Music Therapy and Music in Heath Practice at Evelina London Children's Hopsital. Comparing and Contrasting our Roles and Practice..

At Pulse Arts’ programme development days, musicians get together to reflect on their experiences in hospitals and explore different areas of their Music in Health practice. Recently we invited Cathy Birch, Music Therapist at the Evelina London Children’s Hospital, to discuss how our respective practices of Music in Health and Music Therapy fit together at Evelina London.

At present, any kind of music provision is not standard across NHS acute hospitals. We have found there can be misunderstanding and confusion from practitioners, hospital staff, families and grant givers around the difference and purpose of different working practices.

Cathy and the Pulse Arts musicians - Joe, Mel and Dave all work at the Evelina,   often working on the same hospital wards and sometimes with the same young people but at different times or days.

During our 2-hour discussion, the following themes emerged (of which we barely scratched the surface!):

• How, if at all, do we affect each other’s work with young people in the hospital?
• To what extent are we doubling up on provision that could be better used elsewhere?
• How are we and our work viewed by others, including young people, families, medical staff and hospital management? Do they make a distinction between our practices and (when) does that matter?

Here we explore further some interesting discussion points that came up. It’s important to note that the following are not provided as definitions of Music Therapy or Music in Health practice, only descriptions of how we each practice at Evelina London Children’s Hospital.

Pulse Arts aim to create positive, artistic experiences for young people in hospital and also their families, visitors and staff. Moving through wards in duos or trios without a specific schedule of people to work with, we are able to engage with anyone and any situation we encounter where music-making could make a positive difference. Staff and family members often seek us out to request a visit to a particular young person. In this way, we tend to engage with between 10 and 25 young people a day in interactions that can last for a few minutes to an hour. Evaluation of our practice has consistently highlighted reduced stress and anxiety as well as improved mood, social relations and the self-confidence of young people, family and staff.

Pulse Arts musicians debrief with each other and often share any observed outcomes with families, nurses and play specialists, but we do not formally feedback or engage in a handover with hospital staff.  Non-confidential briefings by nurses and play-specialists can be very helpful in meeting the needs of a young patient and understanding their responses, however we do not receive or seek a clinical briefing to carry out our role.

As an HCPC regulated therapist, Cathy is part of the clinical Multidisciplinary Team and embedded in the psychology service. The young people and families she works with are identified through referrals from other clinical staff. Cathy uses her skills and training (unique within the clinical team) to work towards specific goals and help understand how a child/young person is affected by their condition. To set and asses these goals Cathy has a detailed knowledge of a patient’s case, attends clinical meetings, and writes reports to share her findings with other professionals, both within the Evelina and sometimes other services involved in the young person’s care, for example their local health providers or school. Music therapy sessions usually last 50 minutes and will see on average 5 young people per day.

Both these descriptions are permeable and by no means absolute. Music Therapy is also artistic and draws on the musicianship and creative skills of young people and the therapist. Music in Healthcare can also bring about positive benefits to a patient’s clinical condition (eg. lowering heart rates, increasing oxygen saturation in blood).

The descriptions of activities, musical repertoire, musical games and facilitation techniques used by Cathy and Pulse Arts Musicians sometimes sounded quite similar. Both Cathy and Pulse Arts continually process and respond to the feedback they are getting from young people to facilitate and shape the interaction as is needed. 

Although the methods may sometimes look similar, it seems there is divergence in why we might each use a particular method, how they relate to our aims. Cathy gave us some very interesting examples of how her detailed clinical knowledge informs her musical and facilitation approach and vice versa. Both feed into one another to achieve the specific goals associated with a case.

For Pulse Arts, how we engage and facilitate tries to bring about the best possible personal, social and clinical impact in an interaction. Yet our role and focus is to create quality musical experiences in the moment which don’t tend to result in a deepened clinical understanding of a young person’s condition. We may however work with the same young person on multiple occasions and could signpost to other musical activities outside hospital, including music therapy.

Both Cathy and Pulse Arts have both found that their work has impacted one another:

Pulse Arts often encounter young people who receive Music Therapy both whilst in hospital and outside. Parents of these young people often remark how important and impactful Music Therapy is for their child is and how much they enjoy it as a family activity. We have found these families often make the most of our visits and are keenly aware of the value of the music-making. Parents/Carers can also be familiar with our working practices and feel comfortable to engage themselves.

Cathy remarked that the presence of skilled and sensitive Music in Healthcare practitioners has also had a positive impact for the Music Therapy service. Since Pulse Arts began providing a meaningful musical experience to the many children who benefit, but whose needs don’t require specific therapeutic input, referrals to music therapy have become more streamlined to those who will benefit most from engaging with music therapy.

The themes discussed above are an initial exploration and based on open curiosity and discussion about our roles and practices which we hope will continue.

We do not expect that our experiences are universally true. We hope they may be a useful case-study that can contribute to the wider discussion of how our two practices can interact and can evolve alongside each other to the benefit of the young people we work with.