a Likert-type scale and indicated
differences in ratings between music therapy and social work ratings of the interventions shown
in the video. Additionally, for questions requiring participants to provide a short answer,
qualitative analysis techniques were used to determine differences in the way social workers and
music therapists discuss effectiveness of interventions. Findings and limitations will be
discussed and suggestions made for future research.
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CHAPTER ONE
INTRODUCTION
Jeanne Calment is known to be the oldest documented human being to have lived
anywhere in the world. Her birth predates both the patenting of the telephone
and the construction of the Eiffel tower. Prior to her death in 1997 at a youthful
122, Mrs. Calment enjoyed two pounds of chocolate per week and smoked until
the age of 117. Acquaintances have spoken of her sharp wit and stress free
lifestyle. Some have speculated that her longevity was genetic; both of her
parents survived well into old age. Whatever the reason for her lengthy existence,
she continues to be a symbol for a growing population of older adults.
A Growing Population of Older Adults
Information from the U.S. Census Bureau indicates that the population of older
Americans is growing rapidly. More precisely, the 2010 U.S. census saw an increase of 4.9% in
the population of Americans aged 65 and older, putting this demographic at approximately 40
million, or about 13% of the total population. Additionally, and more impressively, the
population of Americans aged 85 and older, termed the “oldest old” in gerontological research,
saw an increase of 18.1%, or approximately 5 million Americans, since the last census. This
population now accounts for approximately 1.5% of the total population of the United States
(Werner, 2011).
We see a continuing trend of females outnumbering males in the older population; in both
the 2000 census and the 2010 census, it was found that females outnumber males in every single
age from 65 to 100, with a ratio of about 90.5 males per 100 females in this age bracket. Though
this gap is shrinking, females can expect to have both longer life expectancy and lower mortality
rates than males. This trend continues into the oldest old age bracket. In fact, of the 53,364
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centenarians found in the 2010 census, 9,162 were males and 44,202 were females. (Werner,
2011)
In addition to the growth we have seen already in this population, demographers from the
census bureau predict that by the year 2030, the population aged 65 and older will have increased
to approximately 72 million and then 88 million by the year 2050. Likewise, the population of
oldest old, will increase to about 8 million by 2030 and 19 million by 2050 (American
Administration on Aging, 2012).
The American Administration on Aging (2012) attributes this huge projected growth to
the first “Baby Boomers” (those people born between the years of 1946 and 1964) turning 65 in
2011. They predict that the population of people aged 65 and older will slow after 2030 when
the Baby Boomers begin to enter the oldest old category, at which point the 85 and older
population will see a more dramatic increase. Additionally, this growth can be attributed to an
increase in life expectancy. In the early 1900s, average life expectancy in the United States was
47 years. At that time, the population of older Americans was less than 1 million. In today’s
society, average life expectancy is much higher, about 78 years, and is expected to increase to 82
years in 2050 (AOA, 2008; U.S. Census Bureau, 2009a, 2009b, as cited in Hooyman, 2011).
The United States saw the largest increase in life expectancy during the 1900s; as stated before,
this was from 47 years in 1900, to 78 years in 2007. This is due to the 20th
century eradication of
many diseases that contributed to childhood mortality. Likewise, as medicine continues to
advance, we can likely expect diseases like heart disease and cancer to shift to chronic rather
than fatal (Hooyman, 2011).
Rising Disability Rates in the United States
As the field of medical technology grows, so, too, does the both average life expectancy
and rate of disability – this is a worldwide trend. At first glance, it seems easy to dismiss the
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rising rate of disability, as our older population, is generally healthier than ever before.
According to the Administration on Aging (2012), average hospital stay for persons over 65 is
5.4 days, a five-day decrease from 1980. 29% of people aged 75 and older report that they
engage in regular physical activity. 44% of people aged 65 or older reported in 2012 that they
were in excellent or very good health. These statistics should be celebrated as they represent
progress made in the area of health science. They should not, however, blind healthcare
professionals to the still-rising rate of disability in the United States and its implications for the
population, especially those 65 and older.
Disabling conditions are on the rise as the older population continues to grow. According
to the United States Census, in 2010 there were approximately 19,234 people over the age of 65
living with a disability and 14,138 living with a severe disability – accounting for more than half
of the oldest old population (Brault, 2010). The census measures many specific types of
disabilities, including: sight, hearing, and speaking limitations; upper and lower body limitations;
activities of daily living, instrumental activities of daily living, and need for assistance; and
cognitive, mental, and emotional functioning. These disabilities are classified into three different
domains: communicative, mental, and physical, with many adults having difficulties in multiple
domains (Brault, 2010).
According to the Administration on Aging (2012), “there is a strong relationship between
disability status and reported health status.” Most adults aged 65 and older have at least one
disabling condition. Most commonly reported conditions include diagnosed arthritis, heart
disease, any type of cancer, diabetes, and hypertension (AOA, 2012). As a likely result, about
13.6 million people aged 65 and older were discharged from short stay hospitals in 2012 – 3
times the rate of the population as a whole. Additionally, 35% of 65 and older men and 38% of
women in this age bracket reported at least one disabling condition. 28% of community residing
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Medicare beneficiaries aged 65 and older reported having difficulty performing at least one
activity of daily living (ADL), which are defined in the literature as bathing, dressing, eating, and
transferring. An additional 12% of individuals reported having trouble with at least one
instrumental activity of daily living (IADL), defined as preparing meals, shopping, managing
money, using the phone, doing light housework, and taking medications (AOA, 2012). Older
women tend to report higher levels of functional limitations than do older men (U.S. Department
of Health and Human Services, 2010). Unsurprisingly, these physical limitations tend to
increase as people age – for example, about 13% of men ages 65-74 reported difficulties with
ADLs compared with 40% of men aged 85 and older. Likewise, women reported physical
limitations with regard to ADLs at 19% between the ages of 65 and 74 and 53% over the age of
85. Additionally, difficulties with ADLs at any age tend to have a higher prevalence amongst
minorities. About 18% of white men report limitations as opposed to 23% of non-Hispanic black
men, meanwhile 29% of white women report limitations compared to 33% of non-Hispanic
black women.
In addition to physical maladies, older Americans are reporting symptoms of depression
and anxiety with a higher frequency than they have in the past. According to the U.S.
Department of Health and Human Services’ 2010 report (2010), antidepressants and anti-anxiety
medications have increased in use amongst older Americans. Men over 65 have a lower
incidence of use of these medications overall, but have still seen an increase from 2% in the
bracket between 1988-1994 to 10% in the 2005-2008 bracket. Use of these drugs in women of
the same age has also increased from 4% in the 1988-1994 bracket to 17% in the 2005-2008
bracket. This increase is likely due to increasing availability of these drugs, as well as the slowly
waning social stigma surrounding their use. According to data collected in the Key Indicators of
Well Being released by the Federal Interagency Forum on Aging Related Statistics (2012),
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women over 65 are more likely to report clinically relevant depressive symptoms than men, in
keeping with a trend seen across all age brackets. The percentage of women aged 65 and older
who report depressive symptoms has ranged between 16% and 19% since 1998. When men do
report clinically relevant depressive symptoms, those over the age of 85 report at rates almost
twice that of men in any other age group, at about 19% (Federal Interagency Forum on Aging
Related Statistics, 2012). This is likely due, in part, to end-of-life related anxiety and depression.
The rate of obesity is increasing nationwide. Since 1988-1994, the rate of obesity in
people over 65 has increased by 16% (Federal Interagency Forum on Aging Related Statistics,
2012). Obesity is associated with risk of coronary artery disease, type 2 diabetes, cancer,
respiratory illness, osteoarthritis, and disability. Unlike most other conditions, there appears to
be little disparity between the prevalence in men versus women. However over the past 12
years, men have seen a slight increase (Federal Interagency Forum on Aging Related Statistics,
2012). Obesity may also be a contributing factor to the joint pain that almost half of the over 65
population report experiencing, resulting in greater need for surgeries such as knee and hip
replacements, as well as spinal fusion procedures (U.S. Department of Health and Human
Services, 2010, pp. 16-17).
It is not surprising, given the increasing rate of disability in the United States, that the
older population incurs higher costs for healthcare in comparison to the rest of the population.
According to a publication put out by the United States Census (2010), people with disabilities
represent about $200 billion dollars in discretionary spending in the United States. Even after
adjusting for inflation, statistics show that costs are substantially higher for older adults and vary
with different demographic characteristics (Federal Interagency Forum on Aging Related
Statistics, 2012). As stated previously, most older adults report suffering from at least one
disabling condition. Those individuals who suffer from only one condition tend to incur average
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yearly costs of about $5,520, while individuals with five or more conditions incur, not
unpredictably, significantly higher costs, averaging about $24,658 (Federal Interagency Forum
on Aging Related Statistics, 2012). In 2008, physician and outpatient hospital services
accounted for the highest amount of cost, at 36% of total healthcare costs for Medicare
beneficiaries, while prescription drugs accounted for 16% (Centers for Medicare and Medicaid
Services, Medicare Current Beneficiary Survey, as cited in Federal Interagency Forum on Aging
Related Statistics, 2012). As more prescription drugs have become available to treat conditions
not treatable 20 years ago, the amount of money Americans spend on drugs has also risen
significantly, though this has remained stable in recent years. In 2008, the average Medicare
beneficiary spent about $2,834 on prescription drugs (Federal Interagency Forum on Aging
Related Statistics, 2012).
Resulting from the increasingly disabled status of the 65 and older population is the
increased need for long-term care, such as the care provided by assisted living facilities (ALFs)
and skilled nursing facilities (SNFs). According to the U.S. Census, approximately 1.3 million
people aged 65 or older were in SNFs in 2010 (Werner, 2010). This included 24% of the
population aged 95 and older, as well as 32.3% of the centenarian population (Werner, 2010).
