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mats

This is to certify that the
thesis entitled

MUSIC THERAPY ASSESSMENT FOR CHILDREN WITH
DEVELOPMENTAL DISABILITIES: A SURVEY STUDY

presented by

Kristen Mei Cole

has been accepted towards fulﬁllment
of the requirements for

M.M. degree in MUSIC Therapy

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6/01 c:/CIRC/DateDue.p65—p. 1 5

MUSIC THERAPY ASSESSMENT FOR CHILDREN WITH DEVELOPMENTAL
DISABILITIES: A SURVEY STUDY

By

Kristen Mei Cole, MT -BC

A THESIS

Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

MASTER OF MUSIC
Department of Music

2001

ABSTRACT

MUSIC THERAPY ASSESSMENT FOR CHILDREN WITH DEVELOPMENTAL
DISABILITIES: A SURVEY STUDY

By

Kristen Mei Cole, MT—BC

The purpose of this study was to survey music therapists working with children
with developmental disabilities to examine and describe the following: (a) the major skill
areas and subcategories most frequently assessed, (b) how these areas are assessed, (c) the
common features of their current assessment tools, ((1) the positive and/or negative aspects
of their current assessment tools, and (e) the three most important features desired in a
standardized music therapy assessment for use in their clinical practice. Of the 207
respondents who expressed interest in completing a music therapy assessment survey in a
pilot study, 108 surveys were returned for a 52% return rate; 95 (46%) were used as data
for this study. The respondents most frequently assessed the following major skill areas:
Motor (95%), Communication (83%), Social (79%), Cognitive (64%), and Music (3 5%).
Of the 34 (36%) respondents who enclosed an actual assessment form with their survey,
100% require data collection through behavior observation. Respondents most frequently
noted the following positive aspects of their forms: Thorough (34%), Individualized
(26%), and Easy to Use (26%), and the following negative aspects of their forms:
Subjective (28%), Limiting (26%), and Time Consuming (22%). The 3 most commonly
desired features of a standardized assessment were the following: Easy to Use (23%),

Comprehensive (19%), and Adaptable (13%).

Copyright by
KRISTEN MEI COLE
2001

To A, A., B., M., R., R., and Z. for continuing to inspire my music therapy practice.

iii

ACKNOWLEDGEMENTS

I could not have attempted, endured, and completed this undertaking without the

assistance and support of the following important people:

° The music therapists whose survey responses served as the data for this study.
Without them, this study would not have been possible.

0 The undergraduate and graduate students at Michigan State University. I couldn’t
have folded and stuffed alone.

° Jim Haines, who told me long ago that music therapy would suffer a great loss
without me. Thanks for inspiring me to keep going.

0 Roger Smeltekop, whose patience and dedication guided me through this process.
Thanks for checking your email and voice mail more than you probably ever
wanted.

0 Audrey, who without her, I wouldn’t be here, in more ways than one.

it And, to Nick, who rustled through the bird’s nest every day, among other things,
without complaint, and kept me on my toes. Now it’s time for me to return the

favor.

iv

TABLE OF CONTENTS

LIST OF TABLES ............................................................................................................ vii
CHAPTER 1
INTRODUCTION ............................................................................................................ 1
Purpose ..................................................................................................... 3
Deﬁnitions ................................................................................................. 3
CHAPTER 2
REVIEW OF LITERATURE ............................................................................................ 5
Assessment Development Guidelines .......................................................... 5
Assessment Tools: General Music Therapy ................................................. 6
Assessment Tools: Developmental Disabilities ............................................ 11
Pilot Study ................................................................................................. 15
Delimitations .............................................................................................. 21
CHAPTER 3
METHOD ......................................................................................................................... 23
Respondents ............................................................................................... 23
Survey Development .................................................................................. 23
Procedure ................................................................................................... 25
Data Analysis ............................................................................................. 26
CHAPTER 4
RESULTS ......................................................................................................................... 28
Return Rate ................................................................................................ 28
Section 1 .................................................................................................... 28
Section 2 .................................................................................................... 33
Question la .................................................................................... 33
Question 1b .................................................................................... 34
Question 2 ...................................................................................... 34
Question 3 ...................................................................................... 37
CHAPTER 5
DISCUSSION ................................................................................................................... 40
Section 1 .................................................................................................... 40
Section 2 .................................................................................................... 42
Question 1 ...................................................................................... 42
Question 2 ...................................................................................... 43
Question 3 ...................................................................................... 44

V

CHAPTER 6

IMPLICATIONS .............................................................................................................. 46
Recommendations ...................................................................................... 48
REFERENCES ................................................................................................................. 52
APPENDICES .................................................................................................................. 97
Appendix A ................................................................................................. 98
Appendix B ................................................................................................. 100
Appendix C ................................................................................................. 103
Appendix D ................................................................................................. 106
Appendix E ................................................................................................. 107

LIST OF TABLES

TABLE 1

Other Populations .............................................................................................................. 18
TABLE 2

Concentration Areas of Advanced Degrees for Music Therapists Working with Children

with Developmental Disabilities ......................................................................................... 19
TABLE 3

Clinical Work Settings with Children with Developmental Disabilities ................................ 20
TABLE 4

Assessment Source for Music Therapists Working with Children with Developmental
Disabilities ......................................................................................................................... 21
TABLE 5

Major Skill Area: Motor .................................................................................................... 57
TABLE 6

Major Skill Area: Communication ...................................................................................... 63
TABLE 7

Major Skill Area: Social .................................................................................................... 70
TABLE 8

Major Skill Area: Cognitive ............................................................................................... 76
TABLE 9

Major Skill Area: Music .................................................................................................... 81
TABLE 10

Major Skill Area: Emotional .............................................................................................. 84
TABLE 11

Major Skill Area: Sensory .................................................................................................. 85
TABLE 12

Major Skill Area: Adaptive ................................................................................................ 86

vii

TABLE 13
Major Skill Areas: Case History, Impulse Control, Achievement, & Mental Awareness ...... 87

TABLE 14
Frequency of Titled Assessments ....................................................................................... 33
TABLE 15
Features Relating to the Design of Assessment Tools Employed by Music Therapists ........ 35
TABLE 16
Question 2: Positive Aspects ............................................................................................. 88
TABLE 17
Question 2: Negative Aspects ............................................................................................ 90
TABLE 18
Question 3: Important Features for a Standardized Music Therapy Assessment Form ........ 92
TABLE 19
Question 3: Speciﬁc Goal Areas for a Standardized Music Therapy Assessment Form ....... 39
TABLE 20
Question 3: What a Standardized Assessment Will Do For the Music Therapy Profession. 95
TABLE 21
Question 3: Why a Standardized Assessment Would Not Work ......................................... 96

viii

Chapter 1
INTRODUCTION
The music therapy profession lacks formal assessment tools (Isenberg—Grzeda,
1988; Jones, 1986; Lipe, 1991; Maranto, 1991; Wilson & Smith, 2000; York, 1994).
Unfortunately, the profession suffers a lowered respect, approval, and credibility due to a
lack of formal tools and the increased use of informally designed music therapy assessment
tools (Isenberg-Grzeda, 1988). Because music therapists work in a wide variety of clinical
settings, assessments in the profession vary greatly. An assessment used for an older adult
nursing home resident would not be appropriate for a child with autism. A music therapist
working with a child with cerebral palsy would certainly want to assess gross motor skills,
whereas the same therapist may not be as concerned with gross motor skills when
assessing an oncology patient. Because music therapists treat clients and patients with a
variety of needs, a general assessment tool would be extremely difﬁcult to design and
implement. Some authors have suggested the development of assessment instruments for
speciﬁc diagnostic areas (York, 1994). Due to the lack of population-speciﬁc music
therapy assessment tools, music therapists often have little choice but to use a tool that
may be unfamiliar to them or unsuitable to their population. Some of these tools are
outdated and require extensive adaptations and adjustments that often require too much
time of the busy music therapy professional.
In the speciﬁc population of the developmental disabilities (DD), music therapy
assessment research is scarce (Wilson & Smith, 2000). Several clinician-designed
assessment tools and processes exist (Boxill, 1985; Brunk & Coleman, 2000; Hintz, 2000;

Scalenghe & Murphy, 2000; Wigrarn, 2000), but almost none have been the subject of

l

scholarly research. Even more scarce are formal music therapy assessment tools for
children with DD (Wilson & Smith, 2000). Many of the articles, including the American
Music Therapy Association (AMTA) MS of Clinical Practice (2000), provide the
therapist only with suggested assessment areas, leaving the therapist to create an
assessment form and compose music tasks to evaluate the skill areas. With about 11% of
music therapists working with clients with DD (Elkins, 2000), more resources for that
population and possibly even a standardized assessment form should be accessible.

The number of music therapists working with students with DD in school settings
is growing (Chester, Holmberg, Lawrence, & Thurmond, 1999; Smith & Hairston, 1999;
Wilson & Smith, 2000). With the ofﬁcial conﬁrmation of music therapy as a related
service for Individualized Educational Plans (IEP) (Warlick, 2000) and the increased
requests to insurance companies for reimbursement for music therapy services, a
standardized assessment for children with DD would help to increase professional
integrity, potential referrals, and reimbursement. Grant (1995, in Wilson & Smith, 2000)
states that while “there has been a lack of unanimity within the music therapy profession
concerning the need for standardization, there is now greater impetus to proceed in this
area” (p. 111). Teachers, parents, and other pertinent professionals who request music
therapy assessment services, as well as insurance companies who are evaluating services
for reimbursement, should receive a completed form that is valid (Rider, 1981) and
comparable to other therapeutic assessment tools (Jones, 1986). Other professions, such
as physical therapy, occupational therapy and speech therapy, have all given attention to
the standardization of assessment tools, but music therapy has not.

The concept for this study was born ﬁom a combination of expressed needs of

2

music therapists working with children with DD, as evidenced in several recent research
articles, round-table discussions, and national conference meetings, and an emerging
interest of the researcher. The timeliness of this research study is conﬁrmed by an
investigation by Wilson and Smith (2000). In their study, the authors note the growth in
numbers of music therapy service providers in school settings, suggesting the increased
need for investigation into the development of a standardized music therapy assessment
tool. Also, they note a lack of availability of the “titled” or “model” assessment tools for
music therapists and a clear paucity in research concerning these tools. Based on the
results of their study, the researchers suggest that there is a need for additional research in
music therapy assessment and continued development and design of music therapy
assessment tools.
Purpose

The purpose of this study was to survey music therapists working with children
with DD to examine and describe the following: (a) the major skill areas and subcategories
most frequently assessed, (b) how these areas are assessed, (c) the common features of
their current assessment tools, (d) the positive and/or negative aspects of their current
assessment tools, and (e) the three most important features desired in a standardized music
therapy assessment for use in their clinical practice. In addition, the researcher hopes that
the results of the survey will provide information for use in the development of a formal
music therapy assessment tool for children with DD and create increased dialogue
regarding standardized music therapy assessment tools.

Deﬁnitions

For the purpose of this study, “children with developmental disabilities” was

deﬁned as “persons age 0-17 who have failed to progress at a normal rate in at least one of
the following areas: (a) motor skills, (b) adaptive skills, (c) communication skills, (d)
cognitive skills, and (e) social skills” (Boxill, 1985, p. 29) and/or have been labeled or
diagnosed by a medical doctor as having “autism, mental retardation, and
sensory/motor/physical/cognitive impairments” (Elkins, 2000, p. 28).

In addition, a “music therapy assessment tool” was deﬁned as “any music-based
evaluation of a child’s psychological, educational, social, behavioral, physiological, or
musical functioning completed prior to the delivery of music therapy or other
services/interventions” (Wilson & Smith, 2000, p. 99) and or “any evaluative measure
where the response to a music-based stimulus or question was a major determinant for

measuring the success of a later intervention” (Wilson & Smith, 2000, p. 99).

Chapter 2
REVIEW OF LITERATURE

While much of the past 30 years of music therapy literature has included the topic
of music therapy assessment tools, few research studies, including those speciﬁc to
children with DD, have been published. Although research studies in the area of music
therapy assessment tools are lacking, book chapters and literature reviews focusing on
general assessment guidelines and speciﬁc implications for DD provide helpﬁil insight into
assessment development, design, and implementation.
Assessment Development Guidelines

Through their own clinical experiences and literature reviews, music therapy
clinicians have formulated speciﬁc guidelines for assessment creation and implementation.
Isenberg-Grzeda (1988) noted four considerations that not only affect the choice of the
assessment and what the therapist assesses, but the way the assessment and responses are
interpreted. First, she suggests considering a population-speciﬁc assessment and making
certain the assessment meets the demands and requirements of the therapist’s treatment
facility. Additionally, she states that the therapist’s personal relationship with music and
the therapist’s philosophy of life will have a great effect on the assessment choice.

Bruscia (1988) lists seven criteria needed for a clinically effective assessment. The
assessment should contain clear objectives and be conducted by a qualiﬁed therapist. The
tool should be unique, and should employ effective methods of data collection. The
assessment should produce reliable data that will help lead to valid conclusions. Adherence
to ethical standards should always be incorporated.

Along with having guidelines for construction of the assessment form and

5

implementation of the process, the AMTA Standaais of Clinical Practice (2000) state that
music therapy assessments are required to address these following areas of functioning:
psychological, cognitive, communication, social, physiological, and musical.

Davis, Gfeller, and Thaut (1992) list the following nine skill areas that are
evaluated by interdisciplinary team assessments and should be considered in music therapy
assessments: medical, cognitive, social, physical, vocational/education, emotional,
communication, family, and leisure skills.

Hanser (2000) suggests that therapists consider several criteria before beginning a
formal evaluation. First, therapists should consider assessing cognitive skills, sensory-
motor development, music skills, and social/emotional behavior. Second, therapists should
refer to other assessments that might have already been completed on the client by other
therapy professionals. Third, the measuring device should be efﬁcient and easy to
implement. Finally, the therapist should consider how the skills will be measured and
within what context the skills will be examined.

Assessment Tools: General Music Therapy

A limited amount of research has been conducted using researcher-created music
therapy assessments with clients in educational, psychiatric, and geriatric settings.

Rider (1981) designed a music therapy assessment based on the visual assessment
tasks devised by Jean Piaget and developed 15 auditory music tasks that involved
Piagetian developmental concepts such as mental imagery, seriation, class inclusion, and
conservation. The researcher administered the test to typical preschool and elementary age
children (n=109). The two statistics yielded by the Guttman scalograrn analysis,

reproducibility (R=.981) and scalability (S=.901), demonstrated that Musical-Perception

6

Assessment of Cognitive Development (M-PACD) is reliable as a developmental scale. In
addition, the Kendall rank correlation coefﬁcient yielded a signiﬁcant (p<.0001)
correlation between age and developmental level. Rider noted that the M-PACD should be
tested with children with disabilities, as his research only studied typical children.

Jones (1986) decided to use Rider’s M-PACD with students with mental
retardation (n=20). Due to the lack of available subjects, they were not randomly selected.
All students were diagnosed using the Stanford-Binet Intelligence Scale as either severe,
trainable, or educable mentally retarded. M-PACD was administered to each student and
the results were analyzed using the Spearman Rank-Order correlation. The researcher
found a signiﬁcant (p<.001) relationship between the developmental order manifested by
mentally retarded and non-handicapped students. In addition, the Pearson Product-
Moment Correlation yielded a signiﬁcant (p<.01) correlation between the number of tasks
mastered by each student and his or her mental and chronological age. While the results
indicate that M-PACD could be used as a tool for assessing cognitive development, the
limitation of subject selection, the use of two-part verbal cues instead of the suggested
one-part command, and the subjects’ preference for prompting of tasks indicate that some
caution should be exercised in generalizing this study. Jones suggested continued research
aimed at verifying the validity and reliability of M-PACD.

