What is music therapy? Published November 2016
You are walking down the hall of a school and you see a group of children, some able bodied and some with varying levels of disability, singing and playing instruments led by an adult playing guitar. In another room of the school, you might see a child playing different colored bells while the man with the child points to a chart of colors, indicating what the child should play. Or perhaps you are walking through a nursing home and see a group of older adults waving scarves as a woman singing and providing some instructions on how to play while music from the 1950’s plays in the background. You may think to yourself, “This looks like a lot of fun and everyone seems to be having a great time!” What you may not know, is that all of these people are involved in a Music Therapy session.
Music Therapy is defined by the American Music Therapy Association (AMTA) as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” The service can be used to work on a variety of goal areas, including but not limited to: pain management, social interaction, self-expression, emotional management skills, memory enhancement, and physical/motor skills.
Music Therapists work in a variety of settings, such as those aforementioned. They may also work in prisons, clinics, hospitals, in-patient and out-patient psychiatric settings, drug and alcohol rehabilitation centers, and even in peoples’ homes. Music Therapists have received at least a bachelor’s degree and have completed 1200 hours of clinical training. In order to practice as a Music Therapist, they also must pass their board certification exam giving them the title of Board Certified Music Therapist and the credentials MT-BC. Music Therapists are also required to complete continuing education, gaining 100 hours every 5 years, in order to maintain this certification. A Music Therapist assesses individuals and groups, plans activities to promote specific non-musical skills, sets goals, and tracks progress.
At Living Unlimited, there are many examples of growth and progress in the lives of the individuals with whom we work. When I ask the therapists, some found it difficult to come up with just one example. Here are a few examples from our therapists: In working with an adult individual who has Intellectual Disability, therapy goals were focused on communication skills and managing perseverations and echolalia. Upon first meeting this individual, she did not greet the therapist with a hello or any verbal communication. During the initial assessment the client spoke only one or two sentences. When a familiar song was presented by the therapist, the client sang every word. It was also noted that the client matched pitch and kept the rhythm while singing. During those first sessions, the client also had several outbursts, especially when frustrated, presenting with perseveration and echolalia, due to not being able to find items in her home that she was looking for. The music therapist provided a “hide and seek” song to increase her resilience in not knowing where an item is. This song was a motivating way to participate in an otherwise anxiety producing task. Along with supporting her through these tasks, the therapist introduced breathing to music to encourage relaxation. This breathing is structured around a rhythm that is compatible to an appropriate breathing rate for the client’s current arousal state. In 5 months, this individual has grown to request songs using full sentences as well as use yes and no responses to questions. She also has demonstrated minimal frustration and has overcome perseveration and echolalia on some occasions.
Another example is a young man diagnosed with Autism. He presented with a high level of anxiety, rigidity in daily life, behavioral outbursts as well as limited functional communication skills. The music therapists presents music making, often using his preferred music and sometimes exploring new music. This may include singing, playing instruments and practicing coping strategies with music. Through these activities, the music therapist uses music functionally to allow for self-expression in an appropriate manner, to accept changes, and to change problem behavior. Over two years, he has grown and made progress as he works together with the therapist within the music. At this time, he is preparing for discharge from music therapy services to gain more age-appropriate educational and vocational experiences.
Some growth takes time and progress may be slow. For one child diagnosed with autism, coping with several changes in his life and routine was presenting as difficulty with transitions. Behaviors that were being seen included yelling, singing loudly (while okay here may not be okay at school), laughing, as well as some physical aggression. This happened at the beginning of every session for several months. Slowly, the behaviors decreased and after approximately 5 months, minimal behaviors were presented. Using the song Down by the Bay with visuals, the therapist engaged him to sing and make a choice about the next animal to sing about. As the behaviors decreased, the child increased using sentences and eye contact to request. As he has aged, preferences changed. Currently, they use songs about super heroes. The activity has changed but the positive behavior has sustained, as he still is using full sentences and eye contact as he makes a choice.
This same child has the strength of relative pitch. The therapist and his family have recognized this strength and used it to expand his attention to task. They have utilized songs that he likes singing and playing on the piano to grow his focus and ability to follow directions. Initially when starting with him he needed constant prompting and direction to sit for five minutes. Now he has grown to attend to playing his songs for ten minutes with fewer than 5 prompts.