Not shockingly, as they tend to have higher rates of disability as well as a larger population size,
women tend to outnumber men in long-term care facilities. In the 65-74 age-bracket, about 3.9%
of women were in SNFs, compared with 2.1% of males. This gap only continues to grow in the
higher age brackets with 15.3% of males in the 95 and older range residing in SNFs compared to
27.3% of women of the same age (Werner, 2010).
Serving the Needs of the Growing Number of Dementia Patients
As people age, they find themselves at greater risk for Alzheimer’s disease and other
dementias. As such, there has been a growing body of research into these areas. Information
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from the National Institutes of Health indicates that as many as 5 million Americans in the 65
and older population have been or may be diagnosed with Alzheimer’s disease, a number that is
expected to double every five years (NIH, 2013). It is expected that by the year 2040, as many
as 81 million people globally will be afflicted with some form of dementia (Ferri, et al., 2005; as
cited in Duane, et al. 2011). Data available in the Alzheimer’s Association Facts and Figures
Report (2013) indicates that 1 in 3 seniors dies with dementia, making it the 6th
leading cause of
death in the United States.
Dementia is defined as the loss of cognitive functioning. In addition to affecting a
patient’s ability to think and reason, it also affects their ability to interact and behave in daily
life. It is important, in working with the 65 and older population, to distinguish between
dementia and age-related memory problems. Many people have lived well into their 90s or
higher without showing signs of dementia. The following criteria may indicate a dementia
diagnosis: two or more impaired mental functions (for example language, memory, visual
perception, or the ability to focus), and loss of brain function that is so severe that the patient is
unable to perform daily tasks. Furthermore, patients suffering with dementia will lose the ability
to control their emotions and impulses, resulting in personality changes, delusions, paranoia, or
even hallucinations (NIH, 2013). Research indicates that there are a number of risk factors
associated with dementia, including age, alcohol use, atherosclerosis, diabetes, Down syndrome,
genetics, hypertension, mental illness, and smoking. In order to diagnose dementia, these risk
factors are investigated by a physician, accompanied by number of neurological evaluations,
such as the Mini Mental Status Examination, or MMSE (NIH, 2013).
Though the most common and well-known form of dementia is Alzheimer’s disease,
dementia has many forms and root causes. Alzheimer’s disease is differentiated from other
forms of dementia by amyloid plaques between brain cells and neurofibrillary tangles inside the
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neurons, resulting in death of brain cells. Though there is significant research into the causes and
possible cures of Alzheimer’s disease, leading to the development of drugs to control the
symptoms, there is not a cure at this time (NIH, 2013). Other irreversible forms of dementia
include:
• Vascular dementia, thought to be the second most common form of dementia, which
results from interrupted blood flow to the brain. Dementia of this type is characterized by
confusion, disorientation, language difficulties, and vision loss or disturbances.
(Alzheimer’s Association, n.d. retrieved from: http://www.alz.org/dementia/vascular-
dementia-symptoms.asp)
• Mild cognitive impairment (MCI), characterized by a slight, but noticeable and
measureable change in one’s cognitive abilities. This type of dementia will be classified
into one of two groups, dependent on whether or not memory is affected: “amnestic
MCI,” or “nonamnestic MCI.” MCI does not usually have the devastating physical and
psychosocial effects of other dementia diagnoses; however, patients with this condition
are at significantly greater risk for developing Alzheimer’s disease. (Alzheimer’s
Association, n.d., retrieved from: https://www.alz.org/dementia/mild-cognitive-
impairment-mci.asp)
• Dementia with Lewy bodies, which is characterized by changes in thinking and
reasoning, highly volatile levels of confusion and alertness, Parkinson’s type symptoms,
hallucinations, REM sleep disorder, autonomic nervous system malfunctions, and
memory loss. Lewy body dementia is very similar to Parkinson’s disease and is thought
by researchers to have the same underlying cause. (Alzheimer’s Association, n.d.,
retrieved from: http://www.alz.org/dementia/dementia-with-lewy-bodies-
symptoms.asp#dementia)
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• Parkinson’s disease dementia, a form of dementia that affects only people with
Parkinson’s disease. Symptoms include memory and concentration difficulties, visual
disturbances and hallucinations, delusional paranoia, depression, and sleep disturbances.
(Alzheimer’s Association, n.d., retrieved from: https://www.alz.org/dementia/parkinsons-
disease-symptoms.asp)
• Frontotemporal dementia, caused by progressive cell degeneration in the brain’s frontal
lobe, the area known to control planning and judgment, emotions, speech, and some types
of movement. This type of dementia is grouped into one of three categories: behavior,
aphasia, or movement, based on patient symptomatic presentation. (Alzheimer’s
Association, n.d., retrieved from: https://www.alz.org/dementia/fronto-temporal-
dementia-ftd-symptoms.asp
• Huntington’s disease, a genetic disorder that causes changes in the central area of the
brain resulting in movement, mood, and thought changes. (Alzheimer’s Association, n.d.,
retrieved from: http://www.alz.org/dementia/huntingtons-disease-symptoms.asp)
• Creutzfeldt-Jacob disease is the most common of the prion diseases. Prion diseases are
caused when prion proteins begin to distort throughout the body and brain, ultimately
destroying brain cells. It is characterized by rapid progression of typical dementia
symptoms. (Alzheimer’s Association, n.d., retrieved from:
http://www.alz.org/dementia/creutzfeldt-jakob-disease-cjd-symptoms.asp)
• Korsakoff syndrome, most commonly caused by alcohol abuse resulting in a thiamine (or
vitamin B-1) deficiency. It causes difficulties in learning new information and severe
memory issues that will not affect an individual’s other thinking or social skills.
(Alzheimer’s Association, n.d., retrieved from http://www.alz.org/dementia/wernicke-
korsakoff-syndrome-symptoms.asp#symptoms)
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A dementia diagnosis brings about a range of emotions including fear or grief for the
impending, albeit gradual, loss of one’s mental and physical faculties. In addition to the
frightening prospect of losing one’s physical and cognitive abilities, it is also evident that people
who have received a dementia diagnosis fear the loss of their dignity and personhood. Hughes
(2013) argues that if clinicians deepen their thoughts of personhood as it relates to dementia, it
will support the development of person-centered care (p. 283). He goes on to conclude,
“although on one hand we see increasingly sophisticated scientific explanations of dementia, on
the other hand there continues to be an understanding of its broader spiritual implications” (p.
286). Families of people with dementia become especially preoccupied with these personal and
spiritual implications as the patient reaches the terminal stages of the disease.
Hospice Care in the United States
Dr. Ira Byock is a palliative care physician who is considered one of the pioneers of the
modern hospice movement in the United States. As a resident, he recognized the need for
physicians to be more attentive to terminal patients’ needs by focusing less on curative and
rehabilitative care and more on comfort, or palliative care for these individuals. These ideals,
outlined in detail in his numerous books and publications, provide the basis for the philosophy of
the modern hospice movement in the United States.
In his book Dying Well, Dr. Byock states:
Of the fundamental needs of persons as they die, only the need to control physical
symptoms is uniquely medical. Their more basic needs are broader than the scope of
medicine. They need shelter from the elements, a place to be. They need help with
personal hygiene and assistance with elimination. They need nourishment or, as death
comes close, sips of fluid to moisten their mouth and throat. They need companionship,
and they need others to recognize their continued existence. (p. 247)
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Information retrieved from the website of the National Hospice and Palliative Care
Organization (NHPCO) (“What is Hospice?,” n.d., para. 1) defines hospice care as “a team-
oriented approach to expert medical care, pain management, and emotional and spiritual support
expressly tailored to the patient’s needs and wishes.” This interdisciplinary team typically
consists of the patient’s personal physician, the hospice physician, nurses, home health aides or
hospice aides, social workers, chaplains, volunteers, and therapists. Some members of the
interdisciplinary team, including physicians, nurses, social workers, and chaplains, are
mandatory in order for the hospice to receive Medicare funds, while other members, such as
speech, occupational, expressive arts, or other types of therapists are supplementary – serving as
another avenue for tailoring care to the needs of the patients.
The primary goal of hospice and palliative care is physical and emotional comfort,
meaning that the members of the interdisciplinary team will adapt their care to meet the physical,
psychosocial, and emotional needs of their patients. With this in mind, services provided could
include management and administering of pain medications, provision and maintenance of
medical supplies or equipment, assistance with end-of-life planning and funeral arrangements,
inpatient care, respite care, spiritual and emotional counseling, and counseling for bereaved
family members.
Hospice serves any patient with a diagnosed terminal illness with a documented
prognosis of 6-months or less. The NHPCO (2013) states that 1,113,000 deaths in the United
States in 2012 were under hospice care. Hospice patients are re-assessed at regular intervals in
order to ensure eligibility and continuation of funds for their care. The first recertification occurs
90 days after admission and then every 60 days thereafter, until the patient dies or is discharged.
There is no limit to the amount of time a person can spend in hospice care (“The Medicare
Hospice Benefit,” n.d., p. 1), though criterion for recertification is rigid.
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Many people think of hospice as a place where terminally ill patients can go to receive
care until their death. However most hospice patients receive care in their own residence,
inculding private residences, assisted living facilities or nursing homes, or even acute care
hospitals. Most hospices do have inpatient care facilities where patients can go when their care
cannot be managed at their residence or when the patient’s caregiver needs respite.