The Residual Music Skills Test (RMST) for persons with Alzheimer’s disease is
another music therapist designed and researched assessment tool. York (1994) designed
this tool based on items that would reﬂect active and receptive musical tasks that might be
encountered in a music therapy session and items that would correspond to similar,

nonmusical items contained in the Mini Mental State Examination (MMSE). In addition,

7

the RMST tasks were compared to the National Assessment of Educational Progress and
the rhythm subset of the Luria-Nebraska Neuropsychological Battery. After a pilot study
was completed and revisions were made, the ﬁnalized RMST and the MMSE were
administered to subjects with a probable diagnosis of Alzheimer’s disease (n=3 7).
Subjects with a past history of formal or informal music training, education below the
eighth grade level, or visual or hearing impairments were excluded. In addition to the
experimenter, one additional rater was trained in the use and scoring of the test and was
present during the experimenter administration of both the RMST and the MMSE.
Interrater reliability was .96 for the RMST and .98 for the MMSE. A pattern of stronger
correlations was identiﬁed between items that required singing in the RMST. In addition,
language subscores of the RMST and the MMSE were also highly correlated, and
correlations between total scores of the tests (r =.61) suggest that the RMST may be
measuring unique cognitive ﬁmctions not covered by the MMSE. The experimenter states
that based on the results, the RMST is an improvement over existing qualitative behavioral
assessments currently used in nursing homes and adult day care facilities because its
reliability and validity can be determined. The test needs further research, speciﬁcally with
a larger sample size and with comparisons of normal control groups and patients with
cognitive impairments.

Similar to York’s study of persons with Alzheimer’s disease, Lipe (1995) focused
on the use of music performance tasks in the assessment of cognitive functioning of older
adults with dementia. The subjects were women (n=3 7) aged 57-99 years who resided in a
nursing home or attended an adult day care center. The researcher administered the

MMSE, the Severe Impairment Battery (SIB) and 19 specially designed music

8

performance tasks, while the social worker at the nursing home and a nurse at the adult
day care center administered the Brief Cognitive Rating Scale (BCRS). Two senior music
therapy students along with the researcher were raters. Interrater reliability was .92.
Pearson’s Product-Moment Correlation indicated strong relationships between cognitive
and music task performance, and the music performance tasks were found to be consistent
with the other tests. The researcher states that the results of this study and of York’s
(1994) study indicate the possibility of quantifying music task performance with reliability
and validity.

Wells (1988) discussed the individual music therapy assessment procedure that she
used with emotionally disturbed adolescents. The assessment contains three tasks: (a) song
choice: the client chooses and sings songs ﬁ'om a pre-organized list that describes him or
her, (b) story of music: the client writes a story to his/her choice of four classical music
titles, and (c) instrumental improvisation: the client explores different instruments, chooses
an instrument that best describes him or herself, improvises with the therapist, chooses an
instrument for each family member, and then improvises again or sings a chosen song with
the therapist. Each task lists several areas of assessment with asset and deﬁcit items based
on his/her response to the task. The author demonstrated the implementation process of
the assessment through a case example of a 12-year-old male with oppositional disorder
and borderline personality disorder. The author suggested that this assessment is effective
in providing projective and diagnostic data and determining client suitability for music
therapy services.

Cassity and Theobold (1990), interested in assessments and treatments employed

by music therapists working with clients involved with domestic violence, sent out an

9

initial letter of inquiry and a participation form to all (n=2,564) registered, active, and
certiﬁed music therapists recorded by the National Association for Music Therapy
(NAMT) and American Association for Music Therapy (AAMT). Eighty music therapists
responded to the letter, agreed to participate in the survey, and completed and returned
the questionnaire. The survey was constructed based on the NAMT [now AMTA]
Standards of Clinical Practice (AMTA, 2000), and an assessment model created by
Lazarus (1976, in Cassity & Theobold, 1990). The questions sought to identify areas most
frequently addressed in assessment and treatment. The validity of the survey was
determined by a panel of ﬁve music therapists and ﬁve domestic violence counselors.
Descriptive statistics revealed that behavior, affect, and music behaviors were assessed by
100% of the respondents. In respondents working with battered women, “imagery”
(86.96%), “cognitive” (82.61%), “interpersonal” (86.96%), “drug problems” (73.91%),
and “physical well being” (73.91%) were also assessed. The researchers used this
information to operationally deﬁne music therapy as used with domestic violence clients in
terms of what was being assessed and what procedures were being implemented. The
researchers encouraged others to do the same for other disability areas. Because “speech”
was assessed by a minority of the respondents, the researchers recommended additional
research into the relative importance of speech in the AMTA Standards of Clinical

Practice (AMTA, 2000).

 

In order to deﬁne and measure the common body of knowledge relating to
psychiatric music therapy assessment and treatment, Cassity and Cassity (1994) conducted
a survey study of 100 music therapy clinical training directors in psychiatric settings. The

survey was constructed based on reviews of literature in the area of psychiatric treatment,

10

music therapy, and assessment. The questions sought to identify areas most frequently
addressed in music therapy assessment. A panel of ﬁve Registered Music Therapists
employed as clinical training directors in psychiatric settings evaluated the surveys. The
respondents (n=65) rated “observation of patient’s non-music behavior” as most important
for adults, “interpersonal relationships” as most important for adolescents, and

” 66

“concentration, attention span,” and “retention” as most important for children. In
addition, 72% of all surveyed believed that a standardized music therapy assessment was
needed, and 92% believed that a psychiatric music therapy treatment manual was needed.
The researchers stated that a common body of knowledge exists in psychiatric music
therapy and encouraged others to use these results to design a standardized assessment
form.
Assasament Tools: Developmental Disabilitias

Based on their review of literature in developmental disabilities, Cohen, Auerbach,
and Katz (1978) posed ﬁve dilemmas that are faced by music therapists who assess
children with DD. The ﬁrst is whether the therapist should try to obtain a totality of
signiﬁcant information or settle for a portion of the whole. Second, the therapist may have
to adjust assessment procedures for each client, due to the variation in ﬁmctioning levels.
The third dilemma concerns the procedures used by the therapist in the assessment. The
therapist must decide whether to rely on tests and measurements, rating forms, and other
data gathering devices or to create his/her original assessment form and method. The
fourth dilemma involves the impracticality of the assessment, and questions whether the

music therapist can feasibly complete a long assessment for each client. Finally, the

therapist’s competency, attitudes, and philosophy all must be taken into consideration.

ll

Without giving a speciﬁc assessment example, the authors generally suggested that the
assessment must incorporate all aspects of the person’s functioning relative to music
response and musical activity, and the assessment primarily should be concerned with
whether music should be the modality of choice for the client. Also, the assessment should
be broad based to include a wide range of functioning levels and should be formalized and
systematized.

Cohen and Gericke (1972) designed a music therapy assessment form based on
their experience with clients with DD. They discussed the different types of assessments,
areas of functioning that should be assessed, and how the therapist should go about
assessing the client. While this article contains good suggestions, the material is outdated
and the form is too general to be applied to any speciﬁc population. Many adjustments
would be required to meet the needs of today’s music therapists.

Griggs-Drane and Wheeler (1997) discussed the use of functional assessment in
music therapy treatment with clients with autism, speciﬁcally with an adolescent female
who was challenged by a severe mental impairment, autism, and blindness. The authors
stated that ﬁmctional assessment enables the music therapist to accurately assess
environmental, transitional, and musical intervention issues. The senior author examined
the functional assessment completed by the special education supervisor on the above-
mentioned client in order to see a clear picture of the client’s behaviors. A music therapy
clinical student then completed a functional assessment in the music setting in order to
note any attending and behavioral changes that occurred and indicated these behaviors on
a scatter plot. The assessment then continued throughout the semester, with the student

recording the occurrence and nonoccurrence of behaviors during the music therapy

12

sessions. At the end of the year, the scatter plot showed that aggressive behaviors were
noticeably lower during music therapy. The authors concluded that ﬁmctional assessment
effectively evaluates the impact the music has on the client and clearly indicates which
musical styles are most reinforcing of positive behavior.

Boxill (1985) has written about all facets of music therapy with this population and
designed a sample assessment for children with DD. Her lengthy assessment chapter
emphasized the need for therapist knowledge of the tests commonly administered to
clients, the various approaches to assessment, normal and abnormal development in
adaptive, motoric, communicative, cognitive, affective and social functioning, and musical
characteristics attributed to developmental and maturational stages. In Boxill’s experience,
the music therapist must have a complete knowledge of normal developmental behaviors
in the many assessment areas in order to fully assess the client. She included several
helpful tables showing normal developmental milestones for motor skills, language skills,
social skills, and cognitive skills. Most pertinent, she provided the reader with an actual
assessment form, treatment goals and objectives, and music tasks for each section of the
assessment. In addition, she included a treatment plan form, a progress report form, and
an annual evaluation form. Although her book is now ﬁfteen years old, the information
and forms she provided are still appropriate for practice today.

Cassity (1985) conducted a survey of music therapists (n=192) that were identiﬁed
as working with trainable mentally retarded (TMR) children to determine: (a) the adaptive
behaviors most frequently assessed, (b) the music activities most frequently utilized to
assess the behaviors, (c) the music behaviors most ﬁequently assessed, and ((1) music

activities most frequently used to assess the music behaviors. Additional questions focused

13

on the involvement of music therapists in the initial assessment of TMR children, the use
of assessment in program planning, and the opinions of music therapists regarding
assessment. Music therapists were also asked to return the survey with a copy of their
current assessment tool. The researcher found that the most frequent adaptive behavior
categories were communication skills, sensory-motor skills, and social skills. The most
frequent music behavior categories were reﬂexive behaviors (moving head toward sound,
etc), nonlocomotor movement and locomotor movement, singing, and listening. Speciﬁc
music activities for assessing the behaviors included singing, rhythmic movement, music
instruments, and music listening. The researcher then used the responses to create
guidelines for a common music therapy assessment tool for TMR children.

Wilson and Smith (2000) examined literature from 1980-1997 regarding music
therapy assessment in school settings. This study was conducted in response to music
therapists’ requests for information relating to the availability of music therapy
assessments and the feasibility of a standardized assessment tool. The researchers used
three different online data bases (ERIC, PsychINFO, and Article lst) and hand searched
Arts in Psychotherapy, Jouml of Music Therapy, Journal of Research in Musi_c
Educatioa. J_ou_rnal of the Internatiapal Association of Music for the Handicappe_d, Masjp
Therapy, and Music Therapy Perspectives to answer ﬁve research questions. For the
purpose of the study, assessment was deﬁned as “any music-based evaluation of a child’s
psychological, educational, social, behavioral, physiological, or musical functioning
completed prior to the delivery of music therapy or other services/interventions” (Wilson
& Smith, 2000, p. 99). The researchers found little commonality in assessment tools being

used. Using descriptive statistics, the researchers found that of the 41 studies reviewed,

14

only 20 reported using a “named” or “titled” assessment tool, while 21 reported using an
untitled, experimenter-designed, original assessment tool. In addition, little replication of
existing assessments was found. Out of 16 “titled” assessments, only 3 were found in more
than one research study, and only 3 of the 20 studies using “titled” assessments actually
published a copy of their assessment with the study; only 6 of the 21 remaining studies
published the assessment tool. The authors also found that most assessments (39%)
compared data obtained from other assessment measures or from other populations. The
musical element being assessed most frequently was music perception, and the most
frequent nonmusical elements included self-expression ( 10%), motor responses (10%),
and behavior responses (7%). The most frequent population assessed in the studies was
children with developmental disabilities (44%). The authors noted the increase in number
of music therapy service providers in school settings, suggesting the increased need for
research in music therapy assessment and the development of a standardized music therapy
assessment tool for music therapists working in school settings.
Pilot Study

In order to collect demographic information to assist in the development of the
survey for this study and to discover the interest in completing a survey on music therapy
assessment practices, 593 degree-holding, registered (RMT and CMT) or board-certiﬁed
(MT-BC) music therapists recorded in the 2000/2001 AMTA Member Database as
working with clients with DD were selected to receive an initial letter and participation
survey. The researcher purchased mailing labels from AMTA for all the music therapists
listed in the database as of March 1, 2001.

The participation survey (see Appendix B) was designed to obtain general

15

demographic information, such as age of clients, years worked, highest degree level, work
setting and clinical context, assessment source, and interest in completing a survey on
music therapy assessment practices. The survey questions were then created to address the
aforementioned areas of interest in a format that would take a small amount of time to
answer. The completed survey was examined by two music therapy professors, one music
education professor, and one special education professor at Michigan State University to
check for clarity, and small changes were made by the researcher before mailing them to
the respondents.

The researcher ﬁrst received permission to conduct this study from the Michigan
State University Committee on Research Involving Human Subjects (U CRIHS). Then, an
initial cover letter similar to a letter sent by Cassity (1985), a participation survey (see
Appendix A and B), and a self-addressed stamped envelope were sent to each of the
respondents. The respondents were asked to complete and return the survey by April 10,
2001, allowing three weeks for survey return. Five days after the deadline for returning the
survey, the responses were separated from the identifying information to ensure
conﬁdentiality, and the data was analyzed. Because this researcher was concerned with the
responses from music therapists working with children with DD, the respondents who
worked only with adults with DD were asked to answer the ﬁrst question and then return
the rest of the survey uncompleted. The participation surveys were correspondingly
numbered with a copy of the address labels to account for those who had returned their
survey, because those respondents who worked only with adults with DD or those who
chose not to participate in the study were not asked to include their name and address. All

data was kept in a secure area accessed only by the researcher.

16

A total of 364 surveys were returned for a return rate of 61%. Four surveys were
returned to sender due to incorrect addresses on the labels and 4 surveys were returned
uncompleted. The data collected in the pilot study represented 356 surveys. In accordance
with the participation survey questions, the researcher found the following information
regarding music therapists working with clients with DD:

1. What is the age of the respondents’ current clients with DD? Of the 356
responses, 246 (69%) work with children in some capacity while 84 (24%) work with
adults only. Also, 17 (5%) no longer work with clients with DD, and 10 (2%) are not
working as music therapists.

2. What are the client populations assessed and treated outside of DD? Of the 246
respondents that work with children, 39 (16%) work with children and adults with DD
along with other adult and children populations outside of DD, and 12 (5%) work only
with children with DD along with other adult and children populations outside of DD.
The researcher categorized the responses into the following ﬁve major “other” categories:

psychiatry, medical, geriatrics, other DD, and other (see Table l).

17

Table 1

Other Populations Listed by Music Therapists Working with
Children with Developmental Disabilities
(n=53)

Population #1 %

Psychiatry (includes Substance Abuse, Dual Diagnosis. Behavior disorders,
Attention Deﬁcit Hyperactivity disorder, Oppositional Deﬁance disorder) 30 57

Medical (includes Cancer. Terminal Illness. Hospice. Oncology
Chronic Pain. Cervovascular Accident. Traumatic Brain Injury.

Physical Disabilities. Visual Impairments) 20 38
Geriatrics (includes Geriatric Psychiatry and Alzheimer’s Disease) 17 32
Other Developmental Disabilities (Retts Syndrome, Cerebral Palsy) 3 6
Other (Typical Children) 2 4

 

Note: Some respondents work with more than one other population.

3. How many years have the respondents worked as music therapists? Of the 246
respondents that work with children, 91 (3 7%) have worked for 12 or more years,
followed by 47 (19%) who have worked for 3-5 years, 42 (17%) who have worked for 0-
2 years, 37 (15%) who have worked for 9-11 years, and 29 (12%) who have worked for
6-8 years.

4. What are their highest degrees earned? Of the 246 respondents working with
children with DD, 139 (57%) practice with bachelor’s degrees and 107 (43%) practice
with a master’s degree or higher.