Another child has challenges related to a traumatic brain injury. Her challenges relate to motor planning and communication. Music activities such as children’s songs, fingerplays and movement to music are being used to encompass all the functional skills she is developing through her many therapies. She is attending visually to her mother and the therapist as they sing Itsy Bitsy Spider. Memory skills and motor planning are a focus during this activity as well. She practices cognitive skills such as making choices and matching with instrument play all while extending her attention and focus for learning. During a movement to music activity, she follows verbal directives to move her body in a variety of ways. This not only works on auditory processing of directives, it works on attention to task, motor planning and coordination, body awareness, and bonding with her family. She also seems to be having a good time as evidenced by her smile and laughter.
A little girl with autism has been coming here to us for several years and has been working on emotional identification and appropriate expression of emotions. Regularly, she would identify feeling happy or excited, and denied experiencing other emotions, even if she was visibly upset, mad or sad. This child gradually increased her understanding and ability to appropriately express her emotions through a variety of experiences, including singing songs about emotions and emotional triggers, instrumental improvisations where emotions were musically expressed, and writing songs about emotions. Over time, she began to identify emotional triggers for a wide variety of emotions, and is now able to identify when she feels upset, mad, or frustrated and is able to express why she feels that way. The pairing of emotions, which was a non-preferred topic, with music, which is she finds enjoyable and motivating, greatly helped her to increase her emotional understanding and appropriate expression of emotions.
We measure the success, growth and progress in many ways including direct observation, tracking, documenting after each session and parent report. When a child uses the strategies during their everyday activities or practices an appropriate social skill that has been a focus in our therapy services, we celebrate! When the parents and caregivers see the progress that we make in other environments, we share in that success.
In the community, there is music everywhere being used in many different ways. Some of it may be music therapy and some of it may not. If a college student is playing piano and singing at a nursing home for an audience of older adults or a nurse is playing music in the background for one of her patients, this may be a great benefit for those involved, but it is not music therapy. If a celebrity plays music for a local children’s hospital, it is a wonderful experience for everyone involved, but it is not music therapy. If a staff person at a nursing home puts music on an iPod, placing the headphones on an individual while making sure they are comfortable before walking away, they are giving the person a musical experience, but it is not music therapy. Walking by these experiences, it may be hard to tell the difference between an enjoyable music experience and a music therapy session. It may be hard to see the difference while music is being made and the experience is happening. The difference is in the preparation and planning, the individualized experiences, the knowledge and assessment of strengths and needs, the tracking of goals, the celebration of progress, the problem solving during challenges, the therapeutic relationship, and the specific use of our tool, music!
American Music Therapy Association, www.musictherapy.org
Research in music therapy supports its effectiveness in a wide variety of healthcare and educational settings. For further information, please explore the rest of this site including the Frequently Asked Questions (FAQ) page and the 2014 press release, "Setting the Record Straight: What Music Therapy Is... and Is Not."
Social Skills – Why We Need Them in the Workplace
Published July 2016
It is likely that anyone who has ever worked before can share a story about someone who they worked with who had poor social skills. It could be that the person never had eye contact when speaking, often staring off into space; stood too close causing you to continually back up; had a tendency to continually start talking even though you were in mid-sentence or shared stories that clearly were personal and made for an awkward encounter.
This person likely had little awareness that they had virtually no social skills and could not understand why co-workers avoided them at all costs. Demonstrating social skills at work is generally something that we do not think about – it just happens for many of us. Social skills are considered “skills that allow people to communicate, relate and socialize with others. They include both verbal and nonverbal forms of communication.” These skills are often “hidden” and really help mold others’ impression of us. For employment, the way we act or behave can help land jobs or promotions or just the opposite, resulting in no job offers or even termination.
Social or soft skills in the workplace can include communication abilities, ability to work with a team and problem solving abilities. For example, communication skills include being able to determine what is appropriate to say and when, as well as, demonstrating a clear voice that is appropriate in tone and volume when speaking while remaining on topic during conversations. It can also be eye contact, standing up straight, smiling appropriately, and demonstrating open postures. Communication is generally not positive when speaking to someone who is looking at everything but you while crossing their arms and turning away. This leads to short conversations and the tendency to avoid you.
Listening abilities fall within non-verbal social skills and can be demonstrated by the occasional nodding or shaking of the head, the occasional quick comment, and clearly taking in someone else’s communications is valuable. To ensure effective communication, each person should have equal parts in a conversation.