Hospice providers are organized into three categories: not-for-profit providers of hospice
care account for approximately 32% of active Medicare provider numbers, for-profit providers
account for approximately 63% of Medicare provider numbers, and government-owned
programs comprise the smallest percentage, about 5%, of hospice providers according to data
provided by Medicare (NHPCO, 2013). Data collected by Medicare for the NHPCO (2013)
shows that the number of not-for-profit hospice organizations has been on a steady decline since
about 2007. Medicare provides the majority of hospice funding, and is the payer for 83.7% of
patients according to the NHPCO Facts and Figures report (2013). Another 7.6% of patients are
covered by private insurance and another 5.5% by the Medicaid hospice benefit. The other 2.1%
of patients are listed as self or other payer (NHPCO, 2013).
The Medicare hospice benefit was established in 1983 in order to ensure that Medicare
beneficiaries have access to end-of-life care. The number of Medicare beneficiaries receiving
hospice care has more than doubled since 2000. Over the last several years, Medicare spending
on hospice care has risen to $14 billion dollars per year, though it is important to note that this is
still only about 2% of total Medicare expenditures (“The Medicare Hospice Benefit,” n.d., p. 3).
A publication by the NHPCO (n.d., p. 3) attributes the rising hospice expenditures to the
inclusion by most hospices of many non-cancer illnesses such as heart disease, COPD, and
Alzheimer’s disease. To adjust for the different levels of care needed by the diverse population
of patients served by hospice programs, Medicare offers four different levels of care. Most
13
patients (95.7%) fall into the first level, routine home care. Other levels include general inpatient
care(2.9%), continuous care (1.2%), and respite care (.2%). The patients receiving routine home
care receive care that is reimbursed by Medicare at a per diem rate of about $153 per day (“The
Medicare Hospice Benefit,” n.d., p. 2). This per diem reimbursement is paid to the hospice in
order to cover all daily costs of care accrued by the patient, so long as they are related to the
patient’s hospice diagnosis or related comorbidities. Some days, the patient may require all or
more of this amount in order to fund their care, while other days they may not require even half.
This brings to light the importance of the hospice program maintaining a high average daily
census (ADC) and having strict documentation of eligibility. Simply put, the more patients
whose care is being funded by Medicare, the more money is coming into the hospice in order to
serve patients and meet overhead costs. This makes it rather important for the hospice to be
marketable – especially in large metropolitan areas where consumers may have multiple options
as to which organization handles their end-of-life care. Social services, such as counselors,
expressive arts therapies, chaplains, and volunteers, make a hospice program more appealing
and, therefore, more marketable. Additionally, social services tend to be relatively cheap
avenues for patient care, as they do not require a lot of costly equipment in order to provide care.
14
CHAPTER TWO
REVIEW OF LITERATURE
The Role of Social Work in Hospice Care
An over-arching theme in the social work literature regarding the role of social work in
hospice seems to be that social workers struggle with issues of role definition, status, and identity
issues (Lloyd-Williams, Friedman, & Rudd, 1999; MacDonald, 1991; Reese & Raymer, 2004;
Ryan, 1996; as cited in Parker Oliver, et. al., 2009). This confusion likely stems from the fact
that social work professionals have such a wide skill set, qualifying them for so many jobs
related to care of terminal patients and their families (Parker Oliver, et al., 2009). In addition to
social evaluations completed as part of the intake process, social workers provide counseling
services to patients and their families and facilitate referral to other supportive care services
within the hospice team, as well as to community-based social services. They also attend to end-
of-life planning needs, such as assisting patients and families in funeral home selection and
design of funeral arrangements. Based on this diverse list of duties, it is easy to see how the
multifaceted role of the hospice social worker could be a source of confusion.
Studies available in the social work literature have shown that as a result of the somewhat
questionable job description for hospice social workers, they are underutilized on the hospice
interdisciplinary team (Reese, 2011). In a study by Reese and Raymer (2004, as cited in Reese,
2011) results showed that the median number of patient visits from a nurse was 10, while from
social workers it was 2. Additionally, they found that social workers were participating in initial
intake interviews in only 38% of hospices. They found that social workers had much higher
caseloads than other members of the interdisciplinary team and their services were not well
advocated for resulting in difficulties with serving patients (Reese, 2011). These issues
contribute to a larger problem, wherein social workers are deemed non-essential to the hospice
15
organization, as well as the erroneous notion that other members of the team are as well or more
qualified to provide psychosocial care. In fact, evidence from the social work literature shows
that social work involvement has proven to lower hospice costs, facilitate team functioning,
reduce the need for additional medical services, and decrease the number of non-scheduled visits
by other team members (Reese & Raymer, 2004; as cited in Parker Oliver, et al.; 2009).
In a study by Bosma et. al. (2009) of hospice and palliative care social workers,
participants were asked to review and rate the competencies outlined by the Canadian Hospice
and Palliative Association for effective social work in the field of palliative and end-of-life care.
The study began in response to perceived widespread confusion amongst professionals about
precisely what social workers do in hospice. The findings reflected that, though the original
competencies were adequate, social workers had varying opinions about the true nature of
hospice social work. A vote was held and a consensus reached about social work competencies
in hospice care; listed as their primary goals were advocacy, assessment, care delivery, care
planning, community capacity building, evaluation, decision-making, education, research,
information sharing, interdisciplinary team, and self-reflective practice (p. 82). It was the hope
of the authors in publishing this study that, in addition to providing a clear job description for
social workers, confusion would be eliminated about the value of social work in the field of
hospice and palliative care.
Just what do the aforementioned competencies actually mean in practice? Altilio, et. al.
(2008) similarly describe the role of social work as it relates to the Clinical Practice Guidelines
for Quality Palliative Care (2004), as cited in Altilio, et. al., 2008). Specifically, this is due to
the fact that it uniquely fulfills the fourth of eight domains outlined in the Guidelines, “social
aspects of care” (as cited in Altilio, et. al., 2008, p. 4). Altilio (2008) cites the National Quality
Forum’s A National Framework and Preferred Practices for Palliative Care Quality
16
Measurement and Reporting (2006, as cited in Altilio, et al., 2008), which delineates 38
preferred practices in hospice and palliative care pertaining specifically to the eight domains
listed in the Guidelines (as cited in Altilio, et al., 2008, p. 4). Altilio posits that two of the
preferred practices listed in the National Quality Forum’s Preferred Practices are able to be
executed most effectively by those with a social worker’s unique skill set. The first is Preferred
Practice 18, which states that regular patient and family care conferences should be held in order
to provide information to the patient and family members, and discuss disease progression and
goals of care. The other, Preferred Practice 19, states that clinicians are to develop and
implement a comprehensive social care plan. While the latter practice is (or should be)
commonplace amongst all hospice and palliative care clinicians, social workers have the
opportunity to influence clinicians’ approach to particular social situations within a patient’s
personal environment as they relate to communication, existing social and cultural networks,
decision-making, work and school settings, finances, sexuality and intimacy, caregiver stress,
and access to medicine, equipment, and social services.
Further, social workers are compelled by their own Code of Ethics to go to the lengths
necessary to “alleviate suffering” (Altilio, et al., 2006; as cited in Parker Oliver, et al., 2009).
This could mean that the social worker must address tasks typically thought of as outside their
role, such as spiritual support, or even assessment and addressing of physical pain. Studies by
Terry Altilio (2009) outlined in Parker Oliver, et al. (2009) have shown that social workers are
able to assist with pain management through exploration of the physical, psychological,
emotional, and spiritual aspects of physically manifested pain.
In her article “Notes for the New Hospice Social Worker,” Colleen Barros (2012)
outlines very thoughtfully some of the things she has learned over the years as a seasoned
hospice social worker, mostly relating to self-care for the professional. In regards to patient care,
17
Barros writes something that is quite apt in describing the overall scope of social work care in
hospice: “[patients] need you to hold their hand and help alleviate their fear” (p. 209). For social
workers, this includes management of the minutiae, providing a calming presence, and staunch
advocacy for outstanding patient care.
Dementia in the Social Work Literature
As with hospice social work, a common theme amongst social work researchers in the
field of dementia appears to be the lack of clearly defined roles for social workers working with
this population. There seems to be a consensus throughout the research that the area of
competencies for care of dementia patients is severely lacking (Kaplan & Berkman, 2011;
Kaplan & Andersen, 2013; Manthorpe & Iliffe, 2009; Manthorpe & Iliffe, 2005; Sanders &
Swails, 2011; Tanner, 2013). As a result, Kaplan and Berkman (2011) point out, there is a very
limited amount of empirical data supporting a clear role for social workers in care for these
patients. Kaplan and Andersen (2013) draw attention to the fact that even since the profession of
social work was in its infancy, social workers have struggled with the professional status of their
field (p. 173).
Kaplan and Andersen (2013) posit that this is related to the fact that the biomedical
model is the most widely accepted model of care among healthcare professionals. In caring for
patients whose afflictions are curable or, at the very least, effectively treatable, this is fine. But,
they point out, for dementia patients whose disease is not curable, treatable, or even definitively
preventable, the biomedical model does not offer the best course of care. Medical research is
showing optimistic strides in understanding and treatment of Alzheimer’s and dementia, but it is
still necessary to provide help for patients who are currently struggling with the challenges of
dementia as well (p. 171). Kaplan and Andersen argue that the current medical response to care
of dementia patients is “disease focused” and provides services in response to crises. This is
18
ineffective, as it does not address chronic issues related to the disease – most of which are
psychosocial in nature. Dementia patients and their families experience a diverse range of needs
that social workers are uniquely equipped to handle, should competencies become available (p.
172).
Manthorpe and Iliffe (2009) make a similar argument in an article about early
intervention by social workers at the initial dementia diagnosis. They state: “at first glance, these
[issues with dementia treatment] may seem medical or nursing rather than social work tasks, but
social workers may provide continuity of care and may be able to indirectly or directly support
the person throughout the process of recognition of dementia.” (pp. 232 & 233) They go on to
argue that the role of social work will have to evolve in order to meet the needs of patients in this
way, positing that another way to care for patients with dementia would be to support other
clinicians and monitor the provision of person-centered care (p. 233). Manthorpe and Iliffe also
assert that though early detection and diagosis of dementia may be encouraged due to greater
possibility of slowing disease progression or treatment of symptoms, it may also bring about
psychosocial issues indirectly related to the disease itself, such as clinical depression. Social
workers in the role of monitoring the person-centered care provided by clinicians may be able to
help distinguish between conditions resulting from the primary diagnosis and secondary
conditions (p. 238).