5. What are their graduate degree titles? The researcher organized the graduate
degree titles into the following 7 categories: advanced music therapy (including any degree

with music therapy as the emphasis), special education, general education, related, music,

18

no title given, and unsure of title (See Table 2). Of the 148 respondents with academic
work above a master’s degree, 61 (41%) are currently taking classes towards or have
completed a degree in advanced music therapy.

Table 2

Concentration Areas of Advanced Degrees for Music Therapists working with Children
with Developmental Disabilities
(n=128)

Degree .4 rea fMasters and Doctorate itymgress and completed) # %

Advanced Music Therapy: 61 48

Any degrees with Music Therapy as the Emphasis
(i.e.: Master‘s of Music Education in Music Therapy. Masters of Music in Music Therapy,
Master's of Creative Arts Therapy/Music Therapy etc.)

Special Education: Any degrees with Special Education as the Emphasis 21 16
Related: Any degrees with a related emphasis, such as Psychology.
Counseling. Health Administration. Smeh and Language Pathology 21 16

No Title Given 18 14
Music: Any degree with an emphasis on Music other than Music Therapy 14 l 1
General Education: Any degrees with General Education as the Emphasis 10 8
Unsure of Title 2 2

 

Note: Some respondents have more than one master’s degrees and also were choosing between two
degrees

6. Where are they currently employed? A total of 106 (43%) of the music
therapists who with children with DD work in public schools (see Table 3). The data
represents multiple responses from some of the respondents as many work in more than
one clinical setting. Respondents in all the years-worked categories worked most
frequently in public schools except those who have worked 6-8 years; they work most in
the client’s home. Places of employment indicated as “other” by the respondents included
the following: private practice office, day treatment clinic, early childhood center,

community settings, music therapy center, daycare center, music therapy clinic, parent

19

support group, childhood development clinic, outreach center, residential treatment
center, autism society office, music and art therapy organization, community center, music
retailer, vocational settings, state school, 0-3 program at a sheltered workshop, and

outpatient clinic.

 

Table 3
Clinical Work Settings with Children with Developmental Disabilities
(n = 218)
Settings # %
Public School 106 49
In Client’s Home 64 29
Private School 33 15
Hospital 25 11
In Therapist’s Home 22 10
Developmental Center 19 9
Community Music School 12 6
Group Home 3 l

 

Note: Some respondents work in more than one clinical setting and type of hospital was not speciﬁed.

7. What are the context(s) within the work setting(s) of their music therapy
services? Of the 246 respondents, 157 (64%) provide music therapy in both individual and
group settings (either small, large, or both), 46 (19%) provide only individual sessions,
and 43 (17%) provide only group (either small, large, or both) sessions. Small groups
were deﬁned as 2-4 clients and large groups contained 5 or more clients. Additional
contexts written in the “other” category included the following: mainstreamed classrooms,
music therapy consultations, chorus groups, dance groups, bell choirs, regular classrooms,
parent/child groups, and family therapy groups.

8. Where did they obtain their assessment? Of the 246 respondents, 115 (47%) use

20

a self-created assessment tool that was adapted from other sources. F orty-two (17%)
obtained their tool from colleagues, 40 (16%) use a self-created original tool, 25 (10%)
use a tool from their current workplace, and 18 (7%) use a tool from a book (see Table
4). The researcher noticed that Coleman and Brunk’s SEMT AP assessment was

mentioned by name 13 times and Boxill’s assessment was mentioned by name 1 time.

 

Table 4
Assessment Source for Music Therapists working with Children with Developmental
Disabilities

(n=246)
Assessment Soquce it %
Self Created: adapted from other sources 115 47
Colleague 42 17
Self Created: original 40 16
Current Workplace 25 10
Books 18 7
Internship 11 5
No Formal Assessment 9 4
Undergraduate Program 7 3
Other -- (previous music therapist at workplace; core curriculum goal book;

grad school: professor) 5 2

Research Articles 4 2
Former Workplace 3 1
Conferences 3 1

 

Note: Some respondents chose more than one source for their assessments

9. Do they have an interest in completing a ﬁiture music therapy assessment
survey? Of the 246 respondents working with children with DD in some capacity, 207
expressed an interest in completing a ﬁiture music therapy assessment survey.

Delimitations
The researcher notes that the subjects may not be representative of the entire

population of music therapists working with children with DD. Many graduate students

21

are also board-certiﬁed and active, but may not be listed under the speciﬁc disability areas
due to their “student membership” status as opposed to “professional membership” status.
In addition, membership is not a requirement for practice; some music therapists working

with children with DD may not be AMTA members.

22

Chapter 3
METHOD

Due to the lack of research in music therapy assessment and the expressed need for
increased research in a standardized assessment (Wilson & Smith, 2000), the researcher
designed a survey to examine the current assessment practices of music therapists working
with children with developmental disabilities. The responses from the survey serve as the
data in this study, and a coding system and descriptive statistics are used to analyze the
responses. Results provide music therapy professionals with helpful and useﬁrl information
regarding current music therapy assessment practices, in addition to aiding in the future
development of a formal music therapy assessment tool.
Respondents

The survey was sent to the music therapists (n=207) working with children with
DD in some capacity, and who had responded to the initial letter and participation form
sent for the pilot study and expressed an interest in completing a survey on their current
assessment process and tool.
Survey Development

The survey (see Appendix C) was constructed to allow the respondents to give
descriptive answers regarding their current assessment areas. In Section 1, the researcher
stated that the respondents would ﬁnd 6 lined papers (3 double-sided) for the written
responses. On the enclosed sheets, the respondents were asked to state a major assessment
area, a subcategory area under that major area, and then an explanation of the tasks used
to assess that area. Sample answers were provided to assist the respondents in

understanding the process. Respondents were asked to be clear and descriptive in their

23

responses, and permission was given to duplicate the six sheets if necessary or to
type/handwrite responses on separate papers.

In Section 2, the researcher instructed the respondents to enclose a copy of their
current assessment tools if they used a hard-copy, unpublished assessment tool.
Respondents who used a published form were asked to note the name and author of the
tool. The respondents also were asked to discuss brieﬂy the positive and negative aspects
of their current assessment tools, and list what would be the three most important features
of a standardized music therapy assessment form for children with developmental
disabilities for use in their clinical practice. If the respondents did not feel a standardized
assessment would be feasible, they were asked to discuss the reasons for this in the lines
provided. Finally, respondents interested in receiving a copy of the results were asked to
write their names and addresses on the provided lines.

A panel of three experts in survey design and/or developmental disabilities served
as judges to determine clarity of the instructions, the ease with which the responses could
be provided in the space allowed, and how well the survey addressed the topic
(assessment procedures). The panel members consisted of Dr. Michael Cassity, Professor
of Music Therapy at Southwestern Oklahoma State University, Dr. Cynthia Taggart,
Associate Professor of Music Education at Michigan State University, and Mr. Roger
Smeltekop, Associate Professor of Music Therapy at Michigan State University. In
addition, a copy of the survey was sent to an independent reader who was not on the
AMTA member list, but was a practicing music therapist working with children with DD.
This reader completed the actual survey and e-mailed comments to the researcher. After

making minor adjustments, the survey was mailed to the respondents.

24

Procedure

The researcher received permission to conduct the pilot study and this current
study from the Michigan State University Committee on Research Involving Human
Subjects (UCRIHS). Then, the researcher sent a cover letter (see Appendix D), two
consent forms (see Appendix E), a copy of the survey, a large self-addressed stamped
envelope, and a one-dollar bill (for incentive and extra postage) on June 18 and 19, 2001.
The cover letter thanked the respondents for returning the participation survey and
expressing interest in participation in this current survey study. Also, the respondents were
instructed to keep one consent form for their records and mail back a signed one with the
completed survey. The cover letter also instructed the respondents to give detailed and
descriptive information about their assessment processes and to complete the survey even
if they did not use speciﬁc assessment tools or forms.

The surveys were correspondingly numbered with a copy of the address labels to
account for those who had returned their surveys, because the researcher needed to send
out follow-up emails to those respondents who had not returned their survey by the
deadline (July 6, 2001). Because the postage was difficult to predict due to variability in
the possible number of pages returned in both the survey and possible assessment forms,
the researcher placed a 76-cent stamp on the self-addressed stamped envelope and
enclosed a one-dollar bill. The researcher also placed a label on the outside of the self-
addressed stamped envelope near the envelope lip to remind the respondents to enclose a
consent form, survey, and assessment tool if necessary.

On July 1, 2001, the researcher decided to send out a follow-up email to all 207

original survey participants, which included a thank-you to those who had completed their

25

surveys, and a notice to those who had not, instructing them that the deadline had been
extended to July 31 to accommodate busy summer schedules. Finally, on August, 1, 2001,
the researcher sent a ﬁnal follow-up notice, again thanking those who had completed their
surveys, and instructing those who had not to please return their surveys by August 15,
2001. In addition, the researcher asked anyone who had not received a survey or had
misplaced it to reply to the email and request that another one be sent.

Data Analysis

After August 15, 2001, the researcher began by examining overall return rate in
both frequency and percentage. The researcher then examined the surveys to determine
whether the data was usable for this study. From this point, the survey responses are
referred to by Section 1 and Section 2. In Section 1, respondents were asked to describe
name the major and subcategory areas they assess and describe their assessment process.
For Section 2, respondents were asked to respond to three questions. In Questions 1 and 2
respectively, respondents wrote the title of their assessment if they had one and the
positive and/or negative aspects of their assessment forms. In Question 3, respondents
were asked to list the three most important features of a standardized music therapy
assessment tool for use in their clinical practice.

First, Section 1 data was analyzed. Using large and small note cards for major and
subcategory skill areas, respectively, the researcher analyzed each survey according to
frequency, by writing the respondent’s survey number on the corresponding major and
subcategory note card. This process was then repeated for each major and subcategory
area. After this process was completed, the researcher used colored pencils to mark

certain subcategory areas within a major category that had identical task explanations but

26

different names. Then, the assessment tasks were analyzed for common themes and listed
under each subcategory area according to frequency. Speciﬁc music examples were listed
under each assessment task.

Next, the information in Section 2 was analyzed in 2 parts. In Part 1, the
researcher tabulated the number of respondents who had enclosed their actual assessment
forms and tabulated and compiled the number and names of the “titled” assessments.
Then, using 10 criteria for analyzing the speciﬁc features of assessment forms from Cassity
(1985), the researcher examined the speciﬁc features of the untitled assessment forms
according to frequency.

In Part 2, the researcher examined the responses to Questions 2 and 3. To
complete this process, the researcher used note cards to compile the respondents’ positive
and negative aspects of their current assessments and then used colored pencils to code
the data for common themes according to frequency. Finally, the researcher repeated this
process with respondents’ three most important features of a standardized assessment in

their clinical practice.

27

Chapter 4
RESULTS

Return Rate

The surveys were mailed to 207 music therapists who had indicated interest in
completing a ﬁiture music therapy assessment survey on a previously mailed participation
survey. Of the total number of music therapists identiﬁed, 108 returned the surveys for a
52% return rate. Of that number, 6 surveys were unusable due to gross completion errors,
and 7 surveys were returned not completed but accompanied by notes and emails ﬁom
respondents stating that they had not done music therapy assessments recently, or did not
implement music therapy assessments due to their job situation. Ninety-ﬁve surveys (46%)
were used as data for this study. Considering the amount of time and detail needed to
complete this survey, the ﬁnal return rate was deemed appropriate.
Section 1

Of the 95 usable responses, 80 responses (84%) were used as data for Section 1.
Six respondents who use the Special Education Music Therapy Assessment Process
(SEMTAP) (Brunk and Coleman, 1999) and an adapted SEMTAP process did not include
their assessment process, and nine respondents did not accurately complete this section of
their survey. Tables 5-13 show all related subcategories and task explanations for each
major skill area. The data represent multiple subcategories under each major skill area and
multiple task explanations under each subcategory area. The data are presented using the
following code: (a) N = total number of respondents, (b) n = speciﬁc number of therapists
responding to that subcategory or task explanation, and (c) % = n of N.

Of the 80 responses, 76 (95%) listed Motor as a major skill area. Other names for

28

Motor included the following: (a) Sensori-motor, (b) Physio-motor, (c) Physical, (d)
Perceptual/Motor, (e) Fine Motor, and (0 Gross Motor. The two most common
subcategory areas under Motor were Fine Motor Skills (92%) and Gross Motor Skills
(91%). Tactile Sensitivity was the next most common, with only 6 (9%) of the
respondents listing it as a subcategory.

Respondents most commonly asked clients to grasp and play rhythm instruments
(66%), strum the guitar and/or autoharp with a pick or ﬁngers (43%), and play the
keyboard (39%) in order to assess Fine Motor Skills. In assessing Gross Motor Skills,
respondents most commonly asked clients to imitate and perform basic
motions/movements using upper and lower extremities (72%), followed by reaching for an
instrument (23%), and spontaneously and creatively moving (16%).

The researcher found that 24 (32%) of the respondents listed Sensory
subcategories, such as Tactile Sensitivity, Auditory Tracking, Visual Tracking, Sensory
Functioning, and Perception under the Motor skill area. Also, 2 respondents listed Oral
Motor under the Motor skill area.

The second most common major skill area was Communication (N=80; n=66;
83%). Other names for Communication included the following: (a) Vocal Expression, (b)
Vocalizations, (c) Speech Production, (d) Expressive Language, (e) Language, (f)
Language Development, and (g) Verbal Skills. The three most common subcategories
were Expressive Language/Verbal Skills (89%), Receptive Language (53%), and Non-
Verbal Communication (21%).

Respondents most commonly asked clients to verbalize choices of an

activity/instrument/song (3 9%), ﬁll-in-the-blank of a pre-existing song (3 6%), and answer

29

questions (20%) in order to assess Expressive Language. In order to assess Receptive
Language, the respondents most often assess the client’s ability to follow directions
(83%), identify pictures/objects (23%), and respond to their names in a song (14%). Non-
Verbal Communication was assessed by observing the use of gestures (64%), sign
language (43%), and props and pictures (21%).

Included in this major skill area as a subcategory were Singing/Vocal Skills (15%)
and Eye Contact (5%). Only 7 (11%) respondents listed Vocalizations/Pre-Verbal Skills as
a subcategory.

The third most common major skill area was Social (N=80; n=63; 79%). Other
names included the following: (a) Behavior, (b) Attentiveness, (c) Social/Emotional Skills,
(d) Social/Behavioral Skills, (e) Interpersonal Skills, and (f) Relatedness/Relationship.

The three most common subcategories were Peer/Adult Interaction (44%), Attending
Skills (37%), and Sharing/Tum-Taking (17%).

Respondents most commonly engaged in imitative, parallel, and/or interactive
music-making (3 9%), passing and sharing instruments (3 6%), and conversing with others
(21%) as means to assess Peer/Adult Interaction. In assessing Attending Skills,
respondents observed making and/or maintaining eye contact (61%) and attending to task
(48%). In order to assess Sharing/Ium-Taking, the respondents encouraged passing and
exchanging instruments (73%) and playing in response to name (18%).

Respondents also included Follows Directions (21%) under this major skill area, in
addition to Emotional Expression (6%), Communication Skills (6%), and Interactions with
the Environment/Objects (3%).

The fourth most common major skill area was Cognitive (N=80; n=5 1; 64%).

3O

Other names included the following: (a) Cognitive/Perceptual, (b) Cognitive/Sensory, (c)
Cognitive/Academic, and (d) Academic. The three most common subcategory areas were
Concepts (63%); Sequencing/Memory (33%), and Auditory Perception/Discrimination
(25%).

