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Music Therapy Treatment Planning

First- Assess the assessment

Why Response Hierarchies & Objectives

Why the need for a treatment plan?

  • It frees you to be present and attentive in the therapeutic process. Memorize your plan. ( sticky note on guitar)
  • MT must be consistent with other treatments in meeting the person’s needs.
  • It is what differentiates us between those that provide music for fun.

  • The hierarchy of objectives:
  • functions as a behavioral checklist for assessing client progress
  • progress can be charted in order to analyze the data
  • and it provides an outline for the MT treatment plan.
  • Can be thought of in terms of short and long term objectives.
  • It is important to assess whether the referral, formal music therapy assessment and baseline observations are consistent and relevant.
  • Sometimes the assessment will find that the reason for the referral does not present the most need. For example, after performing the assessment, you may find that a client’s inattentiveness in class may be due to his or her hearing impairment, not a behavior problem.
  • Sometimes behaviors improve or worsen with observation.
  • Ask, has the baseline measurements resulted in a different perspective of the target behavior or need?
  • Determine if there are pre-requisite skills that are needed before working on the target behavior?

Remember you need to have at least 3 sessions of baseline data!

Developmental sequence of objectives

What does a music therapy treatment plan do?

Task Analysis

Consider the developmental sequence of objectives-

  • prerequisite skills must be specified
  • order of the process of learning must be determined

For Example- terminal objective to use complete sentences requires several pre-requisite skills includes vowel imitation, consonant imitation, word imitation and basic expression and identification.

orders objectives in the chronological sequence in which they would normally be performed.

The MT treatment plan begins with a hierarchy of objectives or responses outlining how the client is expected to process throughout the therapy.

What does a music therapy treatment plan do?

1. It organizes the therapist’s plan of action

2. It communicates elements of the program to others who are working with the person (therapists, family and insurance or other financial entity).

Developmental sequence of the group process

Awareness of the stages of the group process can help the MT outline targeted responses and expectations. See Hanser p. 204

Social Hierarchies

A hierarchy of set responses may not be as clear for social and emotional goals.

Could be viewed as a continuum of responses with varying levels and amounts of engagement. See Hanser p. 206

Antecedents & Consequences

(of target behavior)

Musical and

Non-musical Techniques

Antecedents- what will YOU do as the MT to provide a stimulus for a desired response- think about prompts, cues, teaching a new skill, in relationship to environment or timing

Consequences- will there be an immediate consequence for the TB? or other behaviors? What will occur when there is no response and inappropriate response? What and how many prompts will be given, if needed.

Part Three:

Terminal Objective

Part One:

CLIENT AND SETTING

Musical: teaching, iso-principle (meeting them where they are at), dynamics, improvisation, use of musical elements

Non-musical:

  • chaining- layering task one by one
  • modeling- demonstrating behavior
  • molding- "hand over hand"
  • cueing- verbal, physical, gesture
  • scanning- consistent engagement
  • fading- decreasing level of support, cues or prompts

Part Five:

Treatment Procedures

a. Descriptive info of client-

age, ethnicity, diagnoses

b. Reason for referral

c. Facility or school currently enrolled

Reinforcement Schedules

Reinforcement

Two types- Continuous and Partial

a. Continuous- the desired behavior is reinforced every single time it occurs.

b. Partial- desired behavior is reinforced only part of the time.

  • fixed ratio- a response is reinforced only after a specified number of responses- produces a high, steady rate of response.

example- client can play guitar only after participating in 2 activities-

  • variable ratio- a response is reinforced after an unpredictable number of responses- can produce a high, steady rate of response. (like the lotto)
  • fixed interval- a response is reinforced only after a specified amount of time has elapsed- produces a high rate of response near the end of the interval.

example- client can play guitar after participating in 30 minutes of the session.

  • variable interval- a response is reinforced after an unpredictable amount of time has passed- produces a slow, steady rate of response.

This is your long term objective- when the client meets this objective then he or she has met their goal.

a. Should meet the 5 SMART criteria:

Specific, Measurable, Attainable, Realistic and Timely

b. Includes baseline measurement

c. Include a date to meet

Example: Suzy will express 4 verbal positive self-statements in response to one verbal prompt by the music therapist, from a baseline measurement of 1 by December 13, 2019.

Term used in operant conditioning (BF Skinner) to refer to anything that increases the likelihood that a response will occur. In music therapy, music and its related components (instruments, songs, experiences) are used as the reinforcer.

Types of Reinforcement and Punishment

  • Positive reinforcement- strengthening a behavior so that it will likely occur again by GIVING the client something

example: Verbal praise for the desired behavior

  • Negative reinforcement- strengthening a behavior so that it will likely occur again by REMOVING something from the client

example: taking away therapist support (ie. allowing client to play guitar without physical assistance)

  • Positive punishment- decreasing a behavior so that it will not likely occur again by GIVING the client something

example: giving a demerit and only those without demerits get to play the big drum

  • Negative punishment- decreasing a behavior so that it will not likely occur by REMOVING something from the client

example: taking away privileges to listen to favorite song at the end of the session

Other important terms:

  • Time out- time out from reinforcement is a procedure in which a while is placed in a different, less-rewarding situation or setting whenever he or she engages in undesirable or inappropriate behaviors.
  • Primary reinforcement- are unconditioned (meaning they are not learned) tend to be biological in nature- food, water, safety etc.
  • Secondary reinforcement- are conditioned- praise, money, getting to play the guitar

Describing HOW music will be used to achieve goals. Not looking for specific activities, but how music will be utilized within those experiences to facilitate change within the client.

a. Antecedents & Consequences

b. Non-music and music techniques

c. Function of music in therapy (REMS)

d. Elaborate on music based interventions

The Function of Music

Environment

How music will affect the surroundings or conditions in which a person experiences therapy.