A related study by Manthorpe and Iliffe (2005) explored social workers’ knowledge of
and opinions about early detection of dementia and its implications for social care. In their
research, a survey of social workers working with gerontological populations in England
uncovered three themes: skills in dementia identification, which focused primarily on
participants’ abilities to distinguish between forms of dementia as well as determining how their
plans of care would change based on the stage at which a diagnosis was made; second, the
19
impact of resource availability, which focused on participants’ knowledge of social services
available to dementia patients; and finally, dementia as a disability, which emphasized
understanding of the social stigma surrounding dementia as well as effects on individual’s
dignity and autonomy (pp. 197 & 198). In analysis of the results, Manthorpe and Iliffe
uncovered important information regarding participants’ opinions. On the topic of resources,
participants appeared to consider themselves as a resource, but felt that their expertise was
underutilized, possibly stemming from their role being unclearly defined (pp. 200 & 201).
In combination with the ambiguous role of social workers in dementia care, there also
appears to be an unusually low number of social workers interested in working with individuals
in this population (Sanders and Swails, 2011). Sanders and Swails (2011) bring to light that,
although interest in gerontological social work has been low historically, that it is even more
difficult to find social workers interested in working with in adults with cognitive impairments,
such as Alzheimer’s disease and other dementias. They point out that this becomes a greater
concern at the end of life, possibly because the disease process causes difficulties with two-way
communication, leading to feelings of insignificance, lack of purpose, and lack of value amongst
social workers working in this population (p. 129).
Two studies conducted in Europe, postulate that in order to experience success,
gerontological social workers working with dementia patients should address personhood and
identity with these patients (Tanner, 2011; Emilsson, 2008). Tanner (2011) states that
“embracing personhood and citizenship as pivotal concepts around which to plan and deliver
social work and social care services for people with dementia can help to advance these rights”
(p. 165).
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The Role of Music Therapy in Hospice Care
Data from the AMTA indicates that the number of music therapists working in hospice
more than doubled from 87 to 207 in the time between 2002 and 2008 (Pawuk, 2010). Data
suggests that music therapy is one of the most popular forms of complementary therapies
available in hospice care (Hilliard, 2005; Wlodarsczyk, 2007). Commonly used music therapy
interventions in hospice include song writing, improvisation, guided imagery and music, lyric
analysis, singing, instrument playing, and relaxation techniques (Choi, 2010; Hilliard, 2005).
The vast array of interventions utilized by music therapists suggests that they are very well
equipped to treat “the whole person,” an older medical idea becoming more prevalent in the
research in recent years (Wlodarczyk, 2007). Needs addressed by music therapists might consist
of social, emotional, cognitive, physical, and spiritual (Hilliard, 2005; Groen, 2007).
Though there is a huge sum of qualitative research supporting the use of music therapy in
hospice care, empirical data is scarce. What little empirical research does exist has strong
limitations and, as a result, has sometimes yielded insignificant results (Hilliard, 2005).
Statistically significant data does suggest, however, that music can be used in hospice care to
reduce pain (Curtis, 1986; as cited in Hilliard, 2005), reduce anxiety (as evidenced by reduced
heart and respiratory rates and increased body temperature) (Whittal, 1989; Calovini, 1993; as
cited in Hilliard, 2005), enhance mood (Longfield, 1995), treat discomfort (Krout, 2001; Batzner,
2003; as cited in Hilliard, 2007), address spirituality (Wlodarczyk, 2007), and enhance quality of
life (Abbott, 1995; Hilliard, 2003; as cited in Hilliard, 2005). Though the research presented in
the literature makes a compelling argument for the use of music therapy with terminally ill
patients, there is a dearth of empirical research available, at the expense of current and would-be
music therapy programs in hospice organizations.
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Despite the relatively small sample of experimental research available, music therapy is
understood to be very useful in hospice and palliative care, due to the fact that music therapists
are trained to work collaboratively within a medical model of care (Pawuk, 2010). Music
therapists are trained in their degree programs to assess and document patient visits, plan
treatments, monitor patients, and adapt techniques to ensure success of patients in therapy
(Pawuk, 2010). In addition, music therapy is proven to have a positive correlation with job
satisfaction and morale. One study by Mandel indicated that 85% of respondents believed that
music therapy made their agency more effective in treating patients, while 78% of respondents
stated that they felt that they were more satisfied with their agency overall due to the addition of
a music therapy program (Mandel, 1991; as cited in Pawuk, 2010)
In addition to literature supporting use of music therapy in hospice without regard to
where the patient resides, there is empirical data available from Hilliard (2004) regarding
residents in skilled nursing facilities. He collected statistically significant data supporting the
idea that music therapy patients experience a longer duration of life, especially if those patients
are female. The same study also presented findings that music therapists visited patients more
frequently and for longer durations than did social workers. This is supported by the figures that
indicate that social workers tend to spend an average of 25.10 minutes with patients, while music
therapists spent 36.76 minutes on average (p. 274). Of music therapists, social workers and
nurses, music therapists were also found to be the only clinicians who, indeed, treated “the whole
person,” with data collection indicating that they were the only discipline of the three listed that
treated cognitive, emotional, and physiological issues collectively (p. 274).
Music is uniquely suited to hospice and palliative care due to the holistic nature of its
interventions, as well as the spectrum of human emotions accessed through musical activities.
Conclusions drawn from an analysis of interviews with terminal patients conducted in an
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inpatient hospice in Singapore found that a range of music therapy interventions were versatile
enough to support patients’ physical, psychological, and social needs (Leow, 2010). Their
findings uncovered four major therapeutic themes (p. 346), to include: “mirror of the inner
feelings,” which describes participants’ description of music acting as a mirror that reflected
positive feelings; mood, which explored participants’ feelings occurring as a direct result of the
music therapy intervention; “Distraction,” which came about as a result of participants feeling
that music provided a distraction from the physical and emotional pain of terminal illness; and
finally, “bridge of connection,” in which participants expressed how participating in music
allowed them to explore past memories, providing a feeling of peace, relaxation, and motivation
to live. These interviews with actual music therapy clients speak multitudes about the ability of
music therapy to run the gambit of physical, emotional, spiritual, and social needs addressed in
hospice care. Aldridge (1995), in a paper on spirituality and hope in hospice and palliative care,
says:
We are each a song that is continually being sung. What sings that song is a matter of
personal belief. Music therapy is an activity that promotes the expression of this song.
Each person is given the opportunity to creatively define themselves as they wish to be.
[…] It is possible to realize ourselves in the moment not solely as a body restricted by
infirmity, but transcended as a soul realizable in the music. (Aldridge, 1995, p. 104)
Topics discussed in Aldridge’s paper (1995) bring to light spiritual questions asked by
the terminal patient, as well as ways in which music therapists can relate to patients on a spiritual
level. Aldridge points out that patients’ relationship to their God, as well as prayer, meditation,
hope, and fellowship are as important to their health as medical care, though these needs are
rarely spoken about in medical settings. In hospice care, clinicians on the interdisciplinary team
have the opportunity to address meaning and hope as part of the general plan of care (p. 104).
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Conclusions drawn in Aldridge’s paper acknowledge that the reason music therapy is so
important in hospice care is because the client-therapist relationship that is fostered in music
therapy is nonjudgemental. “Furthermore,” he states, regarding the music therapist-client
relationship, “the therapeutic question is not ‘what am I?’ a question that lies in the realm of
categorization and cognition, but ‘how am I?,’ which is one of being” (p. 108).
In a study on music therapy and spiritual well being in hospice patients, Wlodarczyk
(2007) points out that studies are showing a positive correlation between spirituality and health
outcomes as medicine turns more toward treatment of the “whole person” (Anandarajah & Hight,
2001; Edwards & Hall, 2002; Peterman & Fitchett, 2002; as cited in Wlodarczyk, 2007). Studies
cited in Wlodarczyk (2007) indicate strong positive correlations between patients’ spirituality
and good health and hope of recovery. Lipe (2002; as cited in Wlodarczyk, 2007) reviewed 52
articles and found a common occurrence of caregivers utilizing music as a way to help the
patient move toward spiritual comfort. Results of Wlodarczyk’s (2007) study on spirituality in
hospice patients showed that music visits stimulated more discussions of spiritual issues – about
35% as opposed to 15% in the non-music visits. Further, 80% of patients expressed
disappointment with not having music during the non-music visits (p. 119).
In addition to spiritual well being of patients, music therapy can be used to address life
review – making the end-of-life a time of reflection, self-expression, and closure. This can be
done through a variety of music therapy interventions, to include songwriting, poetry, instrument
play, song selection, and creation of “living legacy projects” (Wlodarczyk, 2009). Even in the
case of dementia, when a patient may only be able to participate passively, they can still be
engaged in the life review process to some degree. The act of simply listening to a song from
one’s youth may evoke emotions associated with that time period, even if the patient is not able
to engage in discussion (Wlodarczyk, 2009).
