The effectiveness of a short-term group music therapy intervention for parents who have a child with a disability

The relationship between the quality of parent-child interactions and positive child developmental trajectories is well established (Guralnick, 2006; Shonkoff & Meissels, 2000; Zubrick et al., 2008). However, a range of parental, family, and socio-economic factors can pose risks to parents’ capacity to participate in quality interactions with their children. In particular, families with a child with a disability have been found to have higher levels of parenting stress, and are more likely to experience economic disadvantage, as well as social isolation. The importance of early interventions to promote positive parenting and child development for these families is widely recognised (Shonkoff & Meissels, 2000). However, to date, there is a lack of evidence about the effectiveness of early parenting programs for families who have a young child with a disability. This thesis investigates the impact of a music therapy parenting program, Sing & Grow, on 201 parent-child dyads who attended programs specifically targeted to parents who had a young child with a disability. Sing & Grow is an Australian national early parenting intervention funded by the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs and delivered by Playgroup Queensland. It is designed and delivered by Registered Music Therapists for families with children aged from birth to three years. It aims to improve parenting skills and confidence, improve family functioning (positive parent-child interactions), enhance child development, and provide social networking opportunities to socially isolated families. The intervention targets a range of families in circumstances that have the potential to impact negatively on family functioning. This thesis uses data from the National Evaluation Study of Sing & Grow from programs which were targeted at families who had a young child with a disability. Three studies were conducted to address the objectives of this thesis. Study 1 examines the effects of the Sing & Grow intervention on parent reported pre and post parent mental health, parenting confidence, parenting skills, and child development, and other parent reported outcomes including social support, use of intervention resources, satisfaction with the intervention and perceived benefits of and barriers to participation. Significant improvements from pre to post were found for parent mental health and parent reported child communication and social skills, along with evidence that parents were very satisfied with the program and that it brought social benefits to families. Study 2 explored the pre to post effects of the intervention on children’s developmental skills and parent-child interactions using observational ratings made by clinicians. Significant pre to post improvements were found for parenting sensitivity, parental engagement with child and acceptance of child as well as for child responsiveness to parent, interest, and participation in the intervention, and social skills. Study 3 examined the nature of child and family characteristics that predicted better outcomes for families while taking account of the level of participation in the program. An overall outcome index was calculated and served as the dependent variable in a logistic regression analysis. Families who attended six or more sessions and mothers who had not completed high school were more likely to have higher outcome scores at post intervention than those who attended fewer sessions and those with more educated mothers respectively. The findings of this research indicate that the intervention had a positive impact on participants’ mental health, parenting behaviours and child development and that level of attendance was associated with better outcomes. There was also evidence that the program reached its target of high risk families (i.e., families in which mothers had lower educational levels) and that for these families better outcomes were achieved. There were also indications that the program was accessible and highly regarded by families and that it promoted social connections for participants. A theoretical model of how the intervention is currently working for families is proposed to explain the connections between early parenting, child development and maternal wellbeing. However, more research is required to further elucidate the mechanisms by which the intervention creates change for families. This research presents promising evidence that a short term group music therapy program can elicit important therapeutic benefits for families who have a child with a disability.

The effectiveness of a short-term group music therapy intervention for young parents and their children