For those with a disability, demonstrating effective social and soft skills can be even more challenging. Particular disabilities that preclude effective communication such as Autism can lead to significant challenges for workplace integration for those diagnosed. The National Collaborative on Workforce and Disability (NCWD, 2011) identifies the following skills as necessary social skills for job success: communication skills, interpersonal skills, decision making skills, and lifelong learning skills. Within these areas are specific skills, which may be developed through individual or group skills training. These include active listening, cooperating with others, problem solving, planning, and using technology.
There is debate about whether good social skills are learned or innate. In working in vocational rehabilitation for many years, I have understood the need to help individuals who have challenges with social skills learn how to develop and demonstrate effective strategies to minimize those challenges. Living Unlimited has understood the impact behaviors have on employment potential and have provided interventions since our inception in 1986 to help individuals demonstrate behaviors that employer’s value. Current trends have finally understood that employment opportunities for those with disabilities goes beyond teaching how to master a task but how to best integrate into a work environment.
One of the biggest challenges someone with a disability may have when it comes to social skills is that the rules often change depending on the environment. When with friends or family, it is okay to be less formal – many people hug their friends or family when leaving an event but that is not something that we would do at work. Understanding why there is a difference is at the forefront when teaching social skills to people. Additionally certain topics such as religion, politics, and sex are generally not acceptable at any workplace. Personal topics and questions related to race, ethnicity, sexual orientation, disability or other personal characteristics/topics are also not acceptable. Nevertheless, to someone with a disability, these topics may occur nightly at the dinner table and it is important to help them understand workplace expectations.
Living Unlimited’s Vocational and Community Adjustment Program, established in 1986, was developed to undertake the task of social skills development for effective workplace integration. Through a comprehensive curriculum based service, individuals are taught skills related to team work, self-advocacy, problem solving, initiation, focusing and concentration, stress management and many others. Effective and functional workplace strategies are learned and practiced as individuals recognize, accept and adapt to challenges and achieve vocational goals related to social and soft skill development. Cooperative learning, role-playing, and participation in social adjustment groups during the VCAP day will foster the acquisition of soft skills.
Another effective manner for teaching workplace social skills is related to job coaching efforts where immediate feedback is given to the person. This feedback is intended to convey what is and is not acceptable and why. The development of natural supports on a job site is a job coach’s most important task and one that should begin on day one. In addition to teaching job tasks, the job coach is tasked with teaching the individual how to act for the specific environment as well as providing support to co-workers and supervisors who will continually assist the person as the job coach decreases time on the job.
Our community is now understanding the need for effective social skills in all facets of life. Programs to teach these skills to individuals with disabilities are “popping up” everywhere and while this can be beneficial, it is important to ensure that services are focused on what employers value to fully prepare individuals for a work life. Each workplace is different as is each person – we cannot lose sight of individuality and need to ensure that this is always at the forefront of any program. Preparing for employment can be daunting to anyone, let alone someone with a disability. Nevertheless, there are many resources and programs like Living Unlimited that are trained in making sure each person has the skills needed to succeed in transitioning into a work environment and learning job tasks.
THE IMPORTANCE OF TRANSITION
Simply put, “transition” is an opportunity to help students with disabilities and their families discuss life after high school. Throughout high school, transition meetings are held to help identify short and long term goals that the student wants to achieve by identifying resources, supports, and guidance needed to achieve each goal. Transition in the state of Pennsylvania starts an early at 14 years old and occasionally younger. The purpose for starting the process of transition at an early age is to start educating the student and their families of the resources available to them. An IEP (Individual Education Plan) is the guide that teachers use to help each student who needs specific support in and out of the classroom. Examples can include extra test time, a quite area to take a test, extra time with their homework, reading assistance. Supports can also include community options and one of the goals of the transition team is to assist in identifying resources in the student’s own community that are available. Resources can be available while the student remains in high school or can be available once they graduate. In all cases, the resources are beneficial in assisting the students with their identified goals based on their strengths, preferences, and interests. Transition can be thought of as a bridge between school programs and the opportunities of adult life, including employment, independent living, and community participation.
Living Unlimited is very active in transition meetings for all of their covered counties in the state of PA. Staff attend transition meetings to help “brainstorm” ideas for each student in attendance or presented at the transition clinic. The purpose of this is to “bridge” the gap from high school graduation to the “real world”. Often situations exist where students go from highly structured environments to little or no activity , often remaining at home with no movement toward work or independent living. Transition meetings are held to avoid this. Topics discussed are often centered on postsecondary education or vocational training, employment, independent living, and community participation. Students need to be fully incorporated into each transition meeting with providing information to questions related to future goal, including post-graduation work/school objectives, residential plans, community access, etc. This information guides discussion by the transition team to identify resources and options available to each student as they “bridge” the gap from high school to the adult world.