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As Hilliard (2004) states: “it is difficult to think of a more comforting experience than to
have live music at the bedside of a resident who is terminally ill, who can no longer verbalize,
and who may otherwise be alone.” (p. 278)
Dementia in the Music Therapy Literature
In recent years, research has documented the need for support of the use of music therapy
to benefit patients suffering with a dementia diagnosis at any stage. In particular, music therapy
interventions have proven to be useful in treating cognitive function, increasing meaningful
engagement with family members and loved ones, increasing on-task behavior during group
therapy sessions, improving language functioning, and improving physical functioning to reduce
the risk of falls (Clair, Bernstein, & Johnson, 1995; Clair & Bernstein, 1990b; Clair & Bernstein
1990a; Prickett, 2000; Beatty et al., 1988; Crystal, Grober, & Masur, 1989; as cited in Lipe &
York, 2007; Belgrave, 2009; Ashida, 2000). Useful interventions in this area are passive music
listening (Hilliard, 2007), improvisation (Merrill, 1996), expressive and instrumental touch
(Belgrave, 2009), group reminiscence (Ashida, 2000), and Rhythmic Auditory Stimulation
(Brotons & Koger, 2000) with transfers made to music and movement interventions.
One study conducted by Sato Ashida (2000) examined the use of music therapy
interventions to treat depressive symptoms in patients with dementia. In her literature review,
she points out that depressive symptoms in persons with dementia result in higher rates of
institutionalization, mortality, impairment in ADLs, aggression, and psychological distress in
patients and caregivers. Symptoms of depression in older adults with dementia are typically
treated pharmacologically, however a need exists for nonpharmacological treatment measures to
be explored (Ashida, 2000). Studies exploring this have concluded that it is important to
emphasize active group participation and pleasant activities when designing interventions to be
used with these individuals (Lowy, 1962; Ward, 1979; Teri, 1994; as cited in Ashida, 2000).
25
Results of Ashida’s study indicate that there was a significant difference between depressive
symptoms in the music group in comparison to the non-music control group, after 5 days of
treatment. In addition to the empirical evidence she uncovered, staff members at the facilities
where the study was conducted reported that mood and interaction of participants improved right
after the completion of music therapy sessions, though this was not long lasting.
A similar study by Brotons and Koger (2000) found that music was able to positively
affect language functioning in older adults with dementia. Their findings indicated that there
was not a statistical difference in analyses of interactions, but results trended in the positive
direction, indicating that participants’ performance was better during the music condition in the
categories of speech content and fluency. They point out that there was uncertainty whether the
music directly contributed to language function or whether it contributed indirectly through
short-term memory stimulation (p. 191).
Clair and O’Konski (2006) conducted research using the technique of Rhythmic Auditory
Stimulation (RAS) on gait performance in people in the late stages of dementia. They point out
in their literature review that, due to increased motor impairment, people with dementia are at
heightened risk for falls or accidents (Camicioli & Licis, 2004; as cited in Clair & O’Konski,
2006). In addition, they point out that because walking is an essential activity to maintain good
physical health in older adults, the preservation of ambulation is essential to increasing quality of
life for these individuals. Rhythmic Auditory Stimulation is a technique that uses physiological
effects of auditory rhythm in order to promote control over movement. Their reason for testing
RAS on dementia patients had to do with positive effects on gait characteristics in individuals
with neurological impairments associated with stroke, Parkinson’s disease, and traumatic brain
injury (p. 155). Though their study yielded statistically insignificant results, it did indicate that
using music in gait training can yield positive results. Participants in the study consistently
26
became entrained with the rhythmic stimuli in the treatment phases (p.160). Additionally, they
point out that RAS can ease care burden on clinical staff working with these patients in that
participants required less physical support and had decreased need for more than one staff person
for support as locomotion was improved with RAS (p. 162).
Belgrave (2009) concluded that the use of touch with dementia patients is useful in
building rapport with these individuals leading to higher instances of meaningful interaction.
She tested the effect of expressive touch, or touch that conveys feelings of support, comfort, and
care, and instrumental touch, or touch utilized to assist a client in completing a task, such as
playing of a musical instrument. Belgrave cited studies in the field of nursing, wherein patients
felt an increase in comfort with nursing care when expressive touch was used (Moore & Gilbert,
1995; as cited in Belgrave, 2009). She points out in her literature review that touch can be
utilized to reduce feelings of isolation and disorientation in older adults with dementia, especially
those individuals residing in long-term care facilities (Hollinger, 1986; as cited in Belgrave,
2009). In addition, touch, paired with other forms of stimulation such as musical, visual, and
olfactory, has shown to increase signs of positive stimulation, such as eye blinking, eye opening,
mouth movements, vocalizations, head movements, and increased pulse rate. Results from
Belgrave’s study indicate that while instrumental touch was the most effective overall in eliciting
and maintaining alertness, expressive touch was more effective in the initial touch session in
eliciting and maintaining alertness; this is likely due to expressive touch enhancing the rapport-
building process.
Interdisciplinary Collaboration and Referral to Music Therapy
In a study by Choi (1997), patients and members of interdisciplinary teams in psychiatric
facilities were asked to rate music therapists in several areas including the functional role of
music therapy, the efficacy of music therapy practice and its professional engagement in the
27
medical/health care system. Participants were also asked if they were aware of the existence of
music therapy research. Overall, ratings of the music therapy role in treatment facilities and the
efficacy of music therapy practice were high, indicating that team members looked favorably
upon music therapists working with this population (p. 287). Psychiatrists and psychologists
tended to rate lower in most areas and results indicate that these professionals may have felt as
though music therapy invaded “their” area of treatment (p. 289). Additionally, regarding respect
of music therapy as a health profession, Choi points out that many respondents stated that they
felt the music therapy curriculum was inadequate and thus, music therapists were not as qualified
as they, themselves were to attend to patients’ needs (p. 288).
In the nearly decade and a half since Choi’s research, music therapists have come a long
way in advocating for their profession to other disciplines. However, research also indicates that
significant progress is yet to be made in the area of education. A study by Humphries (2013)
regarding perceptions of music therapy among oncology nurses indicated that nurses had very
little idea of the training and certification requirements to become a music therapist, given that
almost 30% of responding nurses reported that they, themselves were providers of music therapy
(p. 36). Responses indicated a clear lack of understanding of and regard for music therapy as an
evidence-based, allied health profession (p. 36). Furthermore, results indicated little
understanding of the scope of care a music therapist is qualified to provide, as results indicated
that nurses were unaware that music therapists receive training in psychosocial aspects of care
(p. 38). Overall, results from the study indicated that, while nurses were generally aware of
music therapy, many were not understanding of music therapy goals or the evidence base the
profession has built. Additionally, nurses who had no experience working with music therapists
rated efficacy of music therapy practice significantly lower than did nurses who had worked with
a music therapist, perpetuating findings from previous studies (p. 42).
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A similar study by Monas (2013) had much more optimistic results and found that
professionals working in pediatric outpatient settings were supportive overall of music therapy as
a “legitimate and effective” form of therapy (p. 42). In addition, this study also measured the
percentage of participants who had co-treated with a music therapist or believed that co-
treatment would benefit their clients, with 91% of participants responding in the affirmative to
this question (p. 43). Included in Monas’ questionnaire were questions designed to test for
misconceptions about music therapy goals. When asked to state goals for which respondents
believed music therapy would be useful, it was encouraging to find that there was a relatively
low number of participants who chose goals such as “increase musical ability,” or “increase
pleasantness of voice,” which are not typically considered therapeutic treatment goals (p. 43).
Furthermore, she found that participants commonly chose goals that coincided with their own
specialties, for example, a respondent who stated they were a physical therapist might have
chosen gait training as a goal for which music therapy would be useful (p. 44). This represents
progress in the area of advocacy and education in the time since Choi’s (1997) study which
indicated that other disciplines did not feel that music therapists were well qualified enough to
treat the same issues that they, themselves, were treating.
Finally, in the category of perceptions of music therapy, Hillmer (2003) conducted a
similar study testing for nurses’ perceptions of music therapy in a hospital setting. She found
that when testing for attitudinal statements, 17 out of 21 (or about 81%) made statements that
could be regarded as positive, confirming that nurses believed that there is, indeed, a benefit to
music therapy in the medical setting (p. 37). Her findings show that participants who were rated
as knowledgeable about music therapy tended to rate more favorably for music therapy
interventions than did those who had less knowledge about music therapy (pp. 39-40). Despite
29
previous knowledge and exposure to music therapy, Hillmer found that participants had an
overall positive attitude toward music therapy overall (p. 52).
Despite increasingly positive attitudes toward music therapy as an efficacious treatment
method in a variety of settings, there seems to be a dearth of research regarding co-treatment and
referral to these services, while still other studies are showing that clinicians in other areas are
utilizing music therapy techniques without the help of a credentialed music therapist (Lefevre,
2004; Whittlesey-Jerome, 1991). A study by Maddick (2011), however, found that a music
therapy/social work program was effective in treating men with spinal cord injuries. Results
indicated that the combined social work and music therapy program helped their clients to create
new, more positive senses of self and develop a renewed purpose in life. They hypothesized that
as a result of co-treatment, participants’ ability to reconcile many personal issues was enhanced
and accelerated (p. 136).
Finally, in the area of referral to music therapy services, one study by Daveson (2007)
found that patients in their inpatient Huntington’s disease treatment facility were referred based
on symptomatology relating to physical functioning (22%), cognition (9%), and reasons relating
to communication, social issues, and emotional expression (55%). In addition to this, patients
were more likely to be referred if they were younger – especially if these younger patients had
experienced less disease progression than their older counterparts (p. 13). Results from this
study revealed that with regard to these particular patients experiencing Huntington’s disease,
reasons for referral tend to be more rehabilitative than palliative, despite the incurable status of
the disease. The author makes note of this disparity within the literature, and indicates that she
believes that provision of care at the end stage of Huntington’s requires specialist skills in
palliative care (p. 15).
30
The same author of the previous study was involved, however, with a similar study
regarding referral trends in palliative care. This study by Horne-Thompson, et al. found that the
mean number in days from referral to music therapy services to death in a palliative care agency
was 13.24 compared to 22.7 days from admission to death (Horne-Thompson, et al., table 3).