In order to assess Concepts, respondents most commonly encouraged clients to
identify them through prop and picture songs (72%), identify them by pointing (44%),
match them on a keyboard (9%). Clients were asked to recall verses of multi-verse songs
(59%) and recall melodies, themes, and new songs (29%) to assess Sequencing/Memory.
Respondents assessed Auditory Perception/Discrimination by evaluating the client’s ability
to identify changes in tempo and dynamics (46%) and repeat simple melodies (23%).

Subcategories also listed under Cognitive included, but were not limited to, the
following: (a) Attending Skills (20%), (b) Follows Directions (16%), (c) Speciﬁc
Academic Skills (14%), (d) Spatial Awareness (10%), (e) Sorting (6%), and (0 Self Care
(6%).

The ﬁfth most common major skill area was Music (N=80; n=28; 35%). The three
most common subcategories were Rhythm/Beat (75%), Melody/1‘ onal (61%), and
Instrument Exploration (32%) and Interest/Preference (32%).

Respondents most commonly assessed Rhythm/Beat by encouraging the client to
imitate and match rhythms (71%), keep a steady beat (48%), and adapt to rhythmic
changes (24%). Respondents assessed melody/tonal by encouraging the client to match
pitches (59%), sing a familiar song (53%), and ﬁnish a musical phrase (12%). Instrument
Exploration was assessed by allowing the client to choose an instrument and play (89%)

and identify instruments by name (33%). Clients’ Interest/Preference was assessed by

31

observing their response to music (67%) and asking them to choose a song or style (56%).
The researcher noted that all the subcategories, save ones that only had one response,
were original to the Music major skill area and were not listed under any other major skill
area.

The sixth most common major skill area was Emotional (N=80; n=13; 16%). Other
names included the following: (a) Affect, (b) Psychosocial, and (c) Affective Expression.
The three most common subcategories were Identify/Express Feelings (62%),
Mood/Affect (3 8%), and Awareness of Self and Others (23%).

In order to assess Feeling Expression, the respondents most commonly asked
clients to identify feelings in the music with words (3 8%) and with pictures (25%), and
play feelings on an instrument (25%). All 5 respondents encouraged clients to display a
wide range of affect in order to assess Mood/Affect. Respondents observed client’s ability
to interact with the therapist (67%) and the music (33%) in assessing Awareness of Self
and Others.

The seventh most common major skill area was Sensory (N=80; n=10; 13%). The
three most common subcategory areas were Visual (60%), Auditory (60%), and Tactile
(60%). Respondents assessed Visual by observing reactions to color and light (50%),
abilities to read charts (33%) and track stationary and moving objects (3 3%). Auditory
was assessed by observing reactions to loud and soft (67%) and pitched and non-pitched
sounds (50%). Tactile was assessed by the client’s ability to tolerate different textures
(83%).

The eighth most common major skill area was Adaptive (N=80; n=7; 9%). Other

names included the following: (a) Functional Life/ Self Help Skills and (b) Daily Living

32

Skills. The only 2 subcategories were Personal Responsibilities (100%) and Attention
(29%). Clients were assessed by their eating and drinking abilities (3 3%), toileting (14%),
and dressing/undressing ( 14%). Attention was assessed by the client’s ability to focus on a
given task (100%).

Major skill areas receiving only 1 or 2 responses were as follows: (a) Case History
(N=80; n=2; 3%), (b) Impulse Control (N=80; n=1; 1%), (c) Achievement (1), and (d)
Mental Awareness (1).

Section 2
Question la.

Of the 95 usable responses, 33 (35%) mentioned using a titled assessment. The

most commonly mentioned assessment was SEMTAP (n=23; 70%), followed by Boxill

(n=5; 15%). See Table 14 for more details.

 

Table 14
Frequency of Titled Assessments
N=33
Assesgnent n %
SEMTAP 23 70
Boxill 5 15
*Other (Music Therapy) 3 9
"Other (Non-Music Therapy) 2 6

*Other (Music Therapy): Music Therapy Functional Skills Assessment. by Becky Gleasman. Cleveland
Music Settlement Music ”Therapy Assessment Tool, and A Model for Understanding Music Development,

by C. Briggs.
I""‘Other (Non-Music Therapy) Battelle Developmental Inventory combined with Music Activities. and

Assessment, Evaluation. and Programming System for Infants and Children, by Paul H. Brooks, and
Cullier Azusu Scale.

33

Question lb.

Of the 95 usable responses, 34 (36%) enclosed an actual assessment form. This
tabulation and analysis did not include “titled” assessment forms. However, if the
respondent adapted a “titled” assessment process/tool and enclosed the form, then the
researcher included this form in the analysis. The researcher chose ten criteria from
Cassity’s study (1985) to use in the analysis of the enclosed forms. All 34 (100%)
assessments collect data by directly observing client’s behavior and 33 (97%) of the forms
identify the behaviors being assessed. The most common assessment format is a checklist
(n=16; 47%), followed by a symbol system (n=9; 26%), and a narrative form (n=8; 24%).
Only three (9%) tools provide speciﬁc music activities/tasks to be used in the assessment
and 2 (6%) tools specify a speciﬁc assessment procedure. See Table 15 for more details.
Question 2: What do you feel are the positive and negative aspects of your current
assessment tool/process/form?

Of the 95 responses, 84 (88%) gave positive and/or negative aspects of their
current assessment forms. Only one respondent did not answer the question, and ten
respondents stated that they did not use an assessment tool/process/form because either
they saw a large number of clients in a group setting or they didn’t have a “formal”

assessment to refer to in order to answer the question.

34

Table 15

Features Relating to the Design of Assessment Tools
Employed by Music Therapists

 

N=34

Feature n %

A. Examiner collects assessment data by 34 100
directly observing client’s behavior

B. Tool identiﬁes speciﬁc observable 33 97
behavior to be assessed

C. Tool provides space for the therapist’s 28 82
comments or appraisal of the client’s
response

D. Tool provides a checklist format 16 47
for recording client responses
(i.e. presence-absence, yes-no)

E. Tool provides a system of symbols 9 26
or space for recording client
responses (i.e. +/—, circling, letters
representing words)

F. Tool is in narrative form 8 24

G. Tool includes a combination of two or more 8 24
techniques for recording behavior
(i.e. rating scale, checklist, narrative, symbols)

H. Tool utilizes a rating scale for recording 4 12
behavior

1. Tool provides speciﬁc music activities 3 9
for use in the assessment process

J. Tool speciﬁes a speciﬁc assessment 2 6
process

35

In reviewing the 84 responses, the researcher found 113 positive aspects and 86
negative aspects. Many respondents wrote more than one positive aspect or negative
aspect in their responses. The researcher analyzed the responses and created the following
ﬁve positive aspect categories, arranged by frequency: (a) Thorough (N=113; n=3 8;
34%): this category included respondent references to the words “thorough” or
“comprehensive,” (b) Individualized (N=113; n=29; 26%): this category included
respondent references to the word “individualized” or comments highlighting the
individual nature of the assessment, (c) Easy to Use (N=113; n=29; 26%): this category
included respondent references to the words “easy” and/or “easy to use,” in addition to
any aspects of the form/process that made it easy to use, (d) Shows Music Therapy
Viability (N=113; n=10; 9%): this category included respondent references to the music
therapy assessment showing need for services, and (e) Understood by Other Disciplines
(N=113; n=7; 7%): this category included respondent references to the music therapy
assessment being read and/or understood by professionals in other disciplines.

The researcher also created the following ﬁve negative aspect categories, arranged
by frequency: (a) Subjective (N=86; n=24; 28%): this category included respondent
references to the words “subjective,” “not concrete,” and/or “biased,” (b) Limiting (N=86;
n=22; 26%): this category included respondent reference to the word “limiting,” or
comments regarding not covering enough, (c) Time Consuming (N=86; n=19; 22%): this

,1 6‘ '

category included respondent references to the words “takes too much time, time
consuming,” or some references to time being a negative factor, (d) Technical Difficulties
(N=86; n=14; 16%): this category included respondent references to speciﬁc parts of their

forms/process that involved the form construction itself or speciﬁc requirements in

36

completing the form/process, and (e) Broad (N=86; n=7; 8%): this category included
respondent references to the words “vague” and “broad” and those basic concepts in some
capacity. Under each category, the researcher included several sample responses. See
Table 16 and 17 for details.

Question 3: What would be the three most important features of a standardized music
therapy assessment form for children with developmental disabilities for use in your
clinical practice? (If you do not wish to use a standardized assessment form, please state
the reasons for your answers on the lines below).

Respondents answered this question in four different ways. First, of the 95
responses, 60 (62%) listed at least one important feature. Second, 13 (14%) listed features
according to speciﬁc goal areas. Third, 11 (12%) listed features according to what a
standardized music therapy assessment would do for the music therapy profession. Finally,
11 (12%) explained why they did not wish to use a standardized assessment tool. The
researcher grouped the responses according to the manner in which the respondents
answered the question. The question asked for three features. Most of the respondents
gave three responses to the question, while others only listed one or two. Sample
responses for each direction and subsequent categories are included in Tables 18-21.

Of the 60 respondents listing at least one feature for a standardized assessment, a
total of 151 features were grouped by the author into the following nine categories
according to frequency: (a) Easy to Use (n=35; 23%): this category included respondent
references to the word “easy” and similar meaning words in some capacity, (b)
Comprehensive (n=29; 19%): this category included respondent references to the words

“thorough” and “comprehensive” and similar meaning words in some capacity,

37

(c) Adaptable (n=20; 13%): this category included respondent references to the word
“adaptable” and similar meaning words in some capacity, ((1) Reliable and Valid (n=16;
11%): this category included respondent references to the words “reliable” and “valid” and
similar meaning words in some capacity, (e) Efﬁcient (n=15; 10%): this category included
respondent references to the word “concise” and similar meaning words in some capacity,
(f) Provides Speciﬁc Music Therapy Tasks (n=10; 7%): this category included respondent
references to activity guides, bibliographies, and lists of activities and songs, (g) Compares
Skills With and Without Music (n=10; 7%): this category included respondent references
to the concept of comparing skills with and without music, (h) Compares Responses to
“Typical” Developmental Scale (n=8; 5%): this category included respondent references
to the need to compare skills to a “normal” or “typical” developmental scale, and (i)
Provides Goal Areas and Interpretation Guidelines (n=8; 5%): this category included

,3 “

respondent references to “speciﬁc goal areas, speciﬁc guidelines,” and similar meaning
words. See Table 18 for more details.

Of the 13 respondents listing features according to speciﬁc goal areas, a total of 37
responses were grouped into the following ﬁve categories according to frequency: (a)

Motor (n=1 1; 30%), (b) Communication (n=9; 24%), (0) Social (n=7; 19%), ((1) Cognitive

(n=5; 14%), and (e) Music (n=5; 14%). See Table 19 for more details.

38

Table 19
Question 3: Speciﬁc Goal Areas for Standardized Music Therapy Assessment

N=37 Responses; 13 Respondents

 

Qo_al Area n %
Motor 1 l 30
Communication 9 24
Social 7 l9
Cognitive 5 14
Music 5 14

 

Of the 11 respondents listing features according to what a standardized music
therapy assessment would do for the music therapy profession, a total of 13 responses
were grouped into the following three categories according to frequency: (a) Continuity
Within the Music Therapy Profession (n=5; 38%): this category included respondent
references to the words “uniformity,” “continuity,” and/or “commonality,” (b) Justiﬁcation
of Services (n=4; 31%): this category included respondent references to the idea that the
assessment form will show the need for music therapy, and (c) Respect from Others (n=4;
31%): this category included respondent references to “credibility,” “respect,” and other
similar meaning words. See Table 20 for more details.

Of the 11 respondents listing why they did not wish to use a standardized music
therapy assessment in their current clinical practice, a total of 11 responses were grouped
into 1 category: (a) Variance in Clientele (11; 100%): this category included respondent

references to the individual needs of each client in some capacity. See Table 21 for details.

39

Chapter 5
DISCUSSION

The purpose of this study was to examine and describe the assessment practices of
music therapists working with children with DD in order to begin to address the needs of
clinicians working with this client population. The results suggest some interesting and
important ﬁndings.

Section 1

Based on the Section 1 results, it appears that music therapists working with
children with DD are assessing a wide range of skill areas using music-based tasks,
activities, and experiences. The skill areas are mostly congruent with the following AMTA
Standards of Clinicgi Practice for music therapists providing treatment for persons with
DD: Motor, Physiological, Social/Emotional, Sensory, Communicative, and Cognitive
Functioning. The skill areas reported in this study greatly differ from the following AMT A
Stmdards pf Clinical Practice for music therapists conducting assessments with persons
with DD: Motor Functioning, Sensory Integrative Functioning, Emotional States, Coping
Skills, Infection Control Procedures, and Attending Behaviors.

While the wide range of major skill areas and subcategories could contribute to a
comprehensive assessment, the researcher noted a few areas that seemed out of the
compass of music therapy treatment. Though only a few respondents mentioned skills
such as toileting, and dressing and undressing, to name a few, these might be better
assessed by other disciplines. While the knowledge of these skills may be important, music
therapists must accommodate practical limitations. Music therapists might consider

tailoring their assessments to the needs of each client, understanding that some areas may

40

not need to be assessed.

In compiling the major skill areas and subcategory areas, the researcher noted the
increased number of repeated subcategories in several different major skill areas. Many of
the subcategories could easily ﬁt under several different major skill areas. For example, a
task or experience that involves following directions could be seen as assessing both
receptive language (i.e., Communication) and/or auditory processing (i.e., Cognitive).

The researcher also noted a number of seemingly misplaced subcategories in
several different major skill areas. For example, many respondents listed Auditory, Visual,
and Tactile Perception under Motor Functioning, while the researcher might have placed
those subcategories under Sensory Functioning. Respondents may have had conceptual
differences regarding the different major categories, as evidenced by the variety of
different “titles” for each category, thus leading to the seeming “misplacements.” Also,
many music therapists may not ﬁrlly understand the deﬁnitions of each functioning area
and which subcategory areas ﬁt under each one.

Only 28 respondents listed “Music” as a major skill area with only 9 listing
“Interest/Preference” as a subcategory. Many respondents used “instrument choice” or
“song choice” in other categories such as “Communication,” “Motor,“ and “Cognitive,“
and may have evaluated the client’s preference at that time. In addition, respondents might
be required to assess speciﬁcally “non-musical” goals for Individualized Educational Plans
(IEPs) and may not include the skill area of “Music” in their actual assessment, but note
their musical responses in relation to “non-musical” areas.

Ten respondents listed “Sensory” as a major skill area. Other respondents noted

sensory issues under “Motor” (n=24) while others included them under “Cognitive”

41

(n=18). Again, the conceptual differences in major skill areas may have affected the
number of respondents marking “Sensory” as a major skill area.

No respondents noted multicultural considerations in their assessment of children
with DD, nor did music therapists note using “culturally diverse” music in their practice.
Respondents may not be working with children from diverse cultures, or they may adapt
“typical” songs to ﬁt the needs of their diverse clients. Also, music therapists may not be
aware or informed of the role multiculturalism plays in music therapy practice.

Section 2
Question 1

The results regarding the frequency of titled assessments were not surprising, as
the results from the pilot study indicated that most respondents used self-created
assessment forms.

All the assessments were conducted by collecting observable data. In addition, the
most commonly used format was a checklist. This may be because music therapists often
complete assessments within single sessions and need something that is quick to ﬁll out. In
addition, music therapists may not have the luxury of video taping each session and need
something quick and efﬁcient so that they will not forget important observations.

The results relating to the design features of the assessment tools showed that only
three tools actually gave speciﬁc music activities. As a unique profession that uses music
as its treatment medium, it seems the most important aspect of an assessment tool would
be the inclusion of examples of how the music is being used to assess the skill areas. On
the other hand, the music may be so unique or idiosyncratic to each individual that the

music therapists could not “standardize” their music. This may also be why only two tools

42

outlined a speciﬁc process for the user. The process may have to be changed for each
client, and the therapist simply needs a loose but fundamental format to follow, rather than
a speciﬁc process.