Transition is designed to help facilitate a student’s successful transition from high school into the adult world by illuminating the way for students and families. Community based service providers such as Living Unlimited are consulted with and connected with the student to prepare them for crossing the “bridge” into adult life. Living Unlimited is holistic and has a menu of services available to assist students with their transition goals. Please take some time to view our services, view our videos, and read about our talented staff. Living Unlimited Specialists are the front line staff who support students in reaching their goals. Below is a check list used in high schools across the state of PA to help teachers, students, families, support systems ensure that they are on the right path for success after high school. Success is on the horizon and we are just the program to help achieve your success.
The Client Centered Approach
Consider this: You are on an uphill climb and you want to get to the top of the mountain so badly. It is hard. You have so many emotions as you approach this challenge: excitement, anxiety, doubt, fear, but you have hope and a passion to get to the top. This climb seems impossible to do on your own, but you know what you want and you are going to try your best to get to the top! Now imagine you come upon a group of people who ask you what you are doing and you share your dream of climbing to the top of the mountain. These people get to talking and ask you how you are going to get there and listen to you in a supportive way. You learn a little bit about each of them and realize some have tools, some have food and water, some have a tent for rest, some have positive energy, and all of them cheer you on and say they will walk with you and make sure you get to the top. As you travel, you will have good days and bad. You will need flashlights to travel in the dark, ropes to get up the steep parts of the path, a tent to rest and regroup, and people to talk to and listen to what you have to say. The team works together and gets you to the top of the mountain as the sun rises and you have reached your goal.
In this scenario, the person with the goal is the center of the activity. This individual has chosen their own goal and is moving toward that goal with the assistance of others. They are in the center of the service, making decisions and acting as an integral part of the team. In treatment, the client is the center and the team surrounds that individual with support and assistance.
Client Centered Therapy, also called Person Centered Therapy, was introduced by Carl Rogers in the 1930’s. The British Association for Person Centered Therapy describes the approach in the following way, “this therapy moved away from the idea that the therapist was the expert and towards a theory that trusted the innate tendency (known as the actualizing tendency) of human beings to find fulfilment of their personal potentials. “ It was first used in psychotherapy but the theory has adapted itself for other settings such as classrooms, community habilitation, and skills training and with various individuals. The British Association for Person Centered Therapy states, “the approach does not use techniques but relies on the personal qualities of the therapist/person to build a non-judgemental and empathic relationship” which allows for the person and their therapist, or treatment team, to work toward the goal set by the individual in a safe and supportive structure.
In treatment, the therapist or team does not always focus on particular techniques but the therapeutic relationship built upon support, authenticity, empathy, and understanding in order for change to occur. The concept of Self-actualization is an important feature and is defined by Shamekia Thomas in the following way, “Self-actualization refers to the tendency of all human beings to move forward, grow, and reach their full potential.”
Why is it important to be client centered in therapy? In the field of human services, the individual participating in an intervention should be the main focus and should help lead the direction of therapy.
At Living Unlimited, our mission is to encourage individuals to gain the maximum level of independence across a variety of settings. This can be achieved by participating in the many services we offer which may include life skills training, prevocational activities, vocational support programming and music therapy. To maximize independence, a person must be invested in the process to make progress.
No matter what the service, Living Unlimited focuses on the person right from the beginning. At intake, it is important for the individual and their support system to participate fully by offering thought, ideas, and helping set goals for the future. Consider this: Do you want someone else to set goals for you? What if every decision about your life was made by someone else? How would that feel? Would you like someone else to tell you that you should be working at clothing store when you are passionate about food? Each person knows themselves the best which is why each person needs to be a part of their services right from the start!
Our next step at Living Unlimited is to consider each individual’s strengths and the areas that need to improve in order to plan for success. Each individual must share their passions and preferences in order to guide the process. The team will offer suggestions, however the individual has to be an active part of planning in order for the services to be successful.
Services at Living Unlimited will be based around each individual’s goals. If that is to work, we will support and challenge an individual to prepare them to be successful in the work of their choosing. If that is to better access their community and maximize independence, we will support an individual in their community, challenge them to extend their comfort zone, and support the individual to practice skills to be successful and fade support over time. If that is music therapy, the music and music activities that each individual prefers will be used to work toward goals of socialization, communication, emotional management, quality of life and beyond. We work together to determine a course of action and what services will best help challenge a person to get them to their goals. This means the individual must be an active part of the process with the team offering suggestions, ideas and assisting the individual as they walk the path toward their goals.