Additionally, they found that patients were referred most commonly for issues relating to coping
and symptomatic issues. Nursing staff made the most referrals to music therapy (47%), followed
by self-referral (22%). The rest of the referral sources from greatest number of referrals to least
were allied health professionals (16%), medical (12%), other (2%), and family members (1%).
Allied health professions included for the purpose of analysis included art therapists, counselors,
massage therapists, medication teachers, music therapists, occupational therapists, pastoral care
workers, physiotherapists, psychologists, and social workers. The authors made note of the fact
that the referrals that came the most swiftly after a patient’s admission were those from the allied
health professions, with a mean of 8.19 days after admission.
Though the findings of these studies are useful, it should be noted that there is paucity in
the research with regard to referral sources, reasons, and rates. These are important aspects of
music therapy practice, and should be explored.
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CHAPTER THREE
METHOD
Participants
Participants in this study consisted of students at Florida State University (N=71) who
were seeking a Master’s degree in Music Therapy (n=27) or who were seeking a Master’s degree
in Social Work (n=44). The sample of music therapy students were registered for classes at the
main Florida State University campus located in Tallahassee, FL while the sample of MSW
students came from both the main campus in Tallahassee and satellite campus located in Panama
City, FL as well as students seeking their MSW online. Participants were recruited via mass
electronic correspondence from the directors of their respective programs.
Social work students were chosen because of the social work influence in hospice and
palliative care. While other disciplines do make referrals to music therapy services, social
workers deal primarily with case management and referral to allied health services such as music
therapy, bereavement services, or occupational therapy, among others.
Materials
The researcher utilized Qualtrics survey software provided for free by Florida State
University as a benefit of enrollment. Video footage of music therapy sessions was recorded
using a Sony video recorder provided by the Big Bend Hospice Music Therapy Department. The
video footage was edited for length using Apple video-editing software installed on an Apple
MacBook Pro. Video footage was privately hosted through Vimeo.com with a Vimeo Plus
membership paid for by the researcher. Additionally, the researcher utilized a six string classical
guitar provided by the Big Bend Hospice Music Therapy Department for use during their 6-
month clinical internship.
32
In order to take part in this research, all participants were required to have access to a
school or personal computer with access to the internet and a Florida State University email
account.
Procedure
For recruitment purposes, the researcher provided a form letter via email to the director
of the Florida State University Music Therapy program and Master of Social Work program
director. Both directors forwarded this email to students registered for classes in these programs,
encouraging them to participate by clicking a link to the survey. After clicking the link provided
in the letter, students were taken to the survey, wherein they were asked to review a brief
informed consent form. Review of this form informed students that participation was voluntary
and that participation consent could be withdrawn at any time. By clicking continue, participants
agreed that they understood the terms outlined in the informed consent.
After consent was confirmed, participants were asked to view a 21-minute video
containing footage from two music therapy sessions with a 91-year-old end-stage dementia
patient, taken while the researcher was participating in a 6-month clinical internship with the Big
Bend Hospice Music Therapy Department. This video footage was edited for time only and was
not enhanced in any way. The first session documented in the video shows the researcher
performing an intervention referred to in music therapy literature as an “upward iso-principle,”
wherein the therapist matches the music to the patent’s current presentation and gradually brings
the volume, tempo, and level of musical complexity up. In this case, the upward iso-principle
was used to rouse the patient for feeding after she had been sleeping for most of the day. The
second intervention performed in the video showed music provided with slight “downward iso-
principle,” music matched to the patient’s presentation and gradually brought down in volume,
33
tempo, and musical complexity, paired with expressive touch, in order to address signs of
anxiety, likely resulting from the thunderstorm occurring outside (this can be heard in the video).
After viewing the video, participants were asked to complete a brief questionnaire
containing several multiple-choice demographic questions, as well as questions inquiring about
their opinions of the video. These questions included several Likert-type scale questions, “yes or
no” multiple-choice questions, and short answer questions requiring participants to elaborate on
answers provided in the Likert-type scale and multiple-choice questions. Terms outlined in the
informed consent stated that participants were free to skip questions at any time should they so
choose. After submitting the questionnaire online, the survey software recorded participants’
responses and participants were allowed to close their web browser or navigate away from the
webpage. Participants were not compensated in any way.
34
CHAPTER FOUR
RESULTS
A two-tailed, independent sample t-test was performed on raw data collected from
participants’ responses to the three parts of question number six on the questionnaire requesting a
rating (out of seven possible points) of overall effectiveness of both interventions, rating of
effectiveness of the intervention seen in the first half of the video, and a rating of effectiveness
for the intervention seen in the second half of the video. Results of the test indicated a barely
significant difference between music therapy students and social work students in the ratings of
overall effectiveness (refer to table 1) and of effectiveness for the first half of the video (refer to
table 2) with music therapy students rating, on average, slightly higher. There was no significant
difference between music therapy and social work ratings for effectiveness of the second half of
the video, though the mean music therapy rating was still slightly higher than that of social work
(refer to table 3).
Table 1. t-Test Results on Mean Overall Effectiveness Ratings
Variable n Mean SD t df tcrit p Decision
Music Therapy 27 6 .68 3.08 69 1.994 .00293 Reject H0
Social Work 44 5.3636 1.06
Note: p < .05
35
Table 2. t-Test Results on Mean 1st Half Effectiveness Ratings
Variable n Mean SD t df tcrit p Decision
Music Therapy 27 6.1852 .7863 3.31 67 1.994 .00151 Reject H0
Social Work 44 5.4545 1.0665
Note: p < .05
Table 3. t-Test Results on Mean 2nd
Half Effectiveness Ratings
Variable n Mean SD t df tcrit p Decision
Music Therapy 27 5.5926 .9306 .99 69 1.995 .62453 Fail to Reject H0
Social Work 44 5.4643 .9993
Note: p > .05
Table 4 details the results of a two-tailed, independent sample t-test performed on the raw
data from question number 14, requesting participants to rate their likelihood of referring a
patient with end-stage dementia for music therapy services on a five point Likert-type scale.
There was a significant difference between ratings from music therapy students and social work
students, with music therapy students rating higher with a mean of ~4.6, as opposed to the mean
of ~4.1 from social work.
36
Table 4. t-Test Results on Mean Likelihood of Referral to MT Services
Variable n Mean SD t df tcrit p Decision
Music Therapy 27 4.6296 .5649 2.78 69 1.995 .00699 Reject H0
Social Work 44 4.1364 .9299
Note: p < .05
Noteworthy findings were uncovered in the short answer sections of the questionnaire,
with particular regard to the questions requiring participants to name the specific interventions
they believed that they had seen in either half of the video. 27% of social work students stated
that the specific intervention seen in both halves of the video was “music therapy.” This
response occurred three times from music therapy respondents, though 62.9% of music therapy
students used the term “iso-principle” in response to this question. The high percentage of social
work students responding in this manner is likely due to poor knowledge base of music therapy
as an evidence-based, allied health profession within which a multitude of interventions exists.
Additional findings indicated differences in the way music therapists described goals of
interventions as well as effectiveness considerations. While music therapy students tended to use
more objective clinical language when describing goals and effectiveness considerations, social
work students tended to use more colloquial language. For example, a common description of
the goal of the first intervention seen in the music therapy responses was: “to rouse patient,
promote awareness, and elevate mood.” Percentage of music therapy students using some
37
approximation of this language with the words “mood elevation,” “elevate mood,” “promotion of
awareness,” etc. was about 74%.
Meanwhile, social work responses were more varied and tended to focus more on
bringing “comfort,” “peacefulness,” or “joy” as well as showing “empathy” to the patient.
Percentage of social work students who used this type of language to describe the goal of the
intervention was 70.5%. Common responses from social work students with regard to
effectiveness considerations were that the patient “seemed peaceful,” or “seemed calm/at peace.”
One respondent stated that the patient “looked like she was thinking of wonderful things.”
Music therapy students tended to cite the therapist’s proximity to the patient, obvious
changes in the patient’s presentation, as well as facial affect and body language. One music
therapy respondent wrote that factors considered in determining effectiveness were: “the
therapist’s choice of appropriate intervention for the patient’s level of functioning, because
effectiveness is compromised when the intervention does not meet the needs and abilities of the
patient.” This respondent goes on to say: “[I considered] the music therapist’s observation of the
patient’s responses as evidenced by the music therapist’s alterations to the intervention based on
the patient’s responses.”
Social work responses to this question trended more towards the colloquial, for example:
“[I considered] the level of interaction by the patient. End-stage dementia is often a time of
silence, closed eyes, and no interaction.” Another social work respondent stated that they felt the
music “relaxed [the patient] and made her feel more comfortable with her situation.”
Summary
This study sought to examine differences in the way music therapy and social work
students perceive effectiveness of therapeutic interventions. Results from quantitative analysis
of raw data collected from a brief questionnaire indicate that there was a significant difference
38
between music therapy versus social work students’ ratings in three of four questions regarding
effectiveness and likelihood of referral to music therapy services. Music therapy students tended
to rate effectiveness of music therapy interventions and likelihood of referral higher than did
social work students. Additionally, results from qualitative analysis of short-answer responses
indicated differences in use of clinical language to describe interventions, goals, and
effectiveness considerations.
39
CHAPTER FIVE
DISCUSSION
This research sought to determine differences in the way social workers and music
therapists discern effectiveness of therapeutic interventions. Analysis of raw data exposed
significant differences in overall rating of effectiveness, while analysis of written answers
revealed differences in language used by either discipline when describing goals, specific
interventions, and effectiveness considerations. It is the hope of the researcher that the results of
this study will inform design of music therapy in-services in order to facilitate effective
education on music therapy as an allied health profession, as well as the uses and goals of music
therapy, not just in hospice, but in a multitude of clinical settings.