Question 2

The respondents had many positive comments to make about their current
assessment tools considering the apparent increasing focus on the need for a standardized
music therapy assessment. Many respondents stated that their form was individualized;
this aspect may not be congruent with the development of a standardized music therapy
assessment form. From the overall tone of the positive comments, it appeared that music
therapists were satisﬁed with their current assessment tools.

The negative comments focused on assessments being too subjective and not
standardized. In general, the music therapists surveyed do not feel conﬁdent in their
professional opinions about what they observe and experience in the music therapy
session. In contrast to that observation, one respondent stated that the music therapist’s
professional opinion should be enough.

Another negative aspect was that the assessments were time-consuming. Some
music therapists may use several sessions to complete an assessment, while others may
need to complete an assessment in one session or within a group setting. One positive
aspect of a time-consuming assessment might be that the therapist may have the
opportunity to form a relationship with a client before completing an official assessment.
Music therapists who work with children with DD may encounter many clients who will
not perform well on assessments implemented by someone with whom they have no prior

relationship.

43

A smaller complaint was that the music therapy assessment was too broad. The
researcher concludes that due to the wide range of disabilities seen by music therapists
working with DD, a music therapy assessment for children with DD may not meet the
needs of the great variety of clients within this large disability area.

Question 3

This question was interpreted by the respondents in three different ways. The
question may have been more effective if the researcher had given speciﬁc examples of the
word “feature.” Most respondents (n=60; 63%) listed speciﬁc features of a standardized
assessment tool.

From the comments, it seemed that many respondents would like a standardized
form but are not willing to make the compromises necessary to complete such a form. For
instance, respondents want a form that is easy to use and efﬁcient but is also
comprehensive. If a music therapist must complete an assessment within a music therapy
session and produce a written document directly following the session, a comprehensive
form may not be feasible. Music therapists may have to negotiate for documentation hours
and assessment sessions, like other health professionals are allowed, in order to provide a
complete and thorough assessment.

The researcher also observed from the responses that music therapists want a form
that is valid. A valid form must be a result of intense scientiﬁc testing. As Wilson and
Smith (2000) noted in their study, few music therapy assessments have been the object of
scientiﬁc scrutiny.

Finally, several respondents expressed a desire for a scale or format with which to

compare their music observations. Research has been conducted in examining typical

44

music behaviors of “typical” children to provide music therapists with a developmental
scale. The larger questions are, “What does that really tell about the child with the
disability?” and “How will that help in planning treatment?” Researchers are still

examining the role that music development plays in overall cognitive functioning.

45

Chapter 6
IMPLICATIONS AND RECOMMENDATIONS

These ﬁndings present several implications for clinical practice, music therapy
education and research. The results provide music therapists working with similar clients
the opportunity to compare and/or affirm their own music therapy assessment processes.
Music therapists might ﬁnd their processes reafﬁrmed by the similarities of their
procedures to those of other music therapists, or they may ﬁnd new skill areas to add to
their assessments. In addition, many respondents included speciﬁc music examples, which
might assist new music therapists who need ideas or more seasoned music therapists who
need new resources. Also, music therapists need to know what others are doing so that
they can refer clients conﬁdently to others for assessments, consultations, and other
services. The level of music therapy competency varies greatly and, in order for music
therapists to maintain good standing in the professional world, a common level of practice
is necessary. These ﬁndings show that music therapists working with children with DD are
generally using similar tasks, experiences, and assessment practices.

The results suggest that music therapists might consider the role cultural
differences can play in the treatment process. With the growing number of clients from
diverse cultures seeking music therapy from primarily dominant-culture music therapists,
cultural issues should be considered before the assessment and treatment take place. The
process might begin by asking the child’s parents questions regarding their cultural
practices, music preferences, and views of therapy and the treatment process. Therapy is
viewed in many different ways, both positively and negatively, and such views could have

implications for the music therapist’s treatment approach.

46

The ﬁndings may assist AMTA in two ways. First, while the results are congruent
with the AMTA Standards of Clinical Practice for music therapists providing treatment for
persons with DD, they do not reﬂect the standards for music therapy assessment for
persons with DD. The results suggest a re-evaluation of the assessment sections of the
Mrds of Clinical Practice. Understanding what music therapists are actually doing in
their assessments might assist in deﬁning appropriate assessment standards. Second, an
examination of the assessment process will assist the continuing work in insurance
reimbursement. Considering that many music therapists who attempt to obtain
reimbursement must ﬁrst complete a music therapy assessment, knowledge of current
assessment practices may help those committed to government relations, employment
relations, and reimbursement issues.

The results of this study provide implications for music therapy education. The
importance of assessment in the treatment process cannot be over- emphasized in music
therapy training programs. In order for music therapists to show the need for their
services, music therapy assessments must be consistent and well-implemented. Music
therapy educators should use these ﬁndings to prepare their students better in
understanding the major skill areas and how music can be used to assess those areas. In
addition, understanding what those responses mean to the client, the therapist, and others
involved, is an important part of the assessment process.

These results certainly present an opportunity for the creation of a music therapy
assessment tool. Not only do the results show what music therapists are currently
assessing and how they are doing it, but they show what music therapists want in an

assessment form. Although the deﬁnition of a “standardized assessment form” has yet to

47

be determined, this researcher believes a process could be created for use with speciﬁc
clients with a speciﬁc disability for implementation by therapists from a particular
theoretical orientation. lsenberg-Grzeda (1988) states that the therapist’s philosophy of
treatment and the use of music in therapy are important considerations when constructing
a music therapy assessment tool. The music therapist’s personal beliefs about the role of
music in music therapy and their treatment philosophy greatly inﬂuence the decision of
what and how to assess. For example, an assessment tool could be created for use by a
behaviorally-oriented music therapist with children aged two to six with autism. This
assessment might be a valid tool for them to use in their practice if they needed to
complete an “official” assessment for Individualized Educational Plan (IEP) or insurance
reimbursement purposes. Similar forms could be created for use with persons with other
disabilities and by music therapists from particular theoretical backgrounds. Currently,
music therapists are creating their own forms and using what was apparently taught in
their undergraduate programs and/or internships. This researcher believes that any form
that had been a subject of scholarly research with actual clients would be helpful.
Recommendations

Continued focus in the area of music therapy assessment is needed. Researchers
might consider conducting a similar research study with other disability areas. Because
AMTA surveys its members each year regarding their area of “specialty,” access to
respondents is readily available. Considering the positive response to this survey,
researchers interested in surveying music therapists working with other client populations
may ﬁnd a similar level of interest in participating in such studies. The researcher suggests

several considerations for such replication. First, the survey might be more effective if

48

constructed with the music task examples as the major headings with the major skill areas
and subcategories as the subheadings. This way, the respondents could also outline
assessment process. Second, a question asking respondents about the context in which
their music therapy assessment was completed would be helpﬁil. Also, an additional
question on the survey might ask the respondents to deﬁne what a standardized
assessment meant to them. Finally, the survey might include a question addressing the
speciﬁc theoretical orientations of the respondents and the role that plays in the choice and
implementation of the assessment.

Music therapists might consider conducting an action research project by
examining their current assessment tools over time and observing whether they are valid.
Considering that most respondents were satisﬁed with their assessment tool, a scientiﬁc
examination of such tools would be helpful for other practicing music therapists.

This researcher suggests a study testing the reliability and validity of the Special
Education Music Therapy Assessment Process (SEMTAP) (Brunk and Coleman, 1999).
Because SEMTAP is the most-used “titled” assessment, researchers might consider
making it a subject of scholarly research. The concept of SEMTAP seems quite effective,
and while researching such an individualized process may be difﬁcult, this assessment is
the closest the music therapy profession has come to creating a standard assessment
process.

An interesting and appropriate research study might be to interview experienced
music therapists about their assessment processes. Observations and interviews of three or
four outstanding music therapists might be helpful in understanding how the needs of

music therapists have or have not changed, what they have found to be successful, and

49

how their experiences have or have not inﬂuenced their assessment processes.

A survey of music therapy educators regarding their inclusion of the topic of
assessment in undergraduate and graduate music therapy education would be useﬁrl. While
there are AMTA performance competencies, music therapy educators may emphasize
assessment differently from one another and present it in a variety of ways. Also, a similar
survey of internship directors would be helpﬁil. Understanding how music therapists are
being prepared in assessment will help researchers come closer to creating a viable
assessment form.

This study represents an in-depth inquiry into the assessment practices of music
therapists working with children with DD. The information obtained will be helpﬁrl in
creating a ﬁiture assessment form to be used with children with DD in some capacity, in
addition to providing practical assessment applications for music therapy clinicians and
educators.

The music therapy profession can only beneﬁt from persistent focus on the music
therapy assessment process. Music therapy assessment is often the only means for a music
therapist to represent his/her client and the client’s relationship and response to the music,
as well as to advocate for music therapy services. For a client seeking treatment, the
assessment process and tool can be a deciding factor in the approval or denial of services
and the difference between an accurate or an inexact portrayal of his/her abilities. For a
music therapist seeking credibility, the assessment process and tool can be the link to
integrity and professional recognition. Continued inquiry into music therapy assessment
and the interpretation and meaning of musical responses will not only assist music

therapists in their clinical practices, but will promote continued grth and development

50

of the music therapy profession.

51

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55

TABLES

56

Table 5

Major Skill Area: Motor (N=80; n=76; 95%)
Altemﬁ Titles: Sensori-motor, Physio-motor, Physical, Perceptual/Motor; Fine Motor;
Gross Motor
Subcategogy Areas
1.00 Fine Motor Skills (N=76; n=70; 92%)
1.10 Grasp and play different rhythm instruments (N=70; n=46; 66%)
(Music examples: Therapist accompanies client on guitar or piano;
therapist models the playing of same instrument; therapist sings song that
calls for client to play speciﬁc instrument; sings “Tingalayo” from L.
Birkenshaw Fleming’s Come On Everybody Let’s Sing to accompany and
encourage client; sings Lollipop Song” with drum/mallet; sings” This Old
Man” with ﬁnger drums; sings “Mr. Sun” while clients play variety of
instruments; client chooses instrument and therapist sings “Shake [or the
appropriate movement] Shake your instrument (repeated three times) Till
the song says STOP,” therapist and client engage in improvisation;
therapist plays songs with instrumental interludes to encourage the client
to play a variety of instruments).
1.11 Strum guitar and/or autoharp with a pick or with ﬁngers (n=30; 43%)

(Music examples: Therapist plays left hand 7th chord and root alternating
while client strums or plucks; sings an age appropriate song to accompany

client).

57

2.00

1.12

1.13

1.14

1.15

1.16

1.17

1.18

1.19

1.20

1.21

Play keyboard (n=27; 39%)

(Music examples: lmprovises on black and white keys; plays one ﬁnger
song such as “Are You Sleeping?”).

Participate in “ﬁnger play” song (n=6; 9%)

(Music examples: Sings “Eeency, Weency Spider”).

Press buttons on a Q-Chord or Omnichord (n=5; 7%)

(Music examples: Sings “You Are My Sunshine” while client presses
buttons).

Point to objects and body parts with ﬁnger (n=2; 3%)

Hold puppets and/or toys (2)

Use an access switch (2)

Play the glockenspiel (2)

(Music examples: Therapist creates a pentatonic set-up and improvises a
song about them playing the glockenspiel).

Clap and tap during song (2)

Turn pages of a songbook (n=1; 1%)

Use a tape/CD player

Gross Motor Skills (N=76; n=69; 91%)

2.10

(Includes “Motor Imitation“)

Imitate and perform basic motions/movements using upper and lower
extremities and trunk through song (N=69; n=50; 72% )

(Music examples: Therapist plays pre-recorded music including the

following: The Youngheart Records “We All Live Together” series to

58

2.11

encourage movement, non-vocal music “Slide Whistle Suite”; Therapist
uses titled songs including: “If You’re Happy and You Know it,” “Shake
Your Sillies Out,” “The Hokey Pokey,” “Body Rock” by Greg and Steve,
“The Chicken Dance,” “Rock-a-my-Soul,” “Boa Constrictor,” “A Sailor
Went to Sea,” “When the Spirit says Sing,” “Toes are Tapping,” “Hot Hot
Hot;” “Going to Kentucky,” “Twist and Shout,” Clap Clap Clap your
Hands, “Uh-Huh” by Barry Bernstein, “Oh What a Miracle” by Hap
Palmer, “To the Music” by Levin, “Head Shoulders Knees and Toes,” “I
Walk You Walk, by Janet Jones, “The Grand Duke of York,” “The Foot
Song” by Laurie F arnan, “Egg Shakin Blues,“ Let’s Everyone Clap Hands
with Me,” “Cowboy Joe,” an acapella song, “Hey Everybody” to “C is for
Cookie” by Joe Raposo, “Adventures in Movement” by Dr. Jo Geiger,
“Toot tee ta“ “all about me” “Let’s Make Music Together,” “Gimme Ice
Cream,” “The Turning Song,” “The Shaker Egg Song,” and “The Body
Rock;” therapist plays steady drumbeat and asks client to move to the beat;
therapist creates a musical obstacle course).

Reach for Instrument (n=16; 23%)

(Music examples: Therapist holds guitar high and low and asks client to
reach and play; therapist holds a paddle drum and asks client to reach and
play; therapist encourages client to stand and reach keyboard; therapist
asks client to play cymbals; therapist encourages client to play “hand-over-

hand” on the piano).

2.12 Spontaneous/Creative Movement (n=1 1; 16%)

59

 

3.00

4.00

5.00

2.13

(Music Examples: Therapist improvises on piano or guitar and encourages
client to freely move; therapist plays prerecorded music such as a George
Winston CD).

Structured Dance (n=3; 4%)

(Music Examples: Therapist uses “The Chicken Dance,” “The Macarena,”

“YMCA,” Parachute dance, and the Hokey Pokey).

Tactile Sensitivity N=76; n=6; 9%)

3.10

3.11

3.12

Respond to touching and holding instruments (N=9; n=3; 50%)

Respond to vibro-tactile input (n=2; 33%)

(Music Example: Observe client’s response to different types of pitches and
timbres).

Explore textured objects

Auditory Tracking (N=76; n=4; 6% )

4.10

4.11

Respond to Sound (N=4; n=4; 100%)

(Music Example: Therapist plays sounds above, behind, and to left and
right of client).

Respond to Name in song

(Music Example: Therapist sings client’s name to see if client responds).

Visual Tracking (N=76; n=4; 6%)

5.10 Look in direction of instrument (N=4; n=3; 75%)

5.11

(Music Example: Therapist plays and holds instrument in different place to
see if client tracks with eyes).

Follow ﬁngers on the piano (n=2; 50%)

60

6.00

7.00

8.00

9.00

10.00

(Music Example: Therapist asks client to follow color/number stickers on
keyboard).

Hand/Eye Coordination (N=76; n=4; 6%)

6.10 Play instruments (N=4; n= 3; 75%)
(Music Example: Therapist encourages client to play a drum set; therapist
encourages client to play a pentatonic set-up xylophone).

