Music Therapy Practice With High-Risk Youth: A Clinician

Survey

Pratique de la musicothérapie avec les jeunes à risque : un

sondage clinique

Beth A. Clark, MM, MT-BC, MTA

Private Practice, Vancouver, British Columbia, CANADA

Edward A. Roth, MM, MT-BC

Western Michigan University, Kalamazoo, Michigan, USA

Brian L. Wilson, MM, MT-BC

Western Michigan University, Kalamazoo, Michigan, USA

Carolyn Koebel, MM, MT-BC

Western Michigan University, Kalamazoo, Michigan, USA

Abstract
This study explores the practices of Canadian and American music therapists
who work with high-risk youth, providing a preliminary picture of music
therapy services for this population. High-risk youth are defined in this study
as those likely to experience a decline in their global level of functioning due
to one or more issues related to social, economic, or cultural disadvantages
that include mental health issues, substance misuse, correctional system
involvement, street involvement, or unstable home environments. Using
an online survey, the authors explored the demographics, clinical practices,
education, and information-seeking behaviour of 60 credentialed music
therapists. Demographic data indicated that music therapists working with
high-risk youth are typically younger than the average music therapist and
that their work with this population is a small part of their overall practice.
Mental health was most frequently identified as a primary area of need, and
typical treatment goals focused on self-expression, self-esteem, coping skills,
and identity. Frequently used interventions were songwriting, drumming,
lyric analysis, and improvisation. Several new areas of music therapy
practice were identified, including using music therapy to address needs
related to sexual health, sexual orientation, and gender identity. The authors
recommend further investigation into these topics as well as the assessment
methods, education, and information-seeking behaviour of music therapists.

Keywords: youth, adolescent, at-risk, high-risk, music therapy, mental

health, substance misuse, corrections

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 66

Résumé
Cette étude explore les pratiques de musicothérapeutes œuvrant avec les
jeunes à risque, au Canada et aux États-Unis; elle vise à offrir un portrait plus
complet des services de musicothérapie pour cette clientèle. Les jeunes à
risque sont définis comme des jeunes qui, pour la plupart, vivent avec une
diminution de leur niveau global de fonctionnement à cause d’un ou de
plusieurs problèmes reliés à la santé mentale, à la consommation de drogues
à mauvais escient, à des désavantages sociaux, économiques ou culturels y
compris l’expérience du milieu carcéral, l’expérience de rue ou l’expérience
d’un environnement familial instable. Un sondage en ligne, effectué auprès
de musicothérapeutes possédant des titres de compétence, a exploré les
données démographiques, l’exercice clinique privé ainsi que le comportement
en recherche d’informations. Les données démographiques indiquent que
les musicothérapeutes qui travaillent avec des jeunes à risque élevé sont
généralement plus jeunes que le musicothérapeute moyen et que leur travail
avec cette clientèle ne représente qu’une partie de leur travail clinique entier.
Les participants ont le plus fréquemment reconnu la santé mentale comme le
domaine ayant le plus de besoins et l’expression personnelle, l’estime de soi,
l’identité et les habiletés d’adaptation constituent les objectifs de traitement.
Les interventions les plus utilisées sont l’écriture de chansons, le jeu sur
les instruments, l’analyse de paroles de chansons ainsi que l’improvisation.
Plusieurs nouveaux domaines de la pratique de la musicothérapie ont été
reconnus dont l’utilisation de la musique pour l’exploration de la santé
sexuelle, de l’orientation sexuelle ainsi que de l’identité sexuelle. Une recherche
plus élaborée sur ces questions, tout comme des méthodes d’évaluation ainsi
qu’une attitude ouverte à l’éducation et au comportement en recherche
d’informations de la part des musicothérapeutes sont recommandées.

Mots clés : musicothérapie, jeune, adolescent, à risque, risque élevé,

santé mentale.

Studies in music therapy and allied professions indicate that music-

based interventions by music therapists, social workers, and other health
professionals are effectively assisting youth with a diversity of needs
(Baker & Jones, 2005; Currie, 2004; Dalton & Krout, 2005; Frank, 2005;
Keen, 2004; Tervo, 2001). Music therapy is used in mental health, oncology,
substance misuse, and bereavement programs for adolescents (Albornoz,
2011; Faulkner, 2011; McFerran, 2010; McFerran, Roberts, & O’Grady,
2010; McFerran-Skewes, 2004; Roth & Kees, 2007). Research published in
Canada and the United States document that at-risk or aggressive youth and
youth offenders are also benefiting from music therapy programs (Barrett
& Baker, 2012; Buchanan, 2000; Camilleri, 2007; Evans, 2010; Gladfelter,

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 67

1992; Rickson & Watkins, 2003; Rio & Tenney, 2002; Snow & D’Amico, 2010;
Wyatt, 2002). Programs designed to meet the needs of youth refugees and
youth involved in gangs, as well as those experiencing schizophrenia, trauma,
and body image issues, are discussed in the music therapy literature as well
(Baker & Jones, 2005; Fouche & Torrence, 2005; Frank, 2005; Ruutel, 2004,
Smith, 2012).

Authors of several of these studies used the terms at risk or high risk
to describe their clientele (Buchanan, 2000; Camilleri, 2007; Nelson, 1997;
Smith, 2012; Snow & D’Amico, 2010). While these terms were used without
a standard definition, they generally referred to youth who were served
by programs dealing with mental health issues, substance use, and street
involvement as well as youth who were in correctional programs (Keating,
Tomishina, Foster, & Alessandri, 2002; Springer, Sale, Herman, Soledad,
Kasim, & Nistler, 2004; Ungar & Teram, 2000). These issues often overlap,
making it difficult and impractical to separate them.