Quantitative analysis used in this study indicates that music therapy students tended to
rate music therapy interventions higher than did social work students. This is likely due to a bias
toward music therapy as a modality. Understanding of our own biases toward our profession is
very important in ensuring that others are able to glean real understanding of our techniques and
goals. As Monas (2013) points out in a similar study of multidisciplinary collaboration and co-
treatment with music therapy, “in order for a collaborative relationship to work, mutual respect
of each discipline is necessary.” In this case, transfers can be made with respect to referral from
other disciplines on the interdisciplinary team. If the referring member of the team does not
understand or identify with your goals as a clinician, the result will show in the size of your
caseload and the number of patients considered for referral to music therapy services. The 27%
of social work respondents identifying “music therapy” as the specific intervention, rather than a
complete treatment modality indicate a lack of education on music therapy and unfamiliarity
with the large evidence base supporting its use.
40
Furthermore, descriptions from both disciplines of the patient’s demeanor, response, and
presentation indicate that respondents may not have been familiar with typical presentation of an
end-stage dementia patient. The patient shown in the video presented with a Functional
Assessment Staging Test (FAST) score of 7d, characterized by the inability to sit up unassisted
or speak more than 1 word clearly. This score precedes the loss of the ability to smile. Some
responses indicating that respondents were looking for more movement or clearer facial affect on
which to base effectiveness of the therapeutic intervention may have been misinformed by the
lack of education with regard to end-stage dementia. These types of responses were not seen in
respondents who indicated geriatrics or hospice as a preferred population.
Music therapy has been proven effective in part due to the accessible nature of music as
an art form. Results from this study coincide with results from similar studies showing that,
overall, music therapy is look favorably upon by other members of the interdisciplinary team.
Though some social work respondents indicated that they may not have noticed any therapeutic
merit to the interventions shown, based on the video they would still be “likely” or “very likely”
to refer a patient to music therapy services. It is our job as clinicians to advocate for our
profession and be sure that referrals come from informed sources with a clear understanding of
the evidence behind our positive therapeutic outcomes.
Limitations
An important factor in experimental research is recognizing and accounting for the
limitations of the investigation. This study limited participation to students at Florida State
University in order to necessitate the need for permission from only one human subjects
committee. Although professionally relevant findings were uncovered, the research could have
benefitted from access to participants with more experience in their fields as these types of
respondents would have been more discriminating in their ability to discern effectiveness of
41
therapeutic interventions. Additionally, most respondents did not state hospice, geriatrics, or
dementia patients as a chosen population with which they work or would like to work.
Unnecessary disparities in ratings likely came about from a lack of familiarity with typical
presentation of an end-stage dementia patient. As such, more specialized responses could have
been established if respondents had been limited to students with experience in the field of
hospice, geriatrics, or dementia.
Suggestions for Future Research
The original intent of this research sought to determine differences between social
workers and music therapists in overall rating of therapeutic interventions. During the course of
this research, interesting results came about with regard to clinical language used when
describing interventions. As language disparities may cause rifts between disciplines in an
interdisciplinary setting, in-services could be designed with this in mind. Future research could
examine specific differences between disciplines with regard to clinical language. Additionally,
some respondents from social work described feeling unqualified to provide answers due to
unfamiliarity with music therapy and music therapy interventions. Future endeavors may benefit
from doing a pre-post test design wherein participants rate effectiveness before and after having
participated in a music therapy in-service.
Though in hospice social services and alternative therapies are often referred to by social
workers, there are some institutions wherein patients can be referred by anybody. With regard to
this, future research could include respondents from multiple disciplines within the
interdisciplinary setting. This could include nurses, nurse practitioners, medical doctors, or even
chaplains.
Although this research had a slight focus on referral within hospice services, future
research could seek to gain the opinions of professionals in a multitude of settings, hospitals or
42
mental health facilities for example, in order to better aid music therapists in designing in-
services geared toward professionals working with specific populations.
Conclusions
As the field of music therapy continues to grow, it is important to consider how we
educate our colleagues and potential clients on the benefits of music therapy in the populations
we serve. Special consideration must be paid to the values of our audience with regard to how
an in-service is structured, what language is used, and what dimensions of patient care are
emphasized. As with music performance, it is likely that a musician would not choose to
perform contemporary art music for an audience with little musical background or education,
likewise, music therapists should not assume an unreasonable amount of familiarity with
common practices in the field of music therapy. Clinicians should continue to conduct research
in this area in order to discern the values of other disciplines with regard to patient care so that
educational materials and in-services can be customized based on the audience to which they will
be posited.
43
APPENDIX A
RAW DATA FOR QUESTION 6, PART 1:
RATING OF OVERALL EFFECTIVENESS
44
Question 6, Part 1 Raw Data: Ratings of Overall Effectiveness
Music Therapy Social Work
6 4 4
6 7 5
6 5 5
7 5 6
6 5 4
7 6 2
6 6 5
6 6 4
6 7 6
6 7 4
7 6 5
7 7 5
7 5 6
6 6 6
6 5 6
5 6 6
6 7 4
6 6
5 6
7 4
6 5
5 6
5 6
6 4
5 5
6 6
5 5
45
APPENDIX B
RAW DATA FOR QUESTION 6, PART 2:
RATING OF EFFECTIVENESS OF FIRST HALF OF VIDEO
46
Question 6, Part 2 Raw Data: Ratings of Effectiveness of 1st half of video
Music Therapy Social Work
7 5 4
7 7 4
7 5 5
7 6 6
7 5 5
7 6 2
5 7 5
6 6 5
5 7 6
6 7 4
7 6 5
6 7 6
7 5 5
6 5 6
6 5 6
5 6 6
6 7 4
7 6
6 6
7 4
6 5
5 7
6 6
7 4
5 5
6 6
5 5
47
APPENDIX C
RAW DATA FOR QUESTION 6, PART 3:
RATING OF EFFECTIVENESS OF SECOND HALF OF VIDEO
48
Question 6, Part 2 Raw Data: Ratings of Effectiveness of 2
nd half of video
Music Therapy Social Work
5 3 5
5 7 5
5 5 5
6 5 6
6 5 4
7 6 2
7 6 4
6 6 4
6 7 7
6 7 4
6 5 5
7 7 5
7 5 6
5 6 6
5 5 5
4 6 6
5 7 5
6 5
5 7
7 5
6 6
4 6
5 5
5 4
5 5
6 5
4 5
49
APPENDIX D
RAW DATA FOR QUESTION 14:
LIKELIHOOD OF REFERRAL TO MUSIC THERAPY SERVICES
50
Question 14 Raw Data: Likelihood of Referral to Music Therapy Services
Music Therapy Social Work
5 3 3
5 5 3
5 4 4
5 5 5
5 5 3
5 4 4
5 5 3
5 5 5
4 5 3
5 4 3
5 5 4
5 4 4
5 5 5
4 5 4
4 5 5
3 5 2
4 3
5 5
4 2
5 4
5 5
4 5
4 3
5 4
5 3
5 5
4 5
51
APPENDIX E
FSU IRB APPROVAL
Office of the Vice President for Research
Human Subjects Committee
Tallahassee, Florida 32306-2742
(850) 644-8673 · FAX (850) 644-4392
APPROVAL MEMORANDUM
Date:
To:
Address:
Dept.:
From: Thomas L. Jacobson, Chair
Re: Use of Human Subjects in Research
The application that you submitted to this office in regard to the use of human subjects in the proposal
referenced above have been reviewed by the Secretary, the Chair, and two members of the Human Subjects
Committee. Your project is determined to be and has been approved
by an expedited review process.
The Human Subjects Committee has not evaluated your proposal for scientific merit, except to weigh the risk to
the human participants and the aspects of the proposal related to potential risk and benefit. This approval does
not replace any departmental or other approvals, which may be required.
If you submitted a proposed consent form with your application, the approved stamped consent form is attached
to this approval notice. Only the stamped version of the consent form may be used in recruiting research
subjects.
If the project has not been completed by you must request a renewal of approval for continuation of
the project. As a courtesy, a renewal notice will be sent to you prior to your expiration date; however, it is your
responsibility as the Principal Investigator to timely request renewal of your approval from the Committee.
You are advised that any change in protocol for this project must be reviewed and approved by the Committee
prior to implementation of the proposed change in the protocol. A protocol change/amendment form is required
to be submitted for approval by the Committee. In addition, federal regulations require that the Principal
Investigator promptly report, in writing any unanticipated problems or adverse events involving risks to
research subjects or others.
By copy of this memorandum, the chairman of your department and/or your major professor is reminded that
he/she is responsible for being informed concerning research projects involving human subjects in the
department, and should review protocols as often as needed to insure that the project is being conducted in
compliance with our institution and with DHHS regulations.
This institution has an Assurance on file with the Office for Human Research Protection. The Assurance
Number is IRB00000446.
Cc:
HSC No.
Erica Privett <[email protected]>
6964 Coleus Court, Jacksonville, FL 32244
MUSIC SCHOOL
Social Work Versus Music Therapy Graduate Students' Perceived Effectiveness of Music Therapy InterventionsWith an End-Stage Dementia Patient
Expedited per 45 CFR § 46.110(7)
12/04/2014
2013.11548
12/05/2013
Jayne Standley <[email protected]>, Chair
52
APPENDIX F
PROPOSAL TO BBH ETHICS COMMITTEE
The research I am proposing is for a master’s thesis written under the supervision of Dr.
Jayne Standley, Music Therapy Program Director at the Florida State University. The title of my
thesis is “Social Workers’ Perceptions of the Effectiveness of Music Therapy Interventions with
Dementia Patients.” The study will involve participants viewing video footage captured during
three music therapy sessions with one patient during my internship and completing a survey
relating to perceived effectiveness of the interventions.