The quality of early life experiences are known to influence a child’s capacities for emotional, social, cognitive and physical competence throughout their life (Peterson, 1996; Zubrick et al., 2008). These early life experiences are directly affected by parenting and family environments. A lack of positive parenting has significant implications both for children, and the broader communities in which they live (Davies & Cummings, 1994; Dryfoos, 1990; Sanders, 1995). Young parents are known to be at risk of experiencing adverse circumstances that affect their ability to provide positive parenting to their children (Milan et al., 2004; Trad, 1995). There is a need to provide parenting support programs to young parents that offer opportunities for them to come together, support each other and learn ways to provide for their children’s developmental needs in a friendly, engaging and non-judgemental environment. This research project examines the effectiveness of a 10 week group music therapy program Sing & Grow as an early parenting intervention for 535 young parents. Sing & Grow is a national early parenting intervention program funded by the Australian Government and delivered by Playgroup Queensland. It is designed and delivered by Registered Music Therapists for families at risk of marginalisation with children aged from birth to three years. The aim of the program is to improve parenting skills and parent-child interactions, and increase social support networks through participation in a group that is strengths-based and structured in a way that lends itself to modelling, peer learning and facilitated learning. During the 10 weeks parents have opportunities to learn practical, hands-on ways to interact and play with their children that are conducive to positive parent-child relationships and ongoing child development. A range of interactive, nurturing, stimulating and developmental music activities provide the framework for parents to interact and play with their children. This research uses data collected through the Sing & Grow National Evaluation Study to examine outcomes for all participants aged 25 years and younger, who attended programs during the Sing & Grow pilot study and main study from mid-2005 to the end of 2007. The research examines the change from pre to post in self-reported parent behaviours, parent mental health and parent social support, and therapist observed parent-child interactions. A range of statistical analyses are used to address each Research Objective for the young parent population, and for subgroups within this population. Research Objective 1 explored the patterns of attendance in the Sing & Grow program for young parents, and for subgroups within this population. Results showed that levels of attendance were lower than expected and influenced by Indigenous status and source of family income. Patterns of attendance showed a decline over time and incomplete data rates were high which may indicate high dropout rates. Research Objective 2 explored perceived satisfaction, benefits and social support links made. Satisfaction levels with the program and staff were very high. Indigenous status was associated with lower levels of reported satisfaction with both the program and staff. Perceived benefits from participation in the program were very high. Employment status was associated with perceived benefits: parents who were not employed were more likely than employed parents to report that their understanding of child development had increased as a result of participation in the program. Social support connections were reported for participants with other professionals, services and parents. In particular, families were more likely to link up with playgroup staff and services. Those parents who attended six or more sessions were significantly more likely to attend a playgroup than those who attended five sessions or less. Social support connections were related to source of family income, level of education, Indigenous status and language background. Research Objective 3 investigated pre to post change on self-report parenting skills and parent mental health. Results indicated that participation in the Sing & Grow program was associated with improvements in parent mental health. No improvements were found for self-reported parenting skills. Research Objective 4 investigated pre to post change in therapist observation measures of parent-child interactions. Results indicated that participation in the Sing & Grow program was associated with large and significant improvements in parent sensitivity to, engagement with and acceptance of the child. There were significant interactions across time (pre to post) for the parent characteristics of Indigenous status, family income and level of education. Research Objective 5 explored the relationship between the number of sessions attended and extent of change on self-report outcomes and therapist observed outcomes, respectively. For each, an overall change score was devised to ascertain those parents who had made any positive changes over time. Results showed that there was no significant relationship between high attendance and positive change in either the self-report or therapist observed behavioural measures. A risk index was also constructed to test for a relationship between the risk status of the parent. Parents with the highest risk status were significantly more likely to attend six or more sessions than other parents, but risk status was not associated with any differences in parent reported outcomes or therapist observations. The results of this research study indicate that Sing & Grow is effective in improving outcomes for young parents’ mental health, parent-child interactions and social support connections. High attendance by families in the highest category for risk factors may indicate that the program is effective at engaging and retaining parents who are most at-risk and therefore traditionally hard to reach. Very high levels of satisfaction and perceived benefits support this. Further research is required to help confirm the promising evidence from the current study that a short term group music therapy program can support young parents and improve their parenting outcomes. In particular, this needs to address the more disappointing outcomes of the current research study to improve attendance and engagement of all young parents in the program and especially the needs of young Indigenous parents.

Impact of music therapy to promote positive parenting and child development

The effectiveness of a 10-week group music therapy program for marginalized parents and their children aged 0–5 years was examined. Musical activities were used to promote positive parent–child relationships and children’s behavioral, communicative and social development. Participants were 358 parents and children from families facing social disadvantage, young parents or parents of a child with a disability. Significant improvements were found for therapist-observed parent and child behaviors, and parent-reported irritable parenting, educational activities in the home, parent mental health and child communication and social play skills. This study provides evidence of the potential effectiveness of music therapy for early intervention.

