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We were recently joined at our brain injury training day in London by Rosie Axon of Chiltern Music Therapy, who spoke to delegates about joint working in neurological music therapy provisions.

Following on from her session, Rosie has produced this article for us on the benefits of joint working with Music Therapists.

Joint working in health and social care

Joint-working, integrated practice and multidisciplinary approach are all phrases commonly seen across our health and social care sectors but what really defines these concepts? Does it simply mean that professionals agree to have contact with each other, or read their clinical notes before treating a client? Does it mean sitting in on a session or observing a session with another health professional, to see if you can gain any further information about how a patient presents? The important question however, should be Why? Why are we aiming to work together; why are we hoping to see the same patients and what outcomes or benefits can this approach provide to the client.

Joint working with Music Therapists

As a Music Therapist, I have experienced many different reactions when asking for a joint-session with another Allied Health Professional (AHP), however the response at the end of the session is most frequently the same: surprise, positivity and lots of discussion around ideas and further opportunities to work together.

Music Therapy is a profession that is often misinterpreted, or misunderstood; perhaps in part, due to the small size of profession and the limited opportunities that other professionals ever have to observe sessions or simply learn more about what a Music Therapist does. The traditional aspect of Music Therapy solely as a psychological intervention often means that AHPs such as Speech and Language or Physiotherapy, may only refer a client if they are struggling with the emotional or behavioural difficulties that a client is presenting with. However, the growth over the last decade of Neurologic Music Therapy (NMT) combined with much a more diverse content in the Music Therapy Masters programme has meant that more and more Music Therapists are using their techniques and protocols to work on speech and language goals, cognitive tasks such as executive functioning or physical difficulties such as improving extension or flexion in upper limbs. This also means that Case Managers and Legal teams are quickly seeing the benefits for clients in requesting NMT assessments and sessions as part of their pre-trial and post settlement cases.

The benefits of joint working

I was lucky enough to complete my NMT training in my second year of my Music Therapy Masters, and this was perhaps what led to a passion in joint-working. On placement at the Royal Hospital for Neuro-disability, I had the opportunity to work closely with professionals from every discipline and in every joint-session I worked in, I learnt something new about their profession and something new about my own. NMT has twenty set protocols based around three domains of Speech and Language, Cognition and Motor Skills. These protocols, combined with the Psychodynamic approach from my own training gave me an interesting and unique vantage point. I found I could work on very functional, SMART goals whilst still offering a patient the emotional support they needed. Importantly the knowledge and evidence base that comes via completing the NMT training, offers Music Therapists the important skill set of shared language with other AHP’s.

Shared language working towards a shared goal

The use of shared language between Music Therapists and professionals, health or medico-legal, remains my core training point, when supervising newly qualified Music Therapists. Similarly, being able to discuss a specific communication goal with a Speech and Language Therapist, also offers the Music Therapist the opportunity to tell them about the specific musical task or activity they will use to work on that goal. At Chiltern Music Therapy, every single Music Therapist receives training and guidance from either the jointly-qualified members of the team, or from our consultant Speech and Language and Physiotherapists who frequently work alongside the team in their sessions.

Joint working is a key part of most professions HCPC Standards of Proficiency; such as knowing the limits of practice and when to seek advice or refer to another professional. Or being able to work alongside clients, other professionals or support staff or being able to contribute effectively to work undertaken as part of a multi-disciplinary team. Being able to offer practical advice, strategies, and approaches where Music Therapy can work alongside other AHP goal areas not only provides valuable co-working opportunities but most importantly improves the outcomes for the patient. Feedback from the Occupational Therapists at an acute Stroke ward stated “the patient significantly improved sustained attention to task. She initially required increased prompts to follow tasks and to attend to left side but with the music was able to start following the task independently” or “the patient engaged in music therapy very well, demonstrated ability to use her left hand to the rhythm of the beat. Patient previously has disengaged/got sleepy when using her left hand in activities such as cards/dominoes. Patient’s mood was also noted to improve, stating that she had enjoyed herself” Interestingly, the previous impressions of Music Therapy, i.e. that it is just for enjoyment or well-being, became useful and necessary side benefits to the functional goals being worked on.

It has been interesting to see how the reasons for referrals have improved over time with those AHP’s we work with. From referrals forms which simply stated “Brian appears to like music” we now frequently see a fantastic variety of reasons for referral, as show in the diagrams below:

Reference: Buckinghamshire NHS audit number 5412, Integrated Elderly & Community Care Division – Integrated Therapies and Stroke/Neurology SDUs.

Changing perceptions of Music Therapy

The change in understanding of how music can help people generally, with advances in neuroimaging and neuroscience research have meant that the perception of Music Therapy is gradually changing. In addition to training Music Therapists how to work with other AHP’s, I now frequently provide training and workshops to teams of Case Managers, Legal Team, OT’s, SLT’s and Physiotherapists on working jointly with Music Therapists. My aim is for other professionals working in the health, education or social care sectors, to offer the Music Therapists on their team increased opportunities for joint-working, to improve their colleagues understanding of music therapy through improved communication about the profession and to expand their knowledge of music-based approaches they can also use, whilst improving outcomes for clients.

Whilst we remain cautious that not all Music Therapists will use functional approaches, the more that joint-working is talked about, observed, presented and discussed, the more hope we can have of a truly united approach to improving the lives of the patients that we are privileged enough to see.

Produced by Rosie Axon, Managing Director at Chiltern Music Therapy

Rosie Axon is the Managing Director, Music Therapist, Neurologic Music Therapist and Neonatal Intensive Care Music Therapist at Chiltern Music Therapy. After presenting at one of our Brain Injury Group brain injury training days, Rosie produced this article for us.

You can find more information on Rosie and Chiltern Music Therapy at Chiltern Music Therapy’s Brain Injury Group profile.

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