Music therapy assessments

In this first issue of 2022, we have several articles focused on music therapy assessment tools. This is quite remarkable since, historically, music therapists have predominantly relied on assessment tools developed in other fields. While those play an important role in music therapy research and clinical practice in terms of measuring non-music outcomes (e.g. functional or psychological outcomes), it is important that music therapists develop assessment tools to assess music and music therapy-specific outcomes. Most music therapy assessment scales developed to date focus on non-music health domains such as cognition, communication, and motor skills. However, we have a growing number of music therapy assessments in which music is its “own domain of health” (Carpente & Aigen, 2015, p. 250). In these assessment scales, aspects of a client’s “musical functioning are understood broadly as reflections of one’s overall cognitive and affective relationship to the world and oneself” (Carpente & Aigen, 2015, p. 250).

In 2015, the International Music Therapy Assessment Consortium (IMTAC) was founded (https://www.musictherapy.aau.dk/imtac/) to facilitate and support the development and standardization of robust and research-based music therapy assessment tools, increase awareness of assessment within and around of the field of music therapy, and promote the implementation of music therapy assessment in clinical practice. The IMTAC is a valuable music therapy assessment resource and I encourage you to help build their catalogue of music therapy assessment tools by submitting music therapy assessment tools for inclusion in this online catalogue. Collaborative efforts like this are important to advancing assessment development and implementation in our field. Another great resource for music therapy clinicians and scholars is the book on music therapy assessment by Jacobsen et al. (2018) (book review available here).

The development of a standardized assessment tool is a complex process. Some of the essential steps involved include identification of the domains of the scale, item generation, ascertaining content validity, extraction of latent factors, item reduction, psychometric testing, and development of a manual that details scale administration instructions as well as scoring guidelines, just to name a few. As I assembled articles for this issue, I noticed that three of the authors included in this issue focused or are currently focusing their PhD research on the development of a music therapy assessment scale (Carpente, 2014; McDermott et al., 2015; Salokivi et al., this issue). For many years, PhD students have indeed made major contributions to the development of music therapy assessments. I decided to check in with them about their experience of undertaking such challenging research for their dissertation. In a brief e-mail exchange, Maija Salokivi, John Carpente, and Orii McDermott shared their experiences and offered some advice for future scholars undertaking this type of work. I also reached out to Wendy Magee, guest co-editor of our upcoming special issue on online delivery of music therapy, as her scholarly work has been focused on the development and implementation of a music therapy assessment (Magee, 2007). I asked them to share about their experience of developing an assessment scale (e.g. What was most challenging? What was most rewarding? What nuggets of advice might they have for others?). For all, the decision to pursue the development of an assessment tool stemmed from their clinical work, often out of frustration that no meaningful or suitable scale was available. Wendy pointed out that this can be a strength, but cautioned that this can possibly result in the development of a tool that is not theoretically driven. She recommended that “colleagues pay good attention to the theoretical constructs that are important with a particular client/patient group, and develop measures where music is the medium by which that construct is being measured. This can fit both music-centered and behavioural approaches to practice well.” This is exactly what Maija Salokivi, Sanna Salanterä & Esa Ala-Ruona set out to do in their scoping review reported in this issue (p. 63), namely to identify theoretical frameworks for developing a music therapy assessment tool for early adolescents’ emotional skills. Orii pointed out that music therapists are well positioned and skilled in observing and assessing clients’ strengths and thus rather than exclusively focusing on deficits and pathology when determining concepts for a scale, she recommended that scholars consider developing scales that focus on assessing strengths that may present themselves in the client’s engagement with music.

Another consideration that was emphasized in the e-mail exchange was the need for music therapy assessments to be relevant to the clients and the therapists. Therefore, an important step in the assessment development process is to involve stakeholders and service users, where possible, to gain their perspective on the usability, acceptability and preferred format of the scale. In their study, Kate Aitchison & Katrina McFerran explored, through focus groups, young people’s perceptions of assessment in Child and Youth Mental Health Services in Australia as well as two music therapy assessment scales (p. 25). The young people in their study perceived the use of quantitative assessments as being “principally for the benefit of the service” and they would prefer the use of “individualised, conversational approaches to assessment that can validate the personhood of the consumer.” The study participants also suggested that a thorough explanation about music therapy and details about the music therapy assessment should be provided prior to assessment so that young people can make an informed decision about whether or not they would like to engage in music therapy assessment. This is certainly important advice for music therapy clinicians and assessment developers to consider.

When asked about some of the major challenges they experienced, psychometric testing was mentioned by all as essential but challenging. Music therapy assessment tools need to be standardized through a series of psychometric testing (e.g. Carpente & Gattino, 2018; Magee et al., 2014). Maija mentioned that coursework in psychometrics is needed and Orii recommended involving a statistician to assist with the psychometric testing. John shared an interesting dilemma he experienced related to the need for standardization of assessment scales versus the epistemological foundation of his assessment tool: “In essence, an assessment tool is used to help the therapist create meaning of music events occurring between client and therapist. My struggle, unbeknownst to me at the time, dealt with experiencing the client through a subjective lens (providing music experiences in a reflexive and relational manner), but then attempting to construe meaning through an objective lens. Interestingly, I only became aware of this struggle when I began testing IMCAP-ND for interrater reliability. This process helped me to organize and compartmentalize the role and difference between assessment and treatment.”

Once an instrument has been developed and psychometric properties have been established, instruments should be translated into different languages. The translation of music therapy assessment scales is an evolved process in and of itself as outlined by Ridder et al. (2014). Lídia Sousa, Bárbara Moura, Orii McDermott & Lia Fernandes put the guidelines by Ridder et al. into practice when translating and culturally adapting the Music in Dementia Assessment Scales (MiDAS) into European Portuguese (p. 89). Once an assessment tool is translated into a different language, psychometric testing of the translated assessment tool is an essential next step as noted by Sousa and colleagues.

As for advice for future PhD students opting to develop an assessment tool for their dissertation research, Maija shared: “For future assessment developers, be patient and take your time. If you want your assessment scale to be strong and well validated, you must follow certain protocols on how to develop an assessment scale. You can’t jump over some phases, as it will cause problems later on when you want to continue with validation.” I hope that many more scholars and PhD students will get involved in enhancing music therapy assessment practices by developing tools that are relevant to our clinical practice, informative to the wider interdisciplinary community, and meaningful to service users.

Besides articles focused on music therapy assessment, this issue includes two articles focused on music therapy with children. John Carpente is the lead author of a study that investigated the impact of imitation on engagement in minimally verbal autistic children during improvisational music therapy (IMT) (p. 44). The research team wanted to dismantle the most effective ingredients of IMT and therefore developed a study aimed at examining the impact of specific IMT techniques in children’s engagement in music therapy sessions. They explored the effectiveness of three IMT techniques namely exact imitation, imitation with elaboration, and contingent response. Their findings suggest that exact imitation and imitation with elaboration may result in better overall engagement than contingent response. They concluded that “since engagement is often a clinical goal, and is important in the process of social learning, music therapists are encouraged to consider employing imitation techniques during IMT sessions with children on the autism spectrum.” Finally, the article by Kaja Elise Aaslid Enge, and Brynjulf Stige (p. 7) describes a single site, collective case study of four refugee children’s use of music therapy. The findings suggest that readiness to collaborate with peers is related to both emotional and social processes in music therapy, specifically processes of regulating emotions, negotiating interpersonal relationships, and building a sharable repertoire.

I hope that you will enjoy reading these fascinating and intriguing articles!