Between rights and realities – music as a structuring resource in child welfare everyday life: a qualitative study

Allied health professional support for children and young adults living in and leaving care: A systematic scoping review

BACKGROUND

Children and young people living in and leaving care are known to have experienced significant childhood adversity and trauma resulting in potentially deleterious impact on their health and well-being across the life course. Studies point to the complex needs of this population who may benefit from allied health professional (AHP)-related support with limited studies located. This review sought to address this gap by systematically scoping empirical literature focused on the provision of AHP support to this cohort of children and young adults to assist an understanding of the service needs for this vulnerable population.

METHODS

This scoping review followed Arskey and O'Malley's five steps framework (2005) to identify and review relevant literature. A focus on identifying the evidence, challenges and gaps in research relating to AHP support for children and young people living in and leaving care was initially agreed, followed by a systematic search using a combination of three key concepts to identify relevant studies in five AHP disciplinary areas to identify best evidence in the past decade (2011-2021). Study inclusion criteria were based on empirical studies of children and young people living in care (0-17 years) and leaving care (18-25 years). A data extraction table was formulated as a means of charting the data, aligned with the scope and objectives of this review. Finally, data were subsequently collated, synthesised and reported based on key thematic areas emerging from included studies regarding AHP support to children and young people living in and leaving care.

RESULTS

A total of 13 studies met the review inclusion criteria. Included studies reported specifically on speech and language therapist (SLT; n = 5), occupational therapist (OT; n = 3) and arts-based therapies (n = 5). No studies were identified with regard to the use of physiotherapy and dietetics with this population. Results indicated that children and young people living in and leaving care have high rates of speech, language, communication and sensory needs. More rigorous screening, assessment and early intervention were identified as essential for this vulnerable group. Increased multidisciplinary collaboration and OT support for young adults in preparation for transition to independent living was identified as an urgent requirement. Included studies indicate promising results in relation to access to arts-based therapies with particular reference to identity formation for children and young people living in and leaving care.

CONCLUSIONS

Although evidence of effectiveness remains limited, AHP service provision (specifically speech and language therapy, occupational therapy and arts-based therapies) has the potential to contribute positively to addressing the complex and interacting needs of this vulnerable population. As a result, it is recommended that AHP service provision is integrated into the collaborative, multidisciplinary care available to children living in and leaving care. More extensive, higher quality research related to the benefits of AHP provision for this population of children and young people is essential to provide a more robust evidence base across the various professional disciplines that constitute allied health provision.

Music therapy for adolescents in a child welfare setting: A qualitative interview study

In this article, we explore challenges and possibilities as expressed by adolescents who participated in music therapy in an out-of-home setting. Music activities they reported participating in include listening to music, songwriting, playing in a band, and performing. The study is based on qualitative research methodology where we ask the following research question: What do adolescents in a child welfare setting consider as challenges and possibilities when reflecting on their participation in music therapy activities? To answer this question, we interviewed 11 adolescents between the ages of 16 and 23 years. The themes in the empirical sections emerged during the process of analyzing data. We propose 3 themes, each with 3 subthemes. Empirical findings are discussed in relation to relevant theories in child welfare, music therapy, and psychology, and more specifically, trauma-informed care. Practical and scientific implications are highlighted.

Music, adversity and flourishing: Exploring experiences of a community music therapy group for Australian youth

Community music therapy is a widely accepted approach that has its origins in the British community music scene and was carefully developed with respect to participatory values dominant in Norwegian practice. This article describes the way an Australian community music therapy programme for youth has been experienced by a group of diverse young people participating in a programme that is for youth who share an enthusiasm and a passion for music and often bring formidable talent to the group. They are also young people who are experiencing adversity due to chronic illness, mental ill-health, unstable homes lives or acute personal crisis or challenge. Qualitative analysis of interviews identified a number of themes including It is like a family; We understand one another’s life experiences and It is good for me, and also identified that diverse group members responded first to the emphasis on the value of music-based experiences, but strongly benefitted from the understanding afforded of the challenges they faced as a result of adverse life experiences. Possible distinctions between traditional group music therapy with adolescents and community music therapy are considered, with implications for programme descriptions and the level of focus on music and support adopted by facilitators.