Though the patient is neither able to agree nor disagree, the patient’s daughter is very
supportive of this research and plans to sign release forms as soon as she views the final, edited
footage.* The patient’s needs are a top priority and nothing will be done during the course of
research that would damage the patient’s dignity or reputation – the only role the patient plays in
the research is appearing in footage that will be viewed by participants in the study. No persons
other than the participants in the study or others directly involved in my research will be given
access to this footage and the footage will not be available after the completion of the study. I
will be seeking IRB approval for this study, though this is not yet finalized.
Music therapy is evidence-based and this study will be a contribution to the large body of
research that makes music therapy a valued and respected field, especially with regard to it’s
effectiveness with people who have been diagnosed with dementia. Your consideration is
greatly appreciated.
Should this statement be inadequate in explaining the purpose of my research, please feel
free to contact me by email: [email protected] or by phone (904) 962-1717.
* The total combined length of footage from the three recorded music therapy sessions is approximately 3 hours.
The footage will be edited only for time and will not be augmented in any way.
53
APPENDIX G
BBH ETHICS COMMITTEE PERMISSION
From: Susan Droessler <[email protected]>Subject: FW: Erica's proposal
Date: July 23, 2013 4:47:55 PM EDT
To: 'Erica Privett' <[email protected]>Cc: Candace McKibben <[email protected]>
Thank you Candace! I am sending this along to Erica! Erica…will you please keep us updated on the IRB approval and send over the results when it’s all finished? Thanks,
Susan&Droessler,&MT/BC
Music&Therapy&Department&Manager&&&Internship&Director
Big&Bend&Hospice
Tallahassee,&FL
(850)&878C5310&x128
&
From: Candace McKibben
Sent: Tuesday, July 23, 2013 12:56 PM
To: Susan Droessler
Subject: Erica's proposal
&
Dear&Susan,
&
The&Ethics&Committee&is&excited&about&the&proposal&that&Erica&presented&and&gives&full&blessing&for&her&to&move&forward.&&I&think&if&she
gets&the&IRB&approval&we&would&like&a©&to&add&to&ourðics&committee&minutes.&&We&would&also&like&to&see&her&results&if&possible.&
Thank&you,&Susan&and&best&of&luck,&Erica.
&
Rev. Candace McKibbenDirector of Supportive Care ServicesBig Bend Hospice Where it is our mission to provide compassionate care to our patients, comfort to their families and emotional support to all who grieve.
&
Confidentiality Notice: This email message, including any attachments, is
for the sole use of the intended recipient(s) and may contain confidential
and privileged information. Any unauthorized use, disclosure or
distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply email and destroy all copies of the original
message.
54
APPENDIX H
RECRUITMENT EMAIL
Hello [PROFESSOR],
My name is Erica Privett and I am a graduate student in the school of Music Therapy here at
Florida State University. I am currently conducting research for a thesis that will complete the
requirements for my Master’s degree in Music Therapy. The title of my research is “Social Work
Versus Music Therapy Graduate Students’ Perceived Effectiveness of Music Therapy
Interventions with an End-Stage Dementia Patient.” Ultimately, the goal of this study is to
pinpoint similarities and differences in the way social workers and music therapists evaluate
effectiveness of therapeutic interventions and its effect on referral from social workers to music
therapy services in an interdisciplinary setting.
For recruitment purposes, I would like to ask for you to please take a moment to forward this
message to your [MSW or MUSIC THERAPY] students in order to raise awareness of this
research. Your help regarding this matter is very much appreciated.
The link to this survey can be found here:
https://fsu.qualtrics.com/SE/?SID=SV_cBdeXYriCnn3U5n
Thank you,
Erica Privett, MT-BC
Music Therapy Graduate Student
Florida State University College of Music
55
APPENDIX I
INFORMED CONSENT FORM
Social Work Versus Music Therapy Graduate Students’ Perceptions of Effectiveness of Music
Therapy Interventions With an End-Stage Dementia Patient
Social Work Versus Music Therapy Graduate Students’ Perceived Effectiveness of Music Therapy Interventions With an End Stage Dementia Patient
Informed Consent Purpose of the Study:
This is a study conducted by Erica Privett, a graduate student at the Florida State University in the field of music therapy. This research is being conducted under the supervision of Dr. Jayne Standley, Music Therapy Program Director at the Florida State
University. The purpose of this research is to discover differences in how effective music therapy students perceive an intervention to be versus how social work students perceive the same intervention.
What will be done: You will watch an approximately 20 minute video containing footage taken from two music therapy sessions with a 91-year-old
patient with end-stage Alzheimer’s disease. You will then complete a survey regarding your perception of the effectiveness of the interventions used in the video. The survey should take approximately 10-15 minutes to complete and will contain several brief demographic questions followed by questions relating to the video footage. After the survey, you will have an opportunity to write
freely about anything seen in the video or about any of the questions in the survey. Benefits of this Study:
Music therapy is evidence-based and this study will be a contribution to the large body of research that makes music therapy a valued and respected field, especially with regard to its effectiveness with people who have been diagnosed with dementia. Your
participation is greatly appreciated. Risks or discomforts:
There are no anticipated risks or discomforts associated with participating in this research. Should you feel uncomfortable with any question, you are welcome to skip that question or withdraw your participation at any time. Should you decide to withdraw your
participation in this study, your answers will not be recorded. Confidentiality:
Your responses will be kept completely confidential. Decision to quit at any time:
Your participation in this study is completely voluntary. The decision to quit at any time is yours to make with the understanding that if you withdraw your participation, your answers will not be recorded. Should you decide to quit, simply exit the study.
How the findings will be used:
The results of this study will be used for scholarly purposes only. They will be presented in a Master’s thesis submitted in partial fulfillment of the degree of Master of Music in Music Therapy.
Contact information: If you have concerns or questions about this study, please contact the researcher, Erica Privett by phone: (904) 962-1717 or email: [email protected].
You may also contact the researcher’s major professor, Dr. Jayne Standley by phone at (850) 644-4565 or the Institutional Review Board by phone at (850) 644-7900.
By beginning the survey, you acknowledge that you have read this information in its entirety and agree to participate in this research with the understanding that you are free to withdraw your participation at any time without penalty.
56
APPENDIX J
QUESTIONNAIRE
Q1 What is your age group?
! 18-24-years-old
! 24-30-years-old
! >30-years-old
Q2 What is your gender identification?
! Male
! Female
! Other
! Prefer not to answer
Q3 How many years of experience do you have in your field? (Please include time spent in
practica and internships.)
! <1 year
! 2-4 years
! >5 years
Q4 What is your field?
! Social Work
! Music Therapy
Q5 Please specify the population with which you work and/or hope to work with.
______________________________________________________________________
57
Q6 Please rate the following based on your perceptions from the video.
Very Effective
Effective Somewhat Effective
Neither Effective
nor
Ineffective
Somewhat Ineffective
Ineffective Very Ineffective
Overall
effectiveness
of
interventions used.
! ! ! ! ! ! !
Effectiveness
of interventions
used in the
first half of the video.
! ! ! ! ! ! !
Effectiveness
of interventions
used in the
second half
of the video.
! ! ! ! ! ! !
Q7 Did you see an intervention being used in the first half of the video?
! Yes
! No
Q8 If yes, what was the intervention?
______________________________________________________________________
______________________________________________________________________
Q9 Please briefly describe what you believe was the goal for the intervention used in the first
half of the video. Explain why.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
58
Q10 Did you see an intervention used in the second half of the video?
! Yes
! No
Q11 If yes, what was the intervention?
______________________________________________________________________
______________________________________________________________________
Q12 Please briefly describe what you believe was the goal for the intervention used in the
second half of the video. Explain why.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Q13 Please briefly describe the factors you considered in rating the effectiveness of the
interventions shown in the video. Explain why.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Q14 Please rate based on your perceptions from the video.
Very Likely Likely Undecided Unlikely Very Unlikely
Based solely on
the interventions
seen in the
video, how likely would you be to
refer an end-
stage dementia patient for music
therapy
services?
! ! ! ! !
59
REFERENCES
Administration on Aging. (2012). A profile of older americans: 2012. Retrieved from: http://www.aoa.gov/Aging_Statistics/Profile/Index.aspx
Aldridge, D. (1995). Spirituality, hope and music therapy in palliative care. The Arts in
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practices for palliative and hospice care: A social work perspective. Journal of Social Work in End-of-Life & Palliative Care. 4(1), 3-16.
Alzheimer’s Association. (2013). 2013 Alzheimer’s disease facts and figures with special report
on long-distance caregiving. Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association. 9(2), 5-68.
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https://www.alz.org/dementia/dementia-with-lewy-bodies-symptoms.asp Alzheimer’s Association. (n.d.). Frontotemporal dementia. Retrieved from:
https://www.alz.org/dementia/fronto-temporal-dementia-ftd-symptoms.asp Alzheimer’s Association. (n.d.). Huntington’s disease. Retrieved from:
https://www.alz.org/dementia/huntingtons-disease-symptoms.asp Alzheimer’s Association. (n.d.). Korsakoff syndrome. Retrieved from:
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BIOGRAPHICAL SKETCH
Erica S. Privett currently holds a Bachelor of Music in Music Performance from the
University of North Florida, graduating in 2010. In 2011, she went on to pursue a Master of
Music in Music Therapy from Florida State University. During the course of her graduate
program, Ms. Privett gained experience working with a variety of populations to include: older
adults, adults with terminal illness, grief and loss, premature infants, and adults with
developmental disabilities. In January 2013, Ms. Privett began a 6-month music therapy
internship at Big Bend Hospice working with adults suffering from terminal illness. She became
a board certified music therapist in November, 2013.