Pediatric Medical Pediatric Medical Music TherapyMusic Therapy

Lillieth Grand, MS, MT-BCLillieth Grand, MS, MT-BC

Primary Children’s Medical CenterPrimary Children’s Medical CenterSalt Lake City, UtahSalt Lake City, Utah2005 Utah MT-BC’s and USU did a pilot study2005 Utah MT-BC’s and USU did a pilot study$10,000 donated from Rock Against Cancer $10,000 donated from Rock Against Cancer MT-BC started at the end of January 2008MT-BC started at the end of January 2008$10,000 donated from Rock Against Cancer in $10,000 donated from Rock Against Cancer in

March 2008 March 2008 to purchase a to purchase a portable portable recording recording studio and nowstudio and now PCMC is a RAC PCMC is a RAC School of RockSchool of Rock

Primary Primary Children’s Children’s Medical Medical CenterCenter

271-bed children’s hospital 271-bed children’s hospital + outpatient clinics+ outpatient clinics

MT is an included service MT is an included service = no charge to insurance or = no charge to insurance or patient families patient families (in bed charge) (in bed charge)

Dr. orders for music therapy Dr. orders for music therapy ≈ 10-25% of the inpatient 10-25% of the inpatient census on any given daycensus on any given day

MT participates as a MT participates as a member of the member of the following teams:following teams: Wound Care & IV TeamsWound Care & IV Teams Rehabilitation TeamRehabilitation Team Pain ManagementPain Management Palliative Care TeamPalliative Care Team Behavioral HealthBehavioral Health BereavementBereavement

MT at PCMCMT at PCMC1 Full-Time MT-BC1 Full-Time MT-BC1 Part-Time MT-BC1 Part-Time MT-BCTrain 4 Interns per Train 4 Interns per

year (2 per term) year (2 per term) Music Therapy is Music Therapy is

one of the 10 one of the 10 programs in Family programs in Family Support ServicesSupport Services

Supervise Music Supervise Music Volunteer ProgramVolunteer Program

Internships AvailableJanuary (1st Monday) ~ applications due April 1June (Last Monday) ~ applications due Oct. 1

MT at PCMC Con’t.MT at PCMC Con’t. Music Therapists Music Therapists have full access to have full access to charts and charts and document each and document each and every session.every session.

MT-BC acts as a full MT-BC acts as a full team member and team member and consults and/or co-consults and/or co-treats with all other treats with all other disciplines including: disciplines including: Dr., RN, PT, OT, Dr., RN, PT, OT, SLP, Psych, CCLS, SLP, Psych, CCLS, LCSW, Education, LCSW, Education, IV Team, etc.IV Team, etc.

Practice GuidelinesPractice Guidelines

AudioanalgesiaAudioanalgesia During proceduresDuring procedures For pain controlFor pain control

Emotional processing and Emotional processing and development of coping development of coping skills through musicskills through music

Neurologic stimulation Neurologic stimulation and developmentand development EntrainmentEntrainment Auditory Processing and Auditory Processing and

Hearing functionHearing function Developmental SkillsDevelopmental Skills Sensory IntegrationSensory Integration

Although music therapy Although music therapy cancan address many address many goals, we focus our efforts on those that will goals, we focus our efforts on those that will make a difference MEDICALLY and where our make a difference MEDICALLY and where our services are unique.services are unique.

Referral Referral **

IndicationsIndications

Unresponsive or under Unresponsive or under responsive to responsive to traditional or other traditional or other modalitiesmodalities

Patient/Family needPatient/Family need Invasive procedureInvasive procedure Pain controlPain control

Neurological Neurological impairmentimpairment ComaComaTraumatic Brain InjuryTraumatic Brain Injury Physical TraumaPhysical Trauma

TriageTriage

Immediate needImmediate needWhen other strategies When other strategies

are exhaustedare exhaustedProcedural AssistanceProcedural Assistance1:1 request with 1:1 request with

Doctors orderDoctors order1:1 request without 1:1 request without

Doctors orderDoctors orderGroups Groups

Considerations:Considerations: Length of StayLength of Stay Perceived ImportPerceived Import Clinical Reason for Clinical Reason for

ReferralReferral FSS Staff InvolvementFSS Staff Involvement

Immediate Need Immediate Need (when other strategies are exhausted)(when other strategies are exhausted)

Note: This is the ONE Note: This is the ONE situation where the ISO situation where the ISO Principle doesn’t work!Principle doesn’t work!