The effectiveness of a short-term group music therapy intervention for parents who have a child with a disability

Background The relationship between positive parent-child interactions and optimal child development is well established. Families with a child with a disability may face additional challenges to establishing positive parent-child relationships. There are limited studies addressing the effectiveness of interventions which seek to address these issues with parents and young children with a disability. In particular, prior studies of music therapy with this group have been limited by small sample sizes and the use of measures of limited reliability and validity. Objective This study investigates the effectiveness of a short-term group music therapy intervention for parents who have a child with a disability and explores the factors associated with higher outcomes for participating families. Methods The participants were 201 mother-child dyads, where the child had a disability. Pre and post intervention parental questionnaires and clinician observation measures were taken on a range of parental wellbeing, parenting behaviours and child developmental factors. Descriptive data, t-tests for repeated measures and a predictive model tested via logistic regression are presented. Results Significant improvements pre to post were found for parent mental health, child communication and social skills, parenting sensitivity, parental engagement with child and acceptance of child, child responsiveness to parent, and child interest and participation in program activities. There was also evidence that parents were very satisfied with the program and that it brought social benefits to families. Reliable change on six or more indicators of parent or child functioning was predicted by attendance and parent education. Conclusions This study provides positive evidence for the effectiveness of group music therapy in promoting improved parental mental health, positive parenting and key child developmental areas. Whilst several limitations are discussed, the study does address some of the gaps in the music therapy evidence base in this area.

Evaluating parent-child group music therapy programmes: challenges and successes for Sing & Grow

Sing & Grow is an early intervention music therapy programme for families with children from birth to 3 years of age, who are socially, economically, or physically disadvantaged. It aims to improve parenting skills and confidence, promote positive parent–child interactions, stimulate child development, and provide social networking opportunities. Music and song activities are used in a therapeutic context to enhance parenting skills, improve parent–child interactions, provide essential developmental stimulation for children, promote social support for parenting, and strengthen links between parents and community services.

Sing & Grow : the co-existence of evaluation research and clinical practice in an early intervention music therapy project

Sing & Grow is a short term early intervention music therapy program for at risk families. Sing & Grow uses music to strengthen parent-child relationships by increasing positive parent-child interactions, assisting parents to bond with their children, and extending the repertoire of parents’ skills in relating to their child through interactive . Both the Australian and New Zealand governments are looking for evidence based research to highlight the effectiveness of funded programs in early childhood. As a government funded program, independent evaluation is a requirement of the delivery of the service. This paper explains the process involved in setting up and managing this large scale evaluation from engaging the evaluators and designing the project, to the data gathering stage. It describes the various challenges encountered and concludes that a highly collaborative and communicative partnership bet en researchers and clinicians is essential to ensure data can be gathered with minimal disturbance to clinical music therapy practice.

Action inquiry into the use of standardized evaluation tools for music therapy : a real life journey within a parent-child community program

Sing & Grow is an early intervention music therapy project that provides community group music therapy programs to families with young children who encounter risk factors that may impact on parenting and optimal child develop variety of evaluation tools were devised and used over the first 3 years of the project. Upon the subsequent funding and expansion of the project at the end of this period, it was necessary to find, test and devise more rigorous, valid and reliable measures to withstand the scrutiny of researchers, and to combat the concerns and criticisms associated with the previous methods of data collection. An action inquiry project was therefore undertaken with two groups of project participants to trial the use of the Parenting Stress Index and Depression, Anxiety and Stress Scales, both recommended by leading psychologists. Key findings that will be discussed include the friction between the deficit-focussed nature of many psychometric tools and the strengths-based approach taken in service delivery, the level of difficulty in terms of literacy and comprehension for vulnerable respondents, and the lack of one tool with the ability to comprehensively measure all aspects of a broad scoping program. Keywords: music therapy, evaluation, PSI, DASS, action inquiry.

The effect of music therapy services on classroom behaviours of newly arrived refugee students in Australia

This pilot study examined the effects of a short-term music therapy program on the classroom behaviours of newly arrived refugee students who were attending an intensive 'English as a Second Language' secondary school. A cross-over design with two five-week intervention periods was employed with group music therapy sessions conducted one or two times per week. Data from the Behaviour Assessment Scale for Children were used to evaluate a range of positive and negative school behaviours. A significant decrease in externalising behaviours was found with particular reference to hyperactivity and aggression. No significant differences were found in other behaviours. Explanations and implications of these findings are discussed.