At Living Unlimited, we want you to gain success no matter what that means to you. We want to be your team that offers you the tools, the rest, the listening ear, and the positive support . Ultimately, you need to lead the way and have the drive to meet your goals. You are the center of the service and success is on the horizon.
Work Based Learning and What it Means to You
published January 2017
Hi, my name is Tiffany and I want to get a job…
This is something we hear a lot at Living Unlimited. Since we are a job coaching agency and provide interventions to many individuals regardless of disability type, area and funder, we are able to provide assistance in most cases. As regulations change and more services become available to school aged individuals, we are contacted more often by students asking the same question and expressing interest in employment.. We can start programming by asking a few simple questions including …
Do you have an IEP or a 504 plan?
Do you have updated psychological testing?
Do you have a diagnosed disability?
Do you have a case open with MH/ID?
Do you have a case open with OVR?
Are you eligible for the autism wavier?
Do you get SSI or SSDI?
Do you have your driver’s license?
Do you have a PA photo ID?
Are you over the age of 18?
Do any of these questions sound familiar? Do any of the acronyms sound familiar? What is OVR, what is MH/ID, what is a disability, what is psychological testing? The questions go on and on.
If you are a high school student with a disability or a parent of a high school student with a disability who is between the ages of 14-22, the chances of being asked the questions above are very likely and probably very confusing. High school is a time when students who are between the ages of 14-22 are preparing for life after graduation. Disability or not, high school ends at some point and we want our students to be prepared for the “real world.” High school transition teachers in the state of PA start to schedule appointments called clinics or transition meetings with their students to prepare them for “adult life”. The questions above are typical questions asked during any transition meeting and the answers guide the path each student is presented. The transition meeting involves community providers who present different services to prepare each student for life after high school.
One type of service that is discussed and offered for students who are eligible for the Office of Vocational Rehabilitation (OVR) is the Work Based Learning Experience (WBLE). Here are a few fun facts about WBLE’s completed by Living Unlimited and how each student can benefit from this service:
If these services sound like something you are interested in learning more about, please contact us and we will be happy to provide you with additional information. Living Unlimited is experienced vocational provider and will assist you and your family manage the very confusing transition process from high school to the “real world.”
TRAUMA INFORMED CARE - POSTED FEBRUARY 2015
Traumatic Brain Injury and Trauma Informed Care
Anyone who has experienced a brain injury (TBI), or is the family member of someone with a TBI can share how traumatic that is for them. In an instant, one’s world can be changed in a devastating way. Trauma informed care is an integral part of the therapeutic process for this reason. Trauma informed care can teach skills such as breathing techniques or how an individual’s body reacts to anxiety as well as discussing related feelings. Individuals can then process the memories from the traumatic events with less anxiety. Each person can process the event at their own pace and explore how the trauma has affected their life and work on reducing anxiety.
When anyone experiences a trauma of any kind the brain is literally re-wired. Chemicals are released which are meant to protect the person in the event but can have long lasting effects. Coupled with a TBI, this process has even more significant of an impact on the ability to process what has happened. It is common for anyone who has experienced a trauma to have challenges with remembering the event or it may feel like fractured pieces in the memory. If there is a TBI short term memory deficits can make this even more difficult to process.
There are some important Trauma Informed Care therapies that have been researched and shown to have significant impacts on improving the outcomes for those individuals struggling with trauma and TBI. Prolonged Exposure is an important component of this process. If there is a place or environmental factors that cause extreme anxiety after a trauma; it can be helpful, in a safe environment and in increments, to actually experience that trigger over and over until the feelings of anxiety diminish. If someone is nervous about being in an automobile after an accident, simply sitting in a car that is turned off may be the first step to Prolonged Exposure Therapy. Another step may include not moving the car but turning on the engine with the emergency brake firmly in place. The more the individual is exposed to the trigger the less power it has in their life.
Anxiety can make our lives much smaller. The more we allow the anxiety to make our decisions for us, the less control we have over our lives. By using Trauma Informed Care through Living Unlimited, Inc, individuals can take control of their own destinies. They can make the decisions about what kind of life they would like to make. Their horizons can be unlimited!