6.11 Use props (bean bags, balls, balloons, ribbon sticks) (n=2; 50%)

6.12 Pass instruments

Sensory Functioning (N=76; n=4; 6%)

7.10 Accept application of deep pressure or light touch during song
(N=4; n=2; 50%)

7.11 Bounce on a therapy ball

7.12 Attend to sound played out of sight

Body Awareness (N=76; n=3; 6%)

8.10 Identify Body Parts in song

8.11 Observe client movement around room

Perception (N=76; n=3; 6%)

9.10 Play a steady beat with the therapist (N=3; n=2; 67%)

9.11 Play loud and soft with the therapist

9.12 Read musical notes

Bilateral Dexterity (N=76; n=2; 3%)

10.10 5-ﬁnger piano exercises

10.11 Play 2-handed rhythm instrument

61

11.00 Oral Motor (N=76; n=2; 3%)
11.00 Make tongue noises
11.11 Listen to vocal quality in speaking and singing
11.12 Explore whistles and kazoos

11.13 Observe respiratory and breathing

62

Table 6

Major Skill Area: Communication (N=80; n=66; 83%)

Altemte Titles: Vocal Expression; Vocalizations; Speech Production; Expressive

Language; Language; Language Development; Verbal Skills

Subcategog Areas

1.00 Expressive Language/Verbal Skills (N=66; n=59; 89%)

1.10 Verbalize choices of activity/instrument/song (N=59; n=23; 39%)

1.12

(Music Examples: Therapist sings “Friends are Special” from Kidsongs
Lullaby by Nancy Cassidy and cues client to recall favorite activities; client
chooses favorite song and/or instrument; therapist uses Q-Chord or drum
machine to keep steady beat and composes a direction song).
Fill-in-the-Blank (n=2 1; 36%)

(Music Examples: Therapist sings “She’ll be Coming Around the
Mountain” or “Cotton Needs a Picking” and ask client to ﬁll in parts of the
song; therapist uses hello and goodbye songs or songs with instrumental
interludes that allow for client to ﬁll in the blank both verbally and
instrumentally; therapist sings “Home on the Range” or “Wheels on the
Bus” while playing guitar or omnichord; Therapist sings “Twinkle, Twinkle
Little Star).

Answer Questions (n=12; 20%)

(Music Examples: Therapist incorporates questions into the song;

therapist asks client about their music interests; therapist asks “wh”

questions through song).

63

2.00

1.13

1.14

1.15

1.16

1.17

Songwriting (n=10; 17%)

(Music Examples: Therapist sings songs that client can suggest words such
as “Mama’s Taking us to the Zoo,” “What Can We Do on a Rainy Day?;”
therapist uses client’s spontaneous words as a basis of an improvised song;
therapist sings “Everybody Loves Saturday Night” and “What Can You Do
in the Fall Time?;” therapist works with client to write songs about
important aspects in their life, their feelings, and/or original thoughts).
Engage in Conversation (n=9; 15%)

(Music Examples: Therapist uses “Wheels on the Bus” with an interactive
book; therapist encourages client to talk about him/herself; therapist
encourages client to discuss his/her music therapy expectations).

Singing (n=8; 14%)

(Music Examples: Client chooses song to sing with therapist; therapist
plays familiar songs and encourages client to sing).

Imitate Therapist (n=3; 5%)

(Music Examples: Therapist says words and asks client to imitate;
therapist uses call and response songs).

Label and describe songs and instruments (n=1; 2%)

Receptive Language (N=66; n = 35; 53%)

2.10

Follow directions (N=35; n=29; 83%)
(Music Examples: Original songs; movement-to-music applications; sing
verbal directives; therapist sings “ has a shaker” to Ruthlee

Adler’s “ Has a Hat” from Target on Music and ask them to

64

2.11

2.12

2.13

2.14

2.15

pass; therapist sings “Say your Name,” “Clap, Clap, Clap Your Hands;”
therapist sings “Clean-Up” or Movement song; therapist sings “Egg
Shaking Song” acapella; therapist sings directives to the tune of “Skip to
My Lou;” therapist asks client to select familiar instrument and follow
directions in a movement song; therapist sings “Allelu” and “Gonna Shake
my Sillies Out;” therapist sings “Raise your Hand, or “Jump Like a
Jumping Bean;” therapist sings “The Color Song ﬁom “Wee Sing Games,
Games, Games”).

Identify pictures/objects (n=8; 23%)

(Music Examples: “Going on a Picnic”- client ﬁnds pictures of food used in
the song and “Old McDonald”- client ﬁnds toy animal used in song; “Head
and Shoulders” and “Clap Hands;” therapist sings “Look, Look, Look” by
Betsy Brunk from “Learning Through Music” and have client choose
objects by pointing or pictures).

Respond to name in song (n=5; 14%)

(Music Examples: Therapist sings hello and cues client to shake hands).
Gesture/Point to musical instruments (n=4; 11%)

Localize and track instrument/vocal sounds (n=3; 9%)

Discriminate between two extremes (loud/soft; fast/slow; stop/go)

(n=3; 9%)

(Music Examples: Therapist encourages client to move or play instrument

with both live and recorded music).

65

3.00

4.00

2.16

Imitate Therapist (n=3; 9%)
(Music Examples: Therapist encourages client to imitate given rhythms;

therapist encourages client to imitate body movements and vocal sounds).

Non-Verbal Communication (N=66; n=14; 21%)

3.10

3.11

3.12

3.13

Observe Gestures (N=14; n=9; 64%)

(Music Examples: Therapist observes client with parent; therapist uses
“Follow the Leader” songs; therapist engages in improvisatory drumming
interaction with client).

Use of Sign Language (n=6; 43%)

(Music Examples: Therapist sings songs that use sign language; therapist
sings song while client plays instrument and then signs “Play” and/or

,9 ‘6

“Stop;” therapist sings songs using simple signs- “yes, no,” and “stop”).
Use of Props and Pictures (n=3; 21%)

Engage in Instrumental Call and Response (n=2; 14%)

Singing/Vocal Skills (N= 66; n=10; 15%)

4.10

4.11

4.12

Call and Response/Imitation (N=10; n=4; 4%)

(Music Examples: Therapist sings animal sounds and encourages client to
repeat; therapist sings simple echo songs “Are your Sleeping?” or “I’m
Going to Leave Old Texas”).

Singing Familiar Songs (n=3; 30%)

Fill-in-the-Blank (n=2; 20%)

66

5.00

6.00

4.13

Improvisation (n=1; 10%)
(Music Examples: Therapist encourages client to improvise on syllables to

a Blues Progression).

Picture Exchange Communication Systems (PECS); (or other switches)

=66; n=8; 12%)

5.10

5.1]

Use to make choices in session (N=8; n=7; 88%)

(Music Examples: Client brings PEC S to choose the next song; therapist
sings “It’s time for a choice, It’s time for a choice, Which one do you
want?” and client gives the card/object to the therapist; therapist
encourages client to use PECS to choose instrument).

Use switch to ﬁll-in-the-blank (n=3; 38%)

(Music Examples: Client pushes switch to make “moo” sound in “Old

McDonald Had a Farm).

Vocalizations/Pre-Verbal Skills (N=66; n=7; 11%)

6.10

6.11

6.12

6.12

Improvisation (N=7; n=4; 57%)

(Music Examples: Therapist encourages client to use a variety of
vocalizations; therapist improvises a song using the client‘s
sounds/syllables).

Sing familiar songs with syllables (n=2; 29%)

Sing Syllable Songs (n=1; 14%)

(Music Examples: Therapist sings “Mm-Ah” or “B-B-B-Bubbles).
Use of whistles, horns, and kazoos (n=1; 14%).

(Music Examples: Therapist uses reed-hom to blow and encourage

67

7.00

8.00

vocalization).

Interactive Speech (N=66; n=5; 8%)

7.10 Engage in verbal/instrumental exchanges with others (N=5; n=3; 60%)

7.11

(Music Examples: Therapist engages in a drum conversation with the
client).

Answers Questions (n=2; 4%)

(Music Examples: Therapist sings hello song and asks questions about the

client).

7.12 Use sounds/words to gain attention (n=1; 20%)

7.13

Greet others (n=1; 20%)

Choice Making (N=66; n=3; 5%)

8.10 Make choice in song verbally and/or gesturally (N=3; n=3; 100%)

(Music Examples: Therapist encourages client to choose instrument;
therapist sings “Transportation Song” paired with pictures of different
means of transportation; therapist sings “What Do You Do?” by Kathleen
Coleman to explore wants and needs; therapist sings “Play Your
instrument name” and asks clients to choose an instrument to play during

the song).

9.00 Eye Contact (N=66; n=3; 5%)

9.10 Cue therapist to continue song (N=3; n=3; 100%)

(Music Examples: Therapist encourages client to maintain eye contact in
order to continue with song; therapist encourages client to make eye

contact when singing “Hello” and “Good-bye”).

68

10.00 Breathing (N=66; n=3; 5%)
10.10 Engage in breathing exercises (N=3; n=2; 67%)
10.11 Singing a familiar song (n=1; 33%)
Others (1 each): Hearing, Self-Expression; Identiﬁcation of Animals; Cognitive

Development

69

Table 7

Mapr Skill Area: Social (N=80; n=63; 79%)

Alternate Titles: Behavior; Attentiveness; Social/Emotional Skills, Social/Behavioral

Skills; Interpersonal Skills; Relatedness/Relationship

Subcategog Areas

1.00 Peer/Adult Interaction (N=63; n=28; 44%)

1.11

1.12

1.13

1.14

Engage in imitative, parallel, and/or interactive music making

(N=28; n=11; 39%)

(Music Examples: Therapist engages with client in improvisational
instrument play; therapist plays musical “tag” on the keyboard, encouraging
client to “chase” the therapist and reciprocate; therapist places two clients
at either end of the piano and encourages them to play together; therapist
engages in improvisational drumming).

Passing/Sharing Instruments (n=10; 36%)

(Music Examples: Therapist asks clients to pass instruments in a circle to
music; therapist plays a familiar song, such as “Twinkle, Twinkle” or
“BINGO” and encourages client to share instruments).

Converse with others (n=6; 21%)

(Music Examples: Therapist uses a bongo drum to play “Hello ”
in rhythm and encourages the clients to respond).

Greet and Gesture to others (n=5; 18%)

(Music Examples: Therapist encourages client to use appropriate social

greetings in “hello” and “good-bye” songs; therapist uses songs that

70

1.15

1.16

include hand-shaking, high-”ﬁve”ing; and hand-slapping).

Engages in Play (n=2; 7%)

(Music Examples: Therapist uses hula hoop as centering focus and
encourages client to hold hoop with therapist while they sing “Cobbler,
Mend My Shoe,” and/or “Birds Fly High;” therapist and client stand inside
the hoop and rock together to “Row, Row, Row Your Boat;” therapist a
and client sit on ﬂoor and roll the ball; therapist and client play “Peek-a-
Boo” ).

Dancing with others (n=1; 4%)

(Music Examples: Therapist encourages clients to dance with others in a

group setting).

2.00 Attending Skills (N=63; n=23; 37%)

2.10

2.11

Make and/or maintain eye contact (N=23; n=14; 61%)

(Music Examples: Therapist uses “hello” song to sing client’s name and
observe eye contact; therapist sings song “Look At Me;” therapist sings a
song with pictures and holds them near his/her eyes to promote eye contact
with client; therapist engages client in a tum-taking activity at the piano or
drum where client is asked to look at therapist at the completion of his/her
turn).

Attend to task (n=1 1; 48%)

(Music Examples: Therapist uses action songs and observes the duration of
client’s attention; therapist engages in improvisation with client; therapist

sings songs with multiple verses, such as “There Was an Old Lady” or

71

“She’ll be Coming Around the Mountain” in order to easily observe

duration of eye contact).

3.00 Sharing and Tum-Taking (N=63; n=11; 17%)

4.00

3.10 Pass/exchange instruments with others (N=11; n=8; 73%)

3.11

3.12

3.13

(Music Examples: Therapist and client exchange instruments and play
together; therapist and clients pass instruments in a circle).

Play in response to name (n=2; 18%)

(Music Examples: Therapist plays a song and clients can play only when
the therapist sings their name; therapist sings “Play, Play, Play Uh-huh” to
Barry Bemstein’s “Shake, uh-huh” as the chorus and during the “verse”
calls clients’ names to encourage them to play).

Play with others (n=1; 9%)

(Music Examples: Therapist and client sing a “rolling” song and roll ball
back and forth).

Engage in Improvisation (n=1; 9%)

(Music Examples: Therapist and client engage in improvisation, each

person acting as the “leader” at certain points).

Awareness of Self and Others (N=63; n=10; 16%))

4.10 Passing/Sharing Instruments (N=10; n=4; 40%)

(Music Examples: Therapist employs “Pass the Instrument” Song to
encourage clients to observe person on their left and right; therapist uses a
call-response improvisational music experience (either instrumental or

verbal); therapist and client play bells and pass mallets at the end of each

72

5.00

4.11

4.12

4.13

phrase).

Respond to name (n=3; 30%)

(Music Examples: Therapist chants client’s name in song and observes
response; therapist uses hello/greeting song to sing client’s name).
Acknowledge others (n=2; 20%)

(Music Examples: Therapist uses “1 Spy” to encourage clients to observe
other people; therapist sings “Where is ” and encourages
clients to greet each person whose name is sung).

Improvisation (n=1; 10%)

(Music Examples: Therapist engages in improvisation with or alongside

client to observe his/her reaction and participation within the music).

Direction Following (N=63; n=13; 21%)

5.10

5.11

Response to sung directions (N=13; n=10; 77%)

(Music Examples: Therapist uses song “I Am a Fine Musician” and
encourages client to play instruments in the song;” therapist sings verbal
directions using the song “Shake the Eggs to the Music” by Betsey Brunk
from Prelude Music Learning Through Music Volume 2; therapist uses
many different songs, including “Throw the Bean Bag and Catch” by Hap
Palmer; therapist sings “If You Are Happy and You Know It” and “Hokey
Pokey; therapist sings songs with the directives “stop” and ‘go;” Therapist
sings “Listen to the Water” on guitar and instructs clients to pass the
rainstick).

Response to verbal instructions (n=2; 15%)

73

(Music Examples: Client assists therapist in putting instruments away).

6.00 Participation in Group Music Therapy (N=63; n=7; 1 1%)

6.10

6.11

6.12

Active in session (N=7; n=6; 86%)

(Music Examples: Therapist observes client’s participation in various
tasks).

Remains in Group (n=3; 43%)

Accepts leadership (n=1; 14%)

7.00 Response to Name and Greetings (N=63; n=6; 10%)

7.11

7.12

Response to Name (N=6; n=4; 67%)

(Music Examples: Therapist sings client’s name and observes responses).
Response to “Hello” and “Good-bye” (n=3; 50%)

(Music Examples: Therapist sings “hello” and “good-bye” songs and
observes client’s ability to wave and/or greet others; therapist sings a
adaptation of “Hello” by Betsey Brunk from the Prelude Music Learning
Through Music Volume 2 and encourages client to ﬁll in parts of “Hi,

[client’s name], Hi”).

8.00 Emotional Expression (N=63; n=4; 6%)

8.11

8.12

Affective responses (N=4; n=4; 100%)

(Music Examples: Therapist observes client’s responses within the music
therapy session).

Identify feelings in others (n=1; 25%)

(Music Examples: Therapist uses face cards and facial expression and asks

client to identify or mirror).

