Implementing music therapy through telehealth: considerations for military populations

Figures & data

Figure 1. Telehealth evolution of connectivity.

Figure 2. Facilitation of rhythmic call-and-response group percussion and dance via telehealth.

Table 1. Percent decrease in pre- and post-session self-reported measures of pain, anxiety and depression during 2016 for a veteran receiving telehealth music therapy.

MONTH	Pain	Anxiety	e-ssion	MONTH	Pain	Anxiety	Depre-ssion	MONTH	Pain	Anxiety	Depre-ssion
JAN	25%	25%	65%	MAY	75%	0%	25%	SEPT	10%	12.5%	37.5%
FEB	50%	0%	0%	JUN	25%	10%	30%	OCT	0%	0%	50%
MAR	10%	10%	30%	JUL	50%	0%	37.5%	NOV	10%	10%	40%
APR	25%	12.5%	50%	AUG	12.5%	10%	75%	DEC	50%	25%	0%

Figure 3. Music therapist facilitating active music making for relaxation with guitar (MT-BC) and table drum (participants) during a music therapy telehealth group session.

Figure 4. Individual music therapy telehealth session illustrating active music making on guitar.

Table 2. Factors for Implementing Creative Arts Therapies Telehealth.

Telehealth categories	Considerations for creative arts tele-therapists	Exclusion criteria for creative arts tele-participants
Referral criteria and informed consent	After receiving a referral, the initial session can be used to introduce clinical expectations and review telehealth competencies. Technological troubleshooting can occur during this session to identify and potential technical issues. Securing informed consent from patients at the outset of treatment is obligatory. This includes emergency contact information (family, medical) and awareness of emergency response time.	Severe/acute mental health states may preclude participation in telehealth sessions. Patients with acute psychosis are not appropriate for referral to telehealth creative arts therapies. The initial session can be used as assessment to identify any potential barriers to creative arts therapies telehealth treatment. This can be informed by medical chart review prior to session and clinical observations during the initial session.
Privacy considerations	When selecting clinical settings to conduct telehealth sessions, avoid public spaces and areas in which others may hear session content to preserve confidentiality. Remind patients that it is their responsibility for maintaining privacy on their end of the telehealth creative arts therapy session.	Inability to identify a secure and private location for participation (i.e., participant lives in a residential group home without available space) may be exclusion criteria for participation in telehealth creative arts therapies. An alternative option is to create ‘code words’ that alert if session privacy has been compromised.
Operational considerations	Connecting to telehealth portals requires certain steps and use of specific hardware and software. To ensure proper initiation of telehealth sessions, technological competencies are reviewed with patients prior to starting treatment. Consider making an instructional resource with visual cues.	Cognitive limitations (i.e., memory/recall, cognitive processing), inability to remember the necessary steps to connect to telehealth sessions, and difficulty with sustained concentration and focus may be exclusion criteria for telehealth creative arts therapies participation.
Audio considerations	Using a high-quality external or internal microphone, headphones or dual microphone headset may improve audio fidelity on both sides. If a headset is not accessible, consider using headphones for privacy purposes.	Sensory sensitivities and limitations (i.e., hearing loss, auditory aversions, claustrophobia, etc.), and communication deficits may hinder patient participation in telehealth creative arts therapies.
Video considerations	The positioning of the camera should maximise the ability of the creative arts tele-therapist to clearly model the interventions to the patient within the given frame.	The need for physical assistance in order to participate in creative arts interventions may be exclusion criteria for telehealth creative arts therapies.
Lighting considerations	Natural light is recommended. If using artificial lighting (e.g., lamps), place light sources outside of the given video frame. If using ceiling lights, position the camera between yourself and the light source. Backlighting should be avoided to prevent silhouetting.	High-level sensory sensitivity to light or other visual limitations that may cause severe ocular strain, pain, or anxiety could be exclusion criteria for participation in telehealth creative arts therapies.