Funding and employment conditions : critical issues for Australian music therapy beyond 2009

As the Australian Journal of Music Therapy celebrates its 20th year of publication, it is evident that the profession of music therapy in Australia, has made substantial progress over these last 20 years. Jobs are regularly advertised on the website, there is a greater public awareness of what music therapy is, there are government recognised salary awards applicable in several states of the country, working conditions have generally improved, and many Australian music therapists are recognised on the international stage as leaders in their field of expertise. You can even go to a party and tell someone you are a music therapist and there is a good chance they will say 'oh yeah, I know someone who does that at the hospital / school / community centre / nursing home' instead of saying 'oh, so like, a what?'. Despite the impressive leaps and bounds that have been made, and the success of many programs in Australia to date, there is still a great deal of room for improvement. What are the critical issues ahead for the development of music therapy in Australia? In particular, how do music therapists develop going forward and secure funding for clinical initiatives? In reflecting on this question, this article identifies two key areas, amongst the many, that can be addressed by music therapists over the next 20 years: funding and employment conditions. Examples from the national early intervention music therapy program 'Sing and Grow' are used to illustrate the potential impact of addressing these two issues on the positive development of the profession into the future.

Early intervention music therapy : reporting on a 3-year project to address needs with at-risk families

Sing & Grow is an early intervention music therapy project presented to families with additional needs, or those at risk of experiencing disadvantage due to social and/or economic circumstances that may impact on their parenting experiences. The aim of the project is to provide short term music therapy programs to families in communities where access to such services may be limited. The program is strengths-based and focuses on building upon a parent’s capacity to relate to and respond to their child’s emotional and developmental needs.

Reflections on music therapy with Indigenous families : cultural learning put into practice

This paper will describe the process of learning and development that occurred when the Sing & Grow prevention and early intervention project began to provide services to Indigenous families, a relatively new area or music therapy, particularly in Brisbane. The first attempt at establishing a weekly group music therapy program for Indigenous families was not as successful as anticipated; however through analysis of the contributing factors, guidelines were developed and implemented in the following program, which resulted in a positive learning experience for the families and therapists involved.

Contemporary cultures of service delivery to families : implications for music therapy

Family-centred and early intervention and prevention programs are a strong focus of current policy objectives within Australia, and a significant area of practice within the music therapy community. Recent shifts in the culture of policy and practice increasingly reflect ecological understandings by focussing on integrated and place-based approaches to service delivery. Further, current funding opportunities are strongly concerned with the extent to which interventions are able to reach out to highly vulnerable families that typically do not engage with services easily. Music therapy holds unique promise within these cultural shifts and thus advocates must develop a solid understanding of the concepts and related language in order to confidently engage with both funding and service systems. This paper uses an integrative review to first define and summarise current knowledge in three key areas relevant to contemporary Australian policy and practice: hard-to-reach families, home visiting as assertive outreach, and integrated or place-based service delivery. Evidence for the effectiveness of music therapy in relation to these key themes is then presented. Finally, the paper discusses the implications for the future of music therapy within the current Australian early intervention and prevention policy context and makes recommendations for moving forward on both practice and research fronts. While there is growing evidence and theory to suggest that music therapy may be uniquely efficacious in this area, greater Australian Journal of Music Therapy Vol 25, 2014 149 advocacy, documentation, research and adjustment of practices and language will further cement the position of the industry.

Implementing music therapy on an adolescent inpatient unit: A mixed-methods evaluation of acceptability, experience of participation and perceived impact

Objective: We aimed to assess the feasibility of delivering a music therapy program on adolescent psychiatric wards. Method: We undertook a mixed-methods evaluation of a pilot program. Various active and receptive techniques were employed in group music therapy sessions delivered as part of a structured clinical program. Data collected in interviews with participants and staff and feedback questionnaires were thematically and descriptively analysed and triangulated. Results: Data from 62 questionnaires returned by 43 patients who took part in 16 music therapy sessions, and seven staff, evidenced strong support for music therapy. Patients typically reported experiencing sessions as relaxing, comforting, uplifting, and empowering; >90% would participate by choice and use music therapeutically in the future. Staff endorsed music therapy as valuable therapeutically, reporting that patients engaged enthusiastically and identified sessions as improving their own moods and ward milieu. Conclusions: Integration of music therapy in inpatient treatment of adolescents is feasible and acceptable, and is valued by staff and patients as a complement to ‘talking therapies’. Participation is enjoyed and associated with outcomes including improvement in mood, expression of feelings and social engagement consistent with recovery.