74

9.00 Communication Skills (N=63; n=4; 6%)
9.10 Choice-Making (N=4; n=4; 100%)
(Music Examples: Therapist gives client choice of song and/or instrument).
9.1 1 Singing (n=1; 25%)
10.00 Interactions with the Environment/Objects (N=63; n=2; 3%)
10.10 Response to instruments, toys, etc.G\I=2; n=2; 100%)
10.11 Response to Room (n=1; 50%)
Others (1 each): Transitions, Leadership, Spontaneity/Creativity, Independence, Response

to Physical Contact, Oral Motor

75

Table 8

Major Skill Area: Cognitive (N=80; n=5]; 64% )

Alternate Titles: Cognitive/Perceptual; Cognitive/Sensory, Cognitive/Academic; Academic

Subcategory Areaa

1.00 Concepts (colors, numbers, letters, body parts, shapes) (N=51; 32; 63%)

1.10

Identify through prop and picture songs (N=32; n=23; 72%)

(Music Examples: Therapist sings “Oh, no, Poor, Joe” with pictures of
missing body parts and the client has to ﬁll them in; therapist uses color
and letter cards; therapist sings a song asking client to ﬁnd the red frog,
black animal, etc; therapist uses “Clown Count” from Prelude Music,
Visual Aids 1, “Let’s Sing a Song About...” by Janet Jones for shapes,
“Lollipop Song” from the Prelude Music Learning Through Music Volume
2 for colors; and “The Hungry Worm Alphabet” from the Learning
Workshop; therapist sings song about shapes and then asks client to match
cut-out shapes with corresponding instruments (triangle, sand blocks,
drum); therapist sings “5 Little Speckled Frogs and “I Like Ice Cream”
and asks client to pick up the color in the song; therapist sings “Grandpa’s
Farm” or “Old McDonald” and asks client to pick a picture of an animal or
a stuffed animal out of a bag; therapist plays drum and plays a rhythm for
each letter of the client’s name; therapist sings “This Old Man or “Going
Over the Sea” and asks client to pick numbers out on a number chart of
write them; therapist uses the book “Chicka, Chicka, Boom, Boom” and

sings the words of the book while playing the guitar, asking the client to

76

1.12

point to the letter that was sung; therapist uses “10 Little Bunnies” and
asks client to remove a bunny picture in succession).

Identify by pointing (n=14; 44%)

(Music Examples: Therapist sings song about body parts and asks client to
point to them while singing; therapist sings “Number Rock,” “Head Bone
Connected to the Knee Bone,” “Lollipop Song“- for colors, “ABC Song,”
and “Alphabet Rock; therapist uses improvised songs and chants;
therapist uses “This is a Song About Colors” or Triangle, Circle, Square;”
therapist uses “Head, Shoulders, Knees, and Toes;” therapist adapts “If
You’re Happy and You Know It;” therapist uses “Fish Hunt, “Color
Clown, and” Butterﬂy”- for counting; therapist sings “Show me the
Color” to the tune of “Someone’s in the Kitchen with Dinah” or “I Like
Red” by Kathleen Coleman; therapist sings).

Match concepts on keyboard (n=3; 9%)

2.00 Sequencing/Memory (N=51; n=17; 33%)

2.10

2.11

2.12

Recall through multi-verse songs (N=17; n=10; 59%)

(Music Examples: Therapist sings “She’ll be Comin’ Around the
Mountain” and “The Boa Constrictor” and encourages the client to recall
the order of words and/or movements; therapist sings “There’s a Hole in
the Bottom of the Sea”).

Recall melodies, themes, new songs (n=5; 29%)

Recall through storytelling (n=1; 6%)

(Music Examples: Therapist improvises a story using instruments as the

77

3.00

4.00

5.00

2.13

characters and client much remember instruments in sequence).
Recall through instrument play (n=1; 6%)
(Music Examples: Therapist uses 3 frame drums and asks client to line

them up, play, and then put them away so they all ﬁt inside each other).

Auditory Perception/Discrimination (N=5 1; n=13; 25%)

3.10

3.11

3.12

3.13

3.14

3.15

Identify changes in tempo and dynamics (N=13; n=6; 46%)

(Music Examples: Therapist improvises on piano or guitar and client moves
freely; therapist uses song “This Old Man” and instrument playing).

Repeat simple melodies (n=3; 23%)

Responds to name (n=2; 15%)

Follow sound with eyes (n=1; 8%)

Match instrument sounds (n=1; 8%)

(Music Examples: Therapist gives client bell and maraca and instructs client
to play instrument that he/she hears).

Identify high/low and loud/soft (n=1; 8%)

Attending Skills (N=5 1; n=10; 20%)

4.10

4.11

4.12

Attend to given task (N=10; n=5; 50%)

Make eye contact with therapist (n=3; 30%)

(Music Examples: Therapist uses songs, such as “Old McDonald” to
observe eye contact).

Follow instrument with eyes (n=2; 20%)

Direction Following (N=51; n=8; 16%)

5.10 Respond to sung directions (N=8; n=8; 100%)

78

(Music Examples: Therapist sings a song that directs client to play different
instruments; therapist sings “Egg Shakin’ Blues;” therapist sings a “Do
What I Do” song; therapist encourages client to start and stop playing a
simple rhythm instrument; therapist creates original songs involving

directions for client to complete).

6.00 Academic Skills (N=51; n=7; 14%)

7.00

8.00

6.10 Engage in music that teaches school subjects (N=7; n=3; 43%)

6.11

6.12

(Music Examples: Therapist creates songs to teach math and science
concepts).
Read a song sheet/book (n=3; 43%)

Match instrument names to instruments (n=1;14%)

Spatial Awareness (N=51; n=5; 10%)

7.10 Play instruments in given directions (left, right, up, down, etc)

(N=5; n=5; 100%)
(Music Examples: Therapist uses “Hokey, Pokey” melody and sings

directions).

Sorting (N=5 1; n=3; 6%)

8.10 Put instruments in corresponding box

8.11

Organize instruments in orders and rows

8.12 Arrange instrument by features

(Music Example: Therapist encourages client to play all the instruments

that shake, etc.)

9.00 Self Care (N=51; n=3; 6%)

79

9.10 Identify self-care skills through songs (N=3; n=3; 100%)
(Music Examples: Therapist creates songs to discuss self-care topics such
as dressing, cleaning, eating, etc.)
Others (1 each): Imaginary Play, Abstract Structures, Ability to try new tasks, Multi-tasks,
Choice-making, Musical Conservation, Attempts Difﬁcult Tasks, Expresses Thoughts and

Ideas, Reality Orientation.

8O

 

Table 9

Major Skill Area: Music (N=80; n=28; 35% )

Subcategopy Areas

1.00 Rhythm/Beat (N=28; n=21; 75%)

2.00

3.00

1.10 Match/Imitate rhythm (N=21; n=15; 71%)

1.11

(Music Examples: Therapist plays a rhythm and asks client to play it back
and/or play along; therapist sings a song where speciﬁc rhythms are added;
therapist sings “BINGO” or “Deep in the Heart of Texas” and encourages
clients to ﬁll in the “open” spaces).

Keep a steady beat (n=10; 48%)

(Music Examples: Therapist plays guitar or piano and asks client to play

along on body and/or drums; therapist encourages client to strum guitar).

1.12 Adapt to rhythmic changes (n=5; 24%)

Melody/Tonal (N=28; n=17; 61%)

2.10 Match pitches (N=17; n=10; 59%)

2.11

(Music Examples: therapist plays notes on the keyboard).
Sing a familiar song (n=9; 53%)
(Music Examples: Therapist plays songs such as “If You’re Happy and

You Know It,” “Are You Sleeping,” or “Happy Birthday”).

2.12 Finish a musical phrase (n=2; 12%)

2.13

Adapt to changing keys (n=1; 6%)

Instrument Exploration (N=28; n=9; 32%)

3.10 Choose an instrument and play (N=9; n=8; 89%)

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4.00

5.00

6.00

3.11

3.12

Identify instruments by name (n=3; 33%)

(Music Examples: Therapist sings “I’m a Rhythm Instrument” by Hap
Palmer).

Learn instrument care (n=1; 11%)

(Music Examples: Therapist instructs client as to correct care for

instrument).

Interest/Preference (N=28; n=9; 32%)

4.10

4.11

4.12

Response to music (N=9; n=6; 67%)

(Music Examples: Therapist uses a variety of music (recorded and live) and
observes client reaction).

Choose a song or style (n=5; 56%)

(Music Examples: Therapist asks client’s preference;

Choose an instrument (n=1; 11%)

Changes in Dynamics (N=28; n=3; 11%)

5.10

Adapt to changes in volume (N=3; n=3; 100%)

Musical Form/Phrasing (N=28; n=2; 7%)

6.10

6.11

Identify end of phrase (N=2; n=1; 50%)

(Music Examples: Therapist plays a phrase that involves an ending with a
cymbal “crash” and observes client’s ability to continue the phrasing).
Identify structure and form (n=1; 50%

(Music Examples: Therapist improvises a theme and observes client’s

ability to create an “ending” or structure).

82

Others (1 each): Range of Affect; Awareness. Startle Reﬂex, Movement, Sequencing,

Reception, Perception, Conception, Sound Localization

83

Table 10
Major Skill Area: Emotional (N=80; n=13; 16% )

Altemate Titles: Affect; Psychosocial; Affective Expression

Subcateg01y Areas

1.00

2.00

3.00

Identify/Express Feelings (N=13; n=8; 62%)

1.10 Identify feeling in music with words (N=8; n=3; 38%)

1.11 Identify feeling in music with pictures (n=2; 25%)

1.12 Play feelings on instrument (n=2; 25%)

1.13 Write song about feelings (n=1; 13%)

Mood/Affect (N=13; n=5; 38%)

2.10 Display range of affect (N=5; n=5; 100%)
(Music Examples: Therapist uses variety of songs to elicit affective
response, such as “Pop Goes the Weasel”-surprise, “Silly Sound Song”-
laughing, and “Three Little Pigs”- tense).

Awareness of Self and Others (N=13; n=3; 23%)

3.10 Interact with Therapist (n=2; 67%)

3.1 1 Interact with the music (n=1; 33%)

Others (1 each): Musical Expression, Spiritual, Observable Mannerisms, Attention to

Task, Self-Esteem, Anger Management

84

Table 11
Major Skill Area: Sensory (N=80; n=10; 13%)
Alternate Titles: Awareness of Stimuli; Auditory and Visual Perception; Sensory
Awareness; Perceptual Abilities
Subcateaory Areas
1.00 Visual (N=10; n=6; 60%)
1.10 React to color and light (N=6; n=3; 50%)
(Music examples: Therapist uses streamers and lighted tambourine;
therapist uses colored shakers).
1.11 Read charts (near and far) (n=2; 33%)
1.12 Track stationary and moving objects (n=2; 33%)
2.00 Auditory (N=10; n=6; 60%)
2.10 React to loud and soft sounds (N=6; n=4; 67%)
2.11 React to pitched and non-pitched sounds (n=3; 50%)
2.12 React to start and stop (n=1; 17%)
3.00 Tactile (N=10; n=6; 60%)
3.10 Tolerate different textures (N=6; n=5; 83%)
(Music Examples: Therapist uses scarves, toy animals, drums, etc.;
therapist sings a “Sensory Song;” therapist encourages client to strum and
touch the guitar; therapist uses a variety of vibrating toys).
3.11 Response to touch from therapist (n=1; 17%)

Others (1 each): Attention, Discrimination, Awareness, Environment, Memory

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Table 12
Major Skill Area: Adaptive (N=80; n=7; 9%)
Alternate Titles: Functional Life/ Self Help Skills; Daily Living Skills
Subcategogy Areas
1.00 Personal Responsibilities (N=7; n=7; 100%)
1.10 Eat and Drink (N=7; n=3; 33%)
(Music Examples: Therapist plays “This is the way we eat our lunch” game
with toy food and utensils).
1.11 Initiate Toileting (n=1; 14%)
1.12 Take off coat, boots, shoes (when applicable) (n=1; 14%)
1.13 Understand Trafﬁc Safety (n=1; 14%)
(Music Examples: Therapist adapts “Wheels on the Bus” to include traffic
safety).
1.14 Maintain Personal Hygiene (n=1; 14%)
2.00 Attention (N=7; n=2; 29%)
2.10 Focus on given task (N=2; n=2; 100%)
Others (1 each): Functional Objectives, Body Awareness, Recreational Skills, Follow

Directions, Impulse Control

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Table 13
Major Skill Area: Case History (N=80; n=2; 3% )
Subcategopy Areas
1.00 Referral Reasons (n=2)
2.00 Medical
3.00 Social

Major Skill Area: Impulse Control (N=80; n=1; 1%)

Subcategogy Areas

1.00 Parallel Play
2.00 Cooperative Play

Major Skill Area: Achievement (N=80; n=1; 1%)

Subcategopy Areas

1.00 Motivation
2.00 Self Esteem

3.00 Risk Taking

Major Skill Area: Mental Awareness(N=80; n=1; 1% )

Subcategorgy Areas

1.00 Decision Making

2.00 Preferences

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Table 16

Question 2: Positive Aspects
(Categories and Sample Responses)

N=113
Category #1: Thorough (n=38; 34%)

“Every little sub-skill on the assessment form is not assessed in every client, but I like the
comprehensiveness. It serves as a good reminder for me...”

“There have been times when a narrative of the assessment session takes a lot of time.
Sometimes over an hour if there is a lot of detail. Because of the detail provided though,
the funding for sessions is almost always approved.”

“Provides a thorough overview of client’s strengths and weaknesses.”

Category #2: Individualized (n=29; 26%)

“I am able to individualize the assessment process for each student.”

“Each new client is approached with a sense of discovery, with as few preconceptions as
possible. As a result, the shape of the assessment varies widely from client to client, and

we are able to obtain what we call a ‘musical portrait’ of the client.”

“I take a very spontaneous, creative approach to assessing clients. I come into the process
with a few song ideas. a movement activity... and a very open mind.”

Category #3: Easy to Use (n=29;26°@)

“My assessment tool follows my typical music therapy session format, so it’s easy to use
with a new student on an individual basis or within a group setting.”

“Tracks progress and generally easy to administer.”

“There are a lot of overlays that allow me to assess multiple skills in 1 activity several
times.”

Category #4: Shows Viability of Mus_ic Therapy Services (n=10; 9%)

“This assessment allows for some more concrete data to show progress towards goals and
have music therapy interventions will help this process.”

“The SEMTAP is a good instrument for determining whether or not a child should receive

88

music therapy as a related service in special education.”

“Gives a good understanding/need for MT services.”

Categogy #5: Understood by Other Disciplines (n=7; 7%)
“It’s comprehensive and uses terminology that is common to several different settings.”

“I made this form but haven’t been using it. I feel it would be helpﬁil if I were
communicating with other disciplines...”

“Is a good adjunct to established play-based assessments used by other professionals on
the team.”

89

Table 17

Question 2: Negative Aspects
(Categories and Sample Responses)

N=86
Category #1 : Subjective m=24. 28%)

“I feel the assessment is too subjective and has no functional use for other professionals
working with the student.”

“Besides comparing a child’s skills from the assessment to developmental criteria, there is
no real concrete determination whether a child should receive music therapy services. It is
solely based on my professional opinion. I’m ﬁnding that school districts want something
more concrete.”

“The downside is coming up with music activities that do not sway results. As a therapist
you want the child to be successﬁil so are my activities biased?

Category #2: Limiting fn=22; 26%)
“I feel it covers enough, yet I’m not sure if it assesses enough areas.”
“The criteria are more academic or cognitive based. They seem limiting.”

“I don’t usually use a chart or checklist, and while this allows me ﬂexibility, I also may
sometimes miss a particular area.”

Category #3: Time-Consuming (n=19; 22%)
“Our assessment is very thorough, but currently is too time consuming to write-up.”

“The only negative aspect (although I do feel it is a necessary one) is that the process
[SEMTAP] takes a lot of time (observation, planning, assessing, writing reports)”

“We like the assessment because it’s very thorough, however, the ﬁnal written report is
often 6 or more pages and very time-consuming to put together.”

CategoryaM: Technical Difﬁculties (n=14; 16%)
“No space to write comments.”

“Does not list speciﬁc tasks to be used while assessing.”

90

“Requires computer.”
Category #5: Brozal (n=7; 8%)

“It is not differentiated between individual or group therapy. It is not differentiated
between ages, populations, and need areas...”