Effective MusicEffective Music Well-known children’s songsWell-known children’s songs Lullabies with and without Lullabies with and without

words (yes, even for a 12-words (yes, even for a 12-year-old)year-old)

Effective ToolsEffective Tools Sung BooksSung Books Nylon String GuitarNylon String Guitar Rainstick & Ocean DrumRainstick & Ocean Drum FabriFinish DrumFabriFinish Drum

Be prepared! You never know Be prepared! You never know what you’re going to need!what you’re going to need!

Procedural Procedural AssistanceAssistance Introduce MTIntroduce MTExplain: Explain:

(consider development)(consider development) Gate Theory of PainGate Theory of Pain Fear–Tension–Pain CycleFear–Tension–Pain Cycle

Assess Music PreferenceAssess Music PreferenceSing “If I Were Brave”Sing “If I Were Brave”

by Jana Stanfieldby Jana Stanfield Provide musical and Provide musical and

emotional comfortemotional comfortEstablish ClosureEstablish Closure

Pain ScalePain ScaleRecord DataRecord Data

no need for sedation and no need for sedation and its potential negative side its potential negative side effectseffects

higher efficiency of higher efficiency of treatment staff (including treatment staff (including time savings)time savings)

lower cost (no sedation lower cost (no sedation staffing or drug cost)staffing or drug cost)

greater patient greater patient satisfactionsatisfaction

less patient anxiety and less patient anxiety and painpain

BenefitsBenefits

Music for Procedural AssistMusic for Procedural AssistUse preferred music Use preferred music

if possible (calming)if possible (calming) Benefits of live music Benefits of live music

vs. recorded musicvs. recorded musicVibro-acoustic elementsVibro-acoustic elementsAlterable in the momentAlterable in the momentInteractiveInteractive

Silly Songs can be Silly Songs can be effective for:effective for:DistractionDistractionSinging Along (one can Singing Along (one can

not stop breathing if not stop breathing if they are singing!)they are singing!)

Learn to play a guitar wearing Learn to play a guitar wearing gloves and to sing wearing a mask!gloves and to sing wearing a mask!

1:1 Request ~ Doctor’s Orders1:1 Request ~ Doctor’s OrdersMost Common GoalsMost Common Goals Clinical Reason Specified Clinical Reason Specified

on orderon order IncreaseIncrease

Relaxation ( heart rate)Relaxation ( heart rate) Oxygen Saturate RateOxygen Saturate Rate Emotional ExpressionEmotional Expression Coping SkillsCoping Skills Quality/Amount of movementQuality/Amount of movement

DecreaseDecrease AgitationAgitation PainPain

MaintainMaintain MotivationMotivation

1:1 Request ~ Other1:1 Request ~ OtherAlthough priority is given to Although priority is given to patients with Dr. orders, patients with Dr. orders, perceived import is always perceived import is always considered – can get ordersconsidered – can get orders

Most Common InterventionsMost Common Interventions Interactive Music makingInteractive Music makingReceptive ListeningReceptive ListeningEmotional SupportEmotional Support Lyric AnalysisLyric AnalysisSongwritingSongwritingTherapeutic Instrumental Therapeutic Instrumental

Music PerformanceMusic PerformanceMovementMovementSensory StimulationSensory StimulationRhythmic EntrainmentRhythmic EntrainmentMusic and RelaxationMusic and Relaxation

GroupsGroupsDrop-in Groups Drop-in Groups

available in the available in the Playroom 2x/wkPlayroom 2x/wk

Drop-in Groups Drop-in Groups available in the available in the Lobby 2x/wkLobby 2x/wk

Teen Group Teen Group available 1x/wkavailable 1x/wk

Staff Groups Staff Groups available ~arrangedavailable ~arranged

Patient Goals include: Patient Goals include: increase positive experiences increase positive experiences

while in the hospitalwhile in the hospital increase distraction from increase distraction from

individual challenges individual challenges connected to hospitalizationconnected to hospitalization

increase emotional expressionincrease emotional expression increase socialization and increase socialization and

group interaction.group interaction.

