Music Therapy Practice in Special Education and Children's Hospice: A Systematic Comparison of Two Music Therapists' Strategies with Three Preadolescent Boys

Abstract

The investigation described in this paper transpired from discussions between the two authors as we struggled to introduce a referral process for young people moving regularly between a special school and a children's hospice in Melbourne, Australia. It became apparent that each of the authors was conducting music therapy sessions with a number of the same young people in the two different settings in which they worked, sometimes within the same week. Parents organized hospice visits independently of the school system, often for respite rather than illness, and it was not feasible to expect families to communicate current music therapy information between the settings for each visit. After the failure of administrative strategies to foster communication, we began to look for more creative, rather than bureaucratic, ways of improving the consistency of service for the young people in both settings. In considering alternatives, we discussed individual young people, and a pattern began to emerge of similar practices despite the diverse settings. Clientcentered practice that incorporated abundant opportunities for choice and control was consistent across both settings, and we hypothesized that the content of sessions would be similar as a result. We chose to explore the similarities and differences in practice and how these impacted the music therapy experiences for the young people involved. Our intention was to better inform one another of relevant strategies for working with young people with profound and multiple disabilities in order to enhance service provision. In addition, we felt that hospice administrators may be interested in knowing if the skill-set for effective music therapy practice in a children's hospice mirrored that of special school clinicians as this knowledge may inform future employment opportunities.The Music Therapy Treatment Process in Two ContextsChildren's HospiceSetting and assessment. A children's hospice is structurally similar to a pediatric hospital, with nurses acting as the gatekeepers who effectively determine what services will and will not be received by young people in their care (Schwarting, 2005). The support team is modeled on adult palliative care services, incorporating consulting doctors, social workers, and counselors, as well as complementary therapists such as play therapists and music therapists (Pavlicevic, 2005). Although the perception of pediatric palliative care is usually oriented to children with cancer, it is young people with neurodegenerative, genetic, and metabolic disorders who dominate children's hospice services (Hynson & Sawyer, 2001). Many present with profound developmental delay, facing significant physical impairments and intellectual damage as well as long trajectories of illness. Instead of the end-of-life model typical of adult services, children's hospices provide respite services as a priority (Martinson, 1996). The team offers safe and stimulating care so that families may choose to utilize the opportunity for a brief period of separation in which they recuperate or spend quality time with siblings of the young person with a life-threatening illness (Sutherland, Hearn, & Eisten, 1993). In this context, the music therapist is often referred to all of the children in the hospice program on a given day, which typically ranges from five to ten. Service is determined by an emerging and intuitive process (Eaves, 2005).Treatment plan. Children's hospices are similar to pediatric oncology units in that families access services over many years and therapeutic relationships are built up over a number of visits (Dun, 2007). Quality of life is central to treatment in pediatric palliative care, and rather than focusing primarily on pain-control, this is enacted through the provision of choices to the young person and their family (Farrell & Sutherland, 1 998). These choices are broadly related to the nature of care accessed and where the care is provided, and specifically within music therapy, choices promote a sense of feeling understood and heard (Levetown, 1996; Davis, 2005). …