“My student’s skills/needs are so different that I constantly need to change songs and
activities for different students/classrooms.”

“The current assessment tool we employ is vague. It is difﬁcult to assess deﬁnitively a
resident’s speciﬁc needs and level of functioning.”

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Table 18
Question 3: Important Features for a Standardized Music Therapy Assessment Form
(Categories and Sample Responses)
N=151 Features; 60 Respondents

Mow #1 : Easy to Use (n=35; 23%)
“Easy to ﬁll out while conducting assessment.”
“Must be easy to use so that attention is not diverted from the client during assessment.”
“Accessible- Preferably as easy to complete as possible without sacriﬁcing quality.”
C_at_egory #2: Comprehensive (n=29; 19%)
“Comprehensive- Music assess a maximum range of skills (general and musical)”

“The form needs to be thorough enough to cover all areas being assessed.”

“Thorough to cover all areas of ﬁlnctioning, including child’s social history, medical
history, music history, etc., reason for referral.”

Categogg #3: Adaptable (n=20; 13%)

 

“Making sure that the assessment is adaptable enough to work with our many diverse
clients.”

“Ability to use the assessment with all ranges of ability levels and age“

“Must be useful for variety of ages and abilities.”

Ciegory #4: Reliﬂle and Valid (n=16; 11%)

“Reliable and Valid: it must measure what it says it measures consistently.”
“Provides valid and measurable information that can stand up to examination.”

“Consistency, measuring what it should measure without having to adapt.”

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Category #5: Efﬁcient (n=1 SJ 0%)
“One page- 2 pages max.- for ease of ﬁling/conciseness.”
“Concise- our school district doesn’t prefer an assessment which is lengthy...”

“For me because of the volume of students, I would want something that pinpoints
targeted areas and can be ﬁlled out quickly with a minimum of commentary...”

Category #6: Provides Speciﬁc Music Therapy Tasks (n=10; 7%)
“Has an activity guide for the examiner so evals are consistent.”

“Resource given to therapist with assessment forms for useful music, songs, activities,
instruments found effective in assessment or treatment process.”

“A bibliography and list of recordings.”

Category #7: Compares Skills With and Without Music (n=10; 7%)

“The assessment must consider the student’s performance with music as compared to
ﬁinctioning levels without music. In terms of special education requirements for related
services, it is clear that if this cannot be documented, MT cannot be justiﬁed as a

necessary related service.”

“Comparison of IEP [Individualized Education Plan] behaviors/ goals in non-music verses
music setting.”

“Comparing students’ skills with and without music.”
Categogj #8: Compares Responses to “Typical” Developmental Scale (n=8; 5%)

“Each assessment should cover speciﬁc developmental periods and be based on “normal”
scales.”

“Having a score of a “normal functioning child” to compare it to i.e. some children may
exceed in some areas, and some may not. I have had some school systems request this.”

“Developmental scale of “age” or “percentage” when skills should be reached in typical
situations.”

93

Category #9: Provides Goal Areas m Interpretation Guidelines (n=8; 5W)

“1 would always know what to look for when assessing, become more aware of certain
things- what to focus on.”

“Speciﬁc areas of functioning being assessed and guideline for typical long-term goals and
objectives appropriate for this group, based on experience of wide use of standard

assessment.”

“Speciﬁc skill measurements with speciﬁc guidelines for meeting the skill.”

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Table 20
Question 3: What a Standardized Assessment Will Do For the Profession
N=13 Responses; 11 Respondents
Categogg #1: Continuity Within Profession (n=5; 38%)
“Gives our discipline more uniformity.”
“It would allow for consistency.”
“It gives a common language to our profession...”

Categog #2: Justiﬁes Services (n=4; 31%)

“We’d have more uniform data to present to law makers etc. to support the beneﬁts of
music therapy.”

“A clearer result regarding the need for music therapy comes to light.”

“It could aid in justifying the use of MT by providing a score or percentage as OT
[Occupational Therapy] and PT [Physical Therapy] standardized tests do.”

Category #3: Respect from Others (n=ﬂl%j
“Parents trust the results more because a standardized test often does not lie.”
“Other professions honor your words and assessments more.”

“Standardized form might provide more credibility to other professionals.”

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Table 21
Question 3: Why a Standardized Assessment Would Not Work
N=11 Responses; 11 Respondents
C_atagory #1 :Va_ri_ance in Clientele Ln=1 L: 100%)
“While I feel some administrators would be more likely to recognize MT with a
standardized assessment tool, I cannot imagine pat; tool that would provide a reliable valid

score for all students receiving special education.”

“I have not found that one approach can ﬁt all circumstances... individual differences vary
greatly.”

“I’m not sure if I would want to use a standardized form. There are so many different
manifestations of DD. I typically rely on the situation, the child, my knowledge of their
disorder, and intuition to guide me in pulling out what is important in my own assessment
form.”

96

APPENDICES

97

 

Appendix A
Initial Cover Letter

Roger Smeltekop, MM, MT-BC
Music Practice Building
Michigan State University

East Lansing, MI 48823

Kristen M. Cole, MT-BC
5690 Rawnsley Avenue, Apt. B
West Bloomﬁeld, MI 48323

March 20, 2001
Dear Fellow Music Therapist,

The topic of formal and/or standardized music therapy assessment tools for children has
been recently addressed in both the Journal of Music Therapyand Music Therapy
Perspectives. Most of the articles suggested more research in the area of assessment,
increased attention to the design of new forms, with implications for a standardized tool.
We are a professor of and staff member in Music Therapy at Michigan State University
and are interested in examining and understanding the current assessment practices of
music therapists currently working with children with developmental disabilities (age 0-
17).

Your name was listed in the 2001 American Music Therapy Association (AMTA) Member
Database under the population listing of “developmental disabilities.” If you work only
with adults with developmental disabilities (age 18+), please disregard this letter, return
the enclosed participation form, and mark “Adults with Developmental Disabilities (age 18
+)”,

As music therapists working with children with developmental disabilities (age 0-17) in
some clinical capacity, your input and response to a survey we have designed would be
very useﬁil and greatly appreciated. The survey will examine common music therapy
assessment skill areas, the assessment process, current tools utilized, and the need for a
standardized assessment. We hope to utilize the results to provide an awareness and
understanding for both music therapy clinicians, music therapy educators, and AMTA
regarding current assessment practices. In addition, we hope to provide useful
information for the future development of a formal and/or standardized music therapy
assessment tool. Please be aware that all information shared on the participation form and
the survey, if you choose to participate, will remain conﬁdential and your name will not be
used in the study. All your postage costs will be paid and your only obligation would be to
complete the survey. In addition, we will gladly mail you a copy of the study results at
your request.

98

Please complete the enclosed participation form and return it using the enclosed self-
addressed-stamped envelope for your convenience. Thank you in advance for your
participation.

Sincerely,

Roger A. Smeltekop, MM, MT-BC Kristen M. Cole, MT-BC
Professor, Music Therapy Music Therapy Clinic Supervisor
Michigan State University Michigan State University

99

Appendix B

Participation Form for Music Therapy Assessment Survey Study

1. I currently assess and work with the following populations: (please check all that apply)

Children with Developmental Disabilities (age 0-17)

(Deﬁned as: Persons age 0-17 who have failed to progress at a normal rate in at least on of the following
areas: (a) motor skills. (b) adaptive skills. (c) communication skills. ((1) cognitive skills, and (e) social
skills and/or have been labeled or diagnosed by a medical doctor as having autism. mental retardation,

and scnsory/rnotor/physical/cognitive impairments)

Adults with Developmental Disabilities (age 18 +)

Other (please specify)

 

" If you work only with adults with developmental disabilities. please stop here and return this form in
the enclosed self-addressed stamped envelope.

2. How long have you been practicing as a music therapist? (please check one)

0-2 years 3-5 years
6-8 years 9-11 years
12 + years

3. What is your highest level of education? (please check one)

Bachelor’s Degree Some Master’s Work
Master’s Degree Some Doctoral Work
Doctoral Degree other (please specify)

 

4. If you have a graduate degree or are currently pursuing one, what is the degree title or

what will it be? (please write in full):
(example: Master of Music degree in Music Therapy: Doctor of Philosophy in Clinical Psychology; etc.)

 

100

5. I work with children with developmental disabilities (age 0-17) in the following settings:
(please check all that apply)

__ group home __ in your home

__ developmental center _ in the client’s home
__ public school __ community music school
__ private school _ other (please specify all)
_ hospital

 

 

6. In the above setting(s), 1 see the clients in the following context(s):
(please check all that apply)

small group (2-4 clients) large group (5 or more clients)

individual sessions other (please specify)

 

 

7. Where did you obtain the assessment you are currently using in your clinical practice?
(please check the one that best ﬁts you)

colleague(s) professor(s)
__ internship __ book(s)
undergraduate school(s) graduate school(s)
research article(s) self-created (original)
conference(s) self-created (adapted from
other forms)
former workplace other (please specify)

current workplace

 

101

8. I currently assess and work with children with developmental disabilities (age 0-17)

and (please check one): *Be reminded that all your postage costs will be protided to you and your
input will be very valuable to both this study and the music therapy profession.

I would complete a survey regarding my music therapy assessment tool and
process. (Please include your name and address below)

I would not complete a survey regarding my music therapy assessment tool
and process. (Name and address optional if you choose not to participate in the survey)

 

 

 

 

 

Name Credentials
Address

City State__ Zip Code
Email

 

Please return this form using the enclosed self-addressed-stamped envelope by April 10,
2001.

Thank you in advance for your response.

Roger Smeltekop, MM, MT-BC Kristen M. Cole, MT-BC
Professor, Music Therapy Music Therapy Clinic Supervisor
Music Practice Building 5690 Rawnsley Avenue Apt. B
School of Music West Bloomﬁeld, MI 48323
Michigan State University (248 ) 865-0129

East Lansing, MI 48323

(517) 353-6753

102

Appendix C

Music Therapy Assessment Survey
Section 1

Enclosed are 6 lined sheets to be used in the completion of this section. Each sheet has a major
functioning area line and several subcategory lines, followed by several more explanation lines.

1. Please write a major functioning area that you assess.
2. Follow this with any number of subcategory areas.

3. Use the remaining lines to describe and provide examples for the tasks, activities, and/or
strategies used in assessing those areas.

Please provide detailed and descriptive responses using the major and subcategory areas you
currently assess. Your assessment process will determine how many of the lines you will need;
take as little or as much space as you want! Feel free to copy the enclosed lined sheets if you
have more than 6 major areas, or enclose separate sheets if you need more explanation space. If
plain paper would better suit your assessment process explanation, please feel free to discard
the lined sheets and use your own (handwritten or typed).

Example: Major area: Motor Functioning
Subcategory: Gross Motor Skills

Explanation: 1 use the songs “If You’re Happy and You Know

it” and/or "The Hokey Pokey.” I sing the songs on guitar or piano
(depending on client preference) and give verbal, musical, and/or
gestural prompts to assess overall lcg, arm, head, and torso
movements.

Subcategory: Fine Motor Skills
Explanation: I use the piano and encourage the child to play the black and

white keys with different hands and ﬁngers. I also have the child attempt
to strum a guitar with a pick, play egg shakers, and hold a paddle drum.

.S_cc_ti_o_r1.2

1) Please enclose a copy of your current music therapy assessment tool only if you use a speciﬁc
form, format, or guideline(s). If you use a published form. you do not nwd to enclose your form,
but please write the name and author(s) on the line below:

 

other side -

103

2) What do you feel are the positive and negative aspects of your current assessment
tool/process/form?

 

 

 

 

 

3) What would be the three most important features of a standardized music therapy assessment
form for children with developmental disabilities for use in your clinical practice? (If you do not
wish to use a standardized assessment form, please state the reasons for your answer on the lines
below)

1.

 

 

 

 

 

 

4) If you would like a copy of the results, please include your name and address on the lines below:

 

 

 

Please return the survey (including this form) using the enclosed self-addressed-stamped envelope
by July 6, 2001. Please be reminded that all information you provide is conﬁdential and your
name will not be used in this study. Thank you in advance for your participation.

104

Major Area:

 

Subcategory:

 

Explanation: (process used and task examples)

 

 

 

 

 

 

 

Subcategory:

 

Explanation:

 

 

 

 

 

 

 

 

Subcategory:

 

Explanation:

 

 

 

 

 

 

 

note: Six of this page (3 double-sided pages) were enclosed in the survey

105

 

Appendix D

Roger Smeltekop, MM, MT-BC
Music Practice Building
Michigan State University

East Lansing, MI 48823

Kristen M. Cole, MT-BC
5690 Rawnsley Avenue, Apt. B
West Bloomﬁeld, M148323

June 10, 2001
Dear Fellow Music Therapist:

Thank you very much for returning our participation form and expressing interest in participating
in our survey study of music therapists working with children with developmental disabilities and
their current assessment practices. Many of you had very encouraging things to say regarding our
efforts and the need for research in this speciﬁc area. Your input on this survey will be very
helpful for music therapy clinicians and educators.

Enclosed you will ﬁnd two copies of a consent form. Please keep one copy for your records and
return a signed and dated copy with your completed survey.

The goal of the enclosed survey is to gain detailed and descriptive information about your
assessment process. On Part 2 of the survey, you are asked to enclose an assessment tool/form if
you use one. Please still complete the survey even if you do not use a specific tool or form. We
are most interested in knowmg the following: (a) what major ﬁinctioning areas you assess, (b) what
skill subcategory areas you assess, and (c) how you assess the areas- regardless of whether you
write them down or follow a written format.

We are so very thankful in advance for your efforts in completing this survey. Please contact us
via email, phone, or mail with any questions or concerns.

Sincerely,

Roger Smeltekop, M.M., MT-BC Kristen M. Cole, MT-BC
Associate Professor of Music Therapy Music Therapy Clinic Supervisor
Michigan State University Michigan State University.

106

Appendix E
Consent F orm

You are being requested to participate in a survey research study on assessment in music
therapy for children with developmental disabilities (age 0-17). This project is being
conducted by Roger Smeltekop, MM, MT-BC, Professor of Music Therapy and Kristen
M. Cole, MT-BC, Music Therapy Clinic Supervisor, Michigan State University. The
researcher will be examining the written survey responses for common themes in major
functioning categories and subcategories in music therapy assessment. Common music
therapy assessment form design will be examined and responses to one question regarding
your ﬁve most important needs in a standardized music therapy assessment will be
calculated with descriptive statistics.

As a participant, you will complete the survey, enclose a current assessment tool, and
answer one question regarding your ﬁve most important needs in a standardized music
therapy assessment tool. The survey will take approximately 35 to 40 minutes to
complete. All the information you provide on the survey will be kept conﬁdential and all
the responses will be kept in a secure area that only the researcher can access. Your
privacy will be protected to the maximum extent allowable by law. There are no risks to
your personal health and/or well-being if you choose to participate in this study and you
are ﬂee to discontinue your participation in this study at any time without penalty. All
postage will be provided by the researcher in the form of self-addressed stamped
envelopes.

 

As a music therapist working with children with developmental disabilities (age 0-17), I
agree to participate in this study that will use my responses to the enclosed survey to
examine common music therapy assessment skill areas, the assessment process, current
tools utilized, and the need for a standardized assessment form.

All the information I provide will remain conﬁdential and the results will be made available
to me if I choose to request them. Please contact Roger Smeltekop, MM, MT-BC at (517)
353-6753, Kristen Cole, MT-BC at (248) 865-0129, and/or David Wright, Ph.D., Chair
of the Michigan State University Committee on Research Involving Human Subjects at
(517) 355-2180 with any questions or concerns.

 

 

 

 

 

 

 

Signed Date

Printed name Credentials
Address

City State____ Zip Code
Email

 

107

          

' 1111111111111110111111'

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