The Limits of Resilience and the Need for Resistance: Articulating the Role of Music Therapy With Young People Within a Shifting Trauma Paradigm

A broad sociocultural perspective defines trauma as the result of an event, a series of events, or a set of circumstances that is experienced as physically or emotionally harmful or life threatening, with lasting impacts on an individual’s physical, social, emotional, or spiritual wellbeing. Contexts and practices that aim to be “trauma-informed” strive to attend to the complex impacts of trauma, integrating knowledge into policies and practices, and providing a sanctuary from harm. However, there is a body of critical and decolonial scholarship that challenges the ways in which “trauma-informed” practice prioritizes individualized interventions, reinscribes colonial power relations through its conceptualizations of safety, and obscures the role of systemic injustices. Within music therapy trauma scholarship, research has thus far pointed to the affordances of music in ameliorating symptoms of trauma, bypassing unavailable cognitive processes, and working from a strengths-based orientation. In critiquing the tendency of the dominant trauma paradigm to assign vulnerability and reinforce the individual’s responsibility to develop resilience through adversity, this conceptual analysis outlines potential alternatives within music therapy. Drawing on a case example from a research project with young people in school, I elucidate the ways in which music therapy can respond to power relations as they occur within and beyond “trauma-informed” spaces. I highlight two overarching potentials for music therapy within a shifting trauma paradigm: (1) as a site in which to reframe perceived risk by fostering young people’s resistance and building their political agency and (2) in challenging the assumption of “safe spaces” and instead moving toward practices of “structuring safety.”

Music Therapy for Delinquency Involved Juveniles Through Tripartite Collaboration: A Mixed Method Study

This study introduces a music therapy project for young offenders through community collaboration and its efficacy through a mixed method. The project called Young & Great Music is carried out via collaboration among three parties, which are the educational institution, the district prosecutor's office, and corporate sponsor, forming a tripartite networking system. In this paper, we present an efficacy evaluation of the project's implementation with 178 adolescents involved with the juvenile justice system: 115 youth was on suspension of indictment and 63 youth was under supervised probation. Quantitative and qualitative measures were collected and analyzed to examine the efficacy of the project. The music therapy program was developed for 15 sessions based on the use of music to prompt positive resources through music making and song writing. The efficacy was examined using three scales; self-concept, resilience, and stress coping skills. The paired t-test showed that there were significant improvement in all three scales respectively (p < 0.000). In order to examine the group difference between suspended indictment and supervised probation groups, Welch-Aspin t-test was conducted due to unequal variance of the group. Results showed there was a significant group difference in self-concept (p = 0.006) and resilience (p = 0.022). The study further examined participant's experience of music and perceived benefits. Twenty participants had in-depth interviews about their music therapy experience which were recorded, transcribed and analyzed. Of the 109 statements derived from a qualitative content analysis of the interview transcripts, music making and song writing was repeatedly reported as helpful in gaining "new perspectives," "courage to challenge and pursuit," "perseverance," and "self-acknowledgment." The positive result of the study showed that the collaborative networking of regional and social resource to support for adolescents at-risk was successful. The results of this project are promising and suggest that other arts-based rehabilitation services and programs should be developed and implemented in juvenile justice system. For this, strategies for program sustainability for long-term facilitation are needed.

Group Music Therapy as a Preventive Intervention for Young People at Risk: Cluster-Randomized Trial

Background

Music forms an important part of the lives and identities of adolescents and may have positive or negative mental health implications. Music therapy can be effective for mental disorders such as depression, but its preventive potential is unknown.

Objective

The aim of this study was to examine whether group music therapy (GMT) is an effective intervention for young people who may be at risk of developing mental health problems, as indicated via unhealthy music use. The main question was whether GMT can reduce unhealthy uses of music and increase potentials for healthy uses of music, compared to self-directed music listening (SDML). We were also interested in effects of GMT on depressive symptoms, psychosocial well-being, rumination, and reflection.

Methods

In an exploratory cluster-randomized trial in Australian schools, 100 students with self-reported unhealthy music use were invited to GMT (weekly sessions over 8 weeks) or SDML. Changes in the Healthy-Unhealthy Music Scale (HUMS) and mental health outcomes were measured over 3 months.

Results

Both interventions were well accepted. No effects were found between GMT and SDML (all p > 0.05); both groups tended to show small improvements over time. Younger participants benefited more from GMT, and older ones more from SDML (p = 0.018).

Conclusions

GMT was associated with similar changes as SDML. Further research is needed to improve the processes of selecting participants for targeted interventions; to determine optimal dosage; and to provide more reliable evidence of effects of music-based interventions for adolescents.