Therefore, the term high-risk youth may be used as a general term to

describe a cohort of youth that is distinct from the general population and
can be differentiated from those whose primary needs are developmental,
educational, physical, or medical in nature. In this study high-risk youth were
defined as those likely to experience a decline in their global functioning due
to one or more issues related to mental health, substance use, or other social,
economic, or cultural disadvantages. These included correctional system
involvement, street involvement, or an unstable home environment.

Music Therapy and High-Risk Youth

An informal review conducted by the authors in 2007 of the music therapy
and allied health research literature revealed 37 studies reporting the use of
music with youth who met this study’s definition of high risk. These studies
varied in their settings, subpopulations, assessment methods, and therapeutic
interventions. The earliest study found was published in 1969, and a cluster of
15 articles and one dissertation were published between 2000 and 2007. The
databases searched included RILM Abstracts of Music Literature, PsycINFO,
PsycARTICLES, ProQuest Dissertations & Theses, ProQuest Research Library,
Wilson Select Plus, CINAHL, Social Sciences Abstracts, and MEDLINE. These
sources provided a foundation for understanding the specific populations
with which clinicians were working as well as the clinical needs, assessment
methods, treatment goals, and interventions they were using.

The settings for these studies were primarily hospitals and residential
treatment programs, but since 2000 there has been a decrease in studies done
in hospitals and an increase in other settings, namely schools (Currie, 2004,

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 68

Dalton & Krout, 2005; Jones, Baker, & Day, 2004), private practice (Hendricks
& Bradley, 2005; Keen, 2004), and community-based programs (Buchanan,
2000; McFerran-Skewes, 2004; Fouche & Torrence, 2005).

The specific subpopulations identified in these publications as meeting

the criteria for high-risk youth included at-risk youth (Buchanan, 2000;
Fouche & Torrence, 2005), offenders (Gardstrom, 1987; Gladfelter, 1992;
Nelson, 1997; Rio & Tenney, 2002; Wyatt, 2002), refugees (Baker & Jones,
2005; Jones, Baker, & Day, 2004), youth with poor body image (Ruutel,
2004), youth experiencing bereavement (Dalton & Krout, 2005), youth
who had experienced abuse or trauma (Clendenon-Wallen, 1991; Keen,
2004; Slotoroff, 1994), and youth with mental health issues (Frank, 2005;
Frisch, 1990; Gardstrom, 2003; Haines, 1989; Hendricks & Bradley, 2005;
Tervo, 2001; Zonneveldt, 1969). The most frequently identified population
over time has been youth with mental health issues. Since 2000, refugees
and youth experiencing bereavement have appeared as specifically
identified populations, and the term at-risk youth has appeared with greater
frequency.

Cassity and Cassity (1994) surveyed clinical training directors at major

psychiatric hospitals to determine the assessment and treatment practices
in adult, adolescent, and child psychiatric music therapy. They found that
music listening, instrumental playing and improvisation, singing, games, and
movement were used in the assessment of adolescent clients. Standardized
assessments were not being used. In the literature review conducted for this
study, 22 of the 36 studies identified the types of music therapy assessments
being used. These included music-based assessment, standardized non-music
assessment, review of records, information provided by the treatment team
and professional referrals, client interview and self-assessment, and mixed
methods. Music-based assessment methods included standardized tools
such as Bruscia’s Improvisation Assessment Profiles (Gardstrom, 2003) and
a songwriting adaptation of the Beck Hopelessness Scale (Goldstein, 1990)
as well as non-standardized techniques including song choice, improvisation,
instrument playing, lyric analysis, songwriting, and singing (Burkhardt-
Mramor, 1996; Frank, 2005; Wells, 1988). Non-musical assessments were
used in 13 studies and included the Coopersmith Self-Esteem Inventory
(Haines, 1989), Beck Depression Inventory (Hendricks & Bradley, 2005),
State-Trait Anxiety Inventory (Gladfelter, 1992), and Shere and Maddux’s
Self-Efficacy Scale (Nelson, 1997). In addition, Dalton and Krout (2005)
developed the Grief Process Scale for use in their work with bereaved youth.

No studies were found in the extant literature that explored the state of
current practices of music therapists with high-risk youth. Although studies

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 69

related to this clinical population in the music therapy literature provide
strong support for the application of music therapy with high-risk youth
around the globe (Baker & Jones, 2005; Buchanan, 2000; Camilleri, 2007;
Frank, 2005; Gardstrom, 2003; McFerran, 2010; Rio & Tenney, 2002; Wyatt,
2002), the limited number and the scope of these studies did not reveal a
comprehensive picture of the music therapy services available to high-risk
youth, the clinicians engaged in this area of practice, or the adequacy of
clinician education.

The Present Study

The primary goal of this study was to identify the current practices of
music therapists working with high-risk youth in Canada and the United
States. More specifically, this study sought to determine the following:

• What are the ages, gender, countries of practice, education, and

theoretical orientations of clinicians practising with high-risk
youth?
• What is the length of time these clinicians have practised music
therapy, and how long have they have worked with high-risk
youth?
• What treatment settings, presenting issues, assessment methods,
goals, and interventions are most commonly identified by music
therapists practising with high-risk youth?
• Which assessment methods are identified as most effective?
• Do the types of presenting issues, assessment methods, goals, and
interventions identified by practising music therapists differ from
those identified in the literature?
• How do clinicians rate the adequacy of their undergraduate
training experience?
• Where do clinicians seek information related to their work with
high-risk youth?

Method
Participants
The 60 participants who completed the survey were credentialed
music therapists practising in Canada or the United States at the time of
the study. Recruitment criteria included having