Raukatauri Music Therapy Trust (RMTT) offers the only music therapy centres in New Zealand, coordinated through its central Auckland operations. RMTT works across Auckland through five satellite services and two regional centres in Hawkes Bay and Northland. RMTT also delivers outreach programmes in partnership with over 20 schools and organisations.
This report presents findings from a comprehensive evaluation of services offered by RMTT throughout its Auckland, regional and outreach activities. The evaluation explores the following:
• The RMTT model of service delivery
• The literature on music therapy practice and outcomes
• The value that RMTT services offer to its clients and families
• The impact that RMTT services are seen to have on its clients
• The factors that support and challenge participation in RMTT services
• Learning for RMTT activity and the music therapy profession.
This report provides a synthesis of quantitative and qualitative data from five sources: a detailed literature review of current thinking in music therapy practice; qualitative interviews with families/client of RMTT in Northland, Auckland and Hawkes Bay; qualitative interviews with outreach partners in Northland, Auckland and Hawkes Bay; a survey of families of RMTT clients from across all sites; and discussion groups with RMTT staff to explore current practice, and learning from the challenges of COVID-19.
Perceived value of working with RMTT
RMTT’s services were widely valued. Over 90% of parents/caregivers participating in the survey rated their experience of RMTT as excellent (64%) or very good (28%). Family members reported their loved ones, and families themselves, highly value working with RMTT for a range of reasons, particularly musical participation, relationships with the therapist, enjoyment of the sessions, building relationships with others, and the tailored approach that RMTT therapists provide.
Outreach partners highly valued their relationships with RMTT, citing their easy fit with services, and the added value of music therapy to their own offerings.
Impacts of RMTT services
Participating in RMTT was strongly seen as having beneficial impacts. Some 78% of survey participants rated RMTT as contributing to loved ones’ ideas and goals as “a great deal” (47%) or “a reasonable amount” (31%). Over 80% reported RMTT participation as either “very beneficial” to their family (46%) or “reasonably beneficial”(38%).
Family members reported key benefits for their loved ones in relation to improved social functioning (such as attention and empathy, and turn-taking); self-expression for both verbal and non-verbal loved ones; cognitive functioning (such as comprehension, focus and engagement); social connections and relationships; communication skills and speech and language improvement; physical coordination and movement; and overall mental health and wellbeing.
Family members reported key benefits for themselves, including being personally therapeutic; supporting improved family relationships; finding support from other parents; applying techniques learned at RMTT; providing respite; and enjoyment of seeing the happiness of their loved one.
Outreach partners noted benefits for their clients from RMTT participation, including experiencing success; strengthening social functioning; improving emotional regulation; building capacity for choice and control; developing motor skills; and providing a release from difficult circumstances.
Factors that sustain participation
Major factors identified from survey responses that support participation are primarily enjoyment of the sessions (95%) and relationships with staff (80%). Interviews revealed that a strong client/therapist relationship was a key influence on the range of benefits and outcomes experienced by their loved one, and supported their ongoing enjoyment of their sessions. Financial assistance was critical for many families’ participation. The flexibility of the service and supportive logistics were also raised. Parents and caregivers were highly likely to recommend RMTT to others, and an exceptionally high Net Promoter Score of 78 was received.
Outreach partners valued the clear and documented processes of RMTT staff; their adaptability to the constraints or requirements of outreach settings; support from RMTT leadership on sourcing funding; and reflected on the genuine warmth and appreciation they feel towards RMTT staff.
COVID-19 lockdown responses
RMTT staff rapidly adapted to the COVID-19 lockdown and introduced a range of new service offerings, including video-based therapy sessions, a “quarantunes” video and resource series on a private Facebook group, and check-ins with clients and families via zoom. These innovations were able to provide some continuity of delivery to clients and families during lockdown.
However, the adaptation to COVID-19 also brought with it an inevitable loss of some service delivery options and an overall reduction in service and revenue. Similarly, outreach settings could no longer be accessed. There was however a shared commitment to making the best of the COVID environment and creating new solutions that would work for as many clients and their families as possible. Bonds between staff members were thought to have strengthened over this time, and online staff meetings gave an opportunity for all members of the team to connect to a greater degree than had been previously possible.
Factors that challenge participation
When asked about common barriers to access, cost was the most significant barrier (41%), with distance from home the next most commonly cited for families (26%). Among respondents, there was also a group that did not experience barriers to access and engagement (30%).
Some interviewees noted that the cost of RMTT services was particularly difficult when their personal circumstances changed (e.g. one parent stopped working), and others expressed frustration in securing financial assistance from external sources, where the value of music therapy was not recognised or seen to be outside of the remit of funding criteria. A small number of survey participants and interviewees raised challenges with client-therapist relationships.
For those who did leave the service, the reasons closely mirror the barriers to access and include cost, location, experience or interactions with a therapist, leaving New Zealand and other settings/services preferred.
Cost was a common barrier raised by outreach partners, despite the efforts by RMTT to support with funding channels.
Enabling Good Lives
Enabling Good Lives (EGL) is a disability movement focused on the transformation of the disability support system. Grounded by eight principles, the evaluation drew on these to understand the extent to which clients’ and families’ experiences reflected and demonstrated the EGL Principles. Reflecting on the data gathered throughout the evaluation, engagement and participation in music therapy with RMTT clients and families is person-centred, mana-enhancing and enables them to practice self-determination and other ordinary life outcomes.
The evaluation also sought to understand the extent to which RMTT was practising and giving effect to the EGL principles. From the perspectives of families and RMTT practitioners, the links and resulting impacts were clearly demonstrated through the values that underpin RMTT and therapeutic practices aligning with the EGL principles, particularly person-centred, relationship building, and self-determination.
Over time, RMTT may look to integrate the EGL principles more explicitly to frame how they share and report on client and organisational progress.
Considerations for RMTT activity and the music therapy profession
Areas of improvement or change were substantially about refining and continuously improving, rather than a need for fundamental reassessment. Potential directions for RMTT from this evaluation include the following:
• Exploring options for systematised and more structured feedback to parents/caregivers, and alongside this, informal or scaled-down feedback processes that do not substitute therapy sessions
• Activities that can involve siblings or other family members
• Opportunities for parents to connect in events or via a RMTT network
• Utilising the network and its own resources to promote and improve access to music therapy
• Exploring the extent to which RMTT, or its supporters, can take on an advocacy role to advance music and other creative therapies.
We note that people often come to music therapy with very limited knowledge of music therapy and that this knowledge advances considerably through exposure and participation. Although the enjoyment of music is a sufficient motivator for many to access music therapy, a lack of knowledge may be a barrier to accessing music therapy when musical expression is an insufficient attractor. This is also compounded when there is a limited understanding of music therapy within the other external agencies that fund support services for clients. Communicating the value and workings of music therapy is, therefore, an ongoing need for the profession.
From a professional perspective, the enjoyment of the sessions and the relationship with the therapist provide important foundations for reaching developmental goals. The evidence from this evaluation also suggests that a more purposeful connection of families accessing music therapy may help build a valuable community of support – for each other and for music therapy. This evaluation has also noted the early stages of cooperation between music therapy and other creative therapies, which may be a fruitful area of development in the future.
This evaluation provides evidence of a music therapy offering that is highly valued throughout its network of participating clients, families and outreach partners. Intrinsic to the value seen in RMTT are the relationships between therapists and their clients and resulting mana-enhancing, person-centred delivery. The avenue of musical expression leads to a wide range of positive impacts, in social functioning, self-expression, cognitive functioning, social connections and relationships, communication skills, and physical coordination and movement.