General TipsGeneral Tips Learn to do swift assessment Learn to do swift assessment

and rapport buildingand rapport buildingBe self-aware and practice Be self-aware and practice

good self-caregood self-care Know your limitsKnow your limits Have ritual practicesHave ritual practices

Have a large repertoire!Have a large repertoire! Listen to Radio DisneyListen to Radio Disney Consider culture!Consider culture! For developmental ages & stagesFor developmental ages & stages For multiple purposesFor multiple purposes Children also listen to the music Children also listen to the music

of their parents of their parents (ie: KISS, Journey)(ie: KISS, Journey)

Always represent yourself & Always represent yourself & our career professionally!our career professionally! ChartingCharting Interactions & AppearanceInteractions & Appearance

Use high Use high quality quality equipmentequipment

Know Know infection infection control & control & instrumentinstrument/equipment /equipment cleaning cleaning proceduresprocedures

RelationshipsRelationshipsare Key!are Key!Related FieldsRelated Fields

Child Life SpecialistsChild Life SpecialistsSocial WorkersSocial Workers ChaplainsChaplains EducatorsEducators Physical TherapistsPhysical TherapistsOccupational TherapistsOccupational TherapistsSpeech Language Speech Language

PathologistsPathologists Respiratory TherapistsRespiratory Therapists Psychology StaffPsychology Staff

Medical StaffMedical StaffNursesNursesDoctorsDoctors

CommunityCommunity Retail Music StoresRetail Music Stores Equipment RetailersEquipment RetailersMusiciansMusicians VenuesVenues

CommentsComments ““When they were finished with When they were finished with

the injections our daughter the injections our daughter hadn’t shed one tear and didn’t hadn’t shed one tear and didn’t realize that the procedure had realize that the procedure had been done. Since then we have been done. Since then we have to have Music Therapy!” – to have Music Therapy!” – mother of a child with regular mother of a child with regular intramuscular Botox injectionsintramuscular Botox injections

“ “She was singing phrases of She was singing phrases of songs with you well before she songs with you well before she started speaking words… started speaking words… Through your combined efforts Through your combined efforts with the other therapists you with the other therapists you increased K’s ability to retrain increased K’s ability to retrain her brains pathways.” – father her brains pathways.” – father of a 4-yr-old TBI patientof a 4-yr-old TBI patient

““They taught me a lot, including They taught me a lot, including things about myself I didn’t things about myself I didn’t know. The way they helped me know. The way they helped me stand pain was amazing!” — stand pain was amazing!” — patient who had spinal fusionpatient who had spinal fusion

““I didn’t realize that Music I didn’t realize that Music Therapy could play such an Therapy could play such an important role in her important role in her rehabilitation … helping in her rehabilitation … helping in her ability to speak” -- mother of a ability to speak” -- mother of a stroke patientstroke patient

“ “I would use Music Therapy I would use Music Therapy rather than sedation because it rather than sedation because it gives the patient/family a gives the patient/family a positive experience, it is more positive experience, it is more cost effective and less risky, we cost effective and less risky, we can do MT on kids who are high can do MT on kids who are high risk for sedation, the patients do risk for sedation, the patients do not have to be NPO, and it is not have to be NPO, and it is faster.” – Dave Craig, IV Teamfaster.” – Dave Craig, IV Team

QUESTIONS?QUESTIONS?

Lillieth Grand, MS, MT-BCLillieth Grand, MS, MT-BCMusic Therapy Program CoordinatorMusic Therapy Program CoordinatorPrimary Children’s Medical CenterPrimary Children’s Medical CenterFamily Support Services DepartmentFamily Support Services Department100 N. Mario Capecchi Drive100 N. Mario Capecchi DriveSalt Lake City, Utah 84113Salt Lake City, Utah 84113801-662-3712801-662-3712Lillieth.grand@imail.orgLillieth.grand@imail.org