Examples: music for relaxation, music used to set a positive tone, music used to match the mood of the client and then change later to a positive mood, music to calm or excite

Reinforcement

Environment

Mediator

Structure

Mediator

How music can be used to create a bridge between the client and themselves; with other clients; with therapist; with family.

Examples: original song recorded by hospice patient to be given to their family; lyric analysis to bring personal insight to client; song composition to shed light on the similarities between group members; playing preferred music to establish a relationship between therapist and client

Structure

How music can be used to structure an entire session, song, activity/experience or task & how the structure of the music (melody, harmony, rhythm, etc.) supports desired or mirrored responses.

Examples: fast music used in the beginning of a session with very energetic clients that progresses to slower, calmer songs towards the end; a musical phrase is sung in between each client’s solo; songs or lyrics that provide directions; an ascending melody line for eliciting or following an upward movement.

Elaborate on musical interventions

songwriting

instrument playing

lyric analysis

Part Four:

SHORT TERM OBJECTIVES:

music performance

movement

stimulate memory

instrument making

listening

vibro-tactile stimulation (somatron)

relaxation

singing

musical stories

Part Two:

Music Therapy Goals

chanting

a. The MT plan should include at least 2 or 3 short term objectives with 2-3 consecutive dates.

b. Measurement tool and type of data recording will be the same for each short-term objective and the terminal objective

c. This is where the hierarchy of objectives are listed.

Remember there may be a hierarchy of pre-requisite skills. Could be listed as tasks, developmental skills and/or prompts that are sequential and indicate a change in the positive direction.

Part Six: DESIGN

Clarify which type of design you are using to record baseline, implement therapy and determine progress.

a. Goal should be reflective of the needs presented in the formal MT assessment

b. Baseline measurements should indicate a need for this goal

c. Include target behavior definition in the goal

Example: To increase S.'s self-esteem, operationally defined as the number of verbal positive self-statements made in response to a prompt from the music therapist.

Part 7: Evaluation

Case study-

  • Single Baseline- AB- baseline (A) is given on one client and one goal and then treatment (B) is documented and evaluated
  • Pretest-posttest design: a pre-test is given before therapy begins and the same test is given again after therapy. Good design for short-term clients where you may only have one session with the client. It functions to record baseline and treatment progress each time it is used.

Single Subject Designs:

  • Reversal design- ABAB- meaning that baseline is recorded (A), treatment given (B), treatment taken away and baseline recorded (A) and then treatment given again (B). This helps to determine if it is truly the intervention that is effecting treatment.
  • Multiple Baseline design- more than one behavior is being measured (or more than one client, etc.)

  • Address how you will evaluate therapy and thereby determine level of progress.
  • Clarify what type of data recording is used: frequency, stimulus/response, interval time sampling, duration.
  • Include a copy of any recording forms or measurements tools (such as a pre-test/post-test).

Example:

Short-term objective 1:

Suzy will express 2 verbal positive self-statements made in response to 2 verbal prompts by the music therapist from a measurement of 1 by September 13, 2019.

Short-term objective 2:

Suzy will express 3 verbal positive self-statements made in response to 2 verbal prompts by the music therapist from a measurement of 2 by October 13, 2019.

Short-term objective 3:

Suzy express 4 verbal positive self-statements made in response to 2 verbal prompts by the music therapist from a measurement of 3 by November 13, 2019.

Short-term objective 4

Suzy express 4 verbal positive self-statements made in response to 1 verbal prompt by the music therapist from a measurement of 4 by December 13, 2019.

the level of prompts is different here

Or Objectives may change due to criteria rather than only frequency:

OR Objectives may change due to criteria rather than only frequency:

Short-term objective 1: Suzy will increase her verbal positive self-statements made in response to no more than 5 prompts from a music therapist from a measurement of 0 to 3 statements by August 13, 2014.

Short-term objective 2: Suzy will increase her verbal positive self-statements made in response to no more than 4 prompts a prompt from a music therapist from a measurement of 0 to 4 statements by September 13, 2014.

Short-term objective 3: Suzy will increase her verbal positive self-statements made in response to no more than 3 prompts from a music therapist from a measurement of 0 to 5 statements by October 13, 2014.

Short-term objective 4: Suzy will increase her verbal positive self-statements made in response to no more than 3 prompts from a music therapist from a measurement of 0 to 6 statements by November 13, 2014.

Short-term objective 5: Suzy will increase her verbal positive self-statements made in response to no more than 2 prompts from a music therapist from a measurement of 0 to 6 statements by December 13, 2014. (this measurement will be the same as the terminal objective).

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