2020 has been a pivotal year for everyone. The Covid-19 pandemic has forever changed our lives. It has changed the way we work, the way we play and the way we live our lives.

Whilst the acute threat of Covid-19 will eventually pass, it is highly unlikely that things will return to the way they used to be. Most industries have adapted to this “new normal”, transitioning towards a more virtual medium than before. Meetings are now conducted virtually, consumers are choosing online shopping more, and telemedicine is being embraced like never before.

Covid-19 has caused a massive acceleration in the adoption of telehealth. With barriers from the demand and supplier side breaking down, consumer adoption of telehealth has increased 400% in the US compared to 2019. This shift towards a more digital world has brought about its own unique challenges for healthcare providers. How do you continue delivering services while ensuring the same quality and safety?

Virtual music therapy in this time of need

Music therapy has a wide range of clinical uses ranging from children to elderly with mental health needs, neurodevelopmental disorders, substance misuse and even acute or chronic pain. Covid-19 restrictions have driven stress, anxiety, depression, and substance misuse rates, and the general population could well benefit from music therapy.

Multiple studies support the use of music as a therapeutic means to deal with the stressors attributed to the pandemic. Achieving the inner calmness, activation of autotherapeutic potential, and psychosomatic rebalancing are the main goals during music therapy. The human brain has shown to translate a structured sequence of sounds, such as music, into a pleasant and rewarding experience by activating the dopaminergic pathways. Through this increased dopamine production, music therapy can induce relaxation, pleasure, reduce cortisol levels that ultimately decrease the stress levels. Systematic reviews also demonstrate the reduction of pain and anxiety, improved sleep quality, and induction of relaxation with music therapy.

With the implementation of lockdown measures due to Covid-19, healthcare services have been reduced to essential care only. Music therapists have been struggling to deliver their traditional face to face service, with reports that many music therapists are not being allowed to deliver therapy as they are not classed as key workers.

However, now more than ever, we need to increase the accessibility and availability of therapies such as music therapy. Telehealth is one solution to these current service delivery challenges.

Virtual music therapy: developing new approaches to service delivery

In a recent article, David Knott from the Seattle Children’s Hospital and his colleagues identified these issues and proposed the following three-tiered scaffold model to enhance how music therapy is delivered virtually.

Tier 1: Curate Online Resources

As a first step, therapists should identify pre-existing content (audio, video, etc) that can be readily employed that reinforces therapeutic concepts (such as social and emotional learning). Resources must be easily accessible, appropriate, and effective in addressing client goals. The therapist should also be responsible for understanding the capability of a client to access these online resources and can further facilitate the client by creating hyperlinked PDF or word documents.

The potential barriers for this approach can be the prior inexperience with digital content among the client and the caregiver. Secondly, some digital content may present copyright issues for its distribution and use, and will require permission or licensing by the content source owner.

Tier 2: Create Original Content

Tier 2 promotes the creation of original content to complement tier 1. This involves developing custom content for their clients to meet therapeutic objectives. Knott proposed a few examples of how original content could be implemented as part of a treatment plan:

● Fingers play songs to reinforce language and motor development in infants and toddlers

● Preschool music to teach pre-academic and academic concepts

● Relaxation-oriented audio and video recordings may help teens and adults in developing new coping skills

● Instructional content (written, audio and video) to reinforce therapeutic benefits outside of therapy for clients and their caregivers

● Songs used in therapy sessions could be recorded and used with other clients

While creating the content, therapists must also consider how their content is delivered to clients. Options include emailing digital files to clients or through cloud-based delivery or hosting websites such as YouTube or Vimeo. Where possible, therapists working in organisations should actively work together with colleagues with marketing, social media and digital health expertise, to ensure the content fits guidelines and organisational objectives. Collaborative work also mean therapists can exploit their organization’s pre-existing social media platforms to distribute their content for clients.

An important consideration in creating original content is copyright protection, which applies to livestreams and digital conferencing platforms. All music sources and publishers must be referenced and recognised. A conservative approach is recommended when using public online platforms. Licensing and permissions should be obtained before their distribution when content is outside of the public domain.

Tier 3: Implement Telehealth

This tier focuses on the effective delivery of virtual music therapy through telehealth. Therapists must conduct an assessment to best match the technical and physical capabilities of their clients, with the telehealth platform to be used. Platforms include Zoom, Google Meet, Facetime, Skype to name a few.

There are several considerations when implementing a virtual music therapy session:

· Safety and security — Utilise private and password protected platforms

· Client’s ability and access — Is a caregiver or family member able to assist in setting up for therapy? (Preparing smartphone or other devices to access the session)

· Therapist’s equipment — An external HD1080P webcam that can be moved freely for alternative placement during sessions. A USB-powered condenser microphone to adequately capture sound, voice and music. An audio interface which allows processing of different audio signals. Software such as Garageband (Mac) or Cubase (PC) for recording content.

· Home office logistics — Consider a space that has adequate lighting with few visual distractions (clutter, laundry, personal effects) and preferably in a space where there is little noise pollution

· Referral and follow-up procedure — Therapists should develop a system for scheduling referrals and communicating with their clients in between sessions.

MindHug and Virtual Music Therapy

Here at MindHug, we believe that this model of virtual music therapy will enhance the therapeutic experience for clients. We still do not know how long this worldwide crisis will last, and therapists must innovate by shifting their delivery models in the face of this uncertain future. Even when the dust settles, telehealth is not going away.

We are currently working hard to develop a digital platform for music therapists and their clients, which employs the three-tiered scaffold model all in one place. Sign up for our newsletter to be notified when we launch!

Resources for therapists

American Music Therapy Association Covid-19 Resources

British Association for Music Therapy Online Therapy resources

Soundscaping Source Coronavirus Coping Kit for Music Therapy Business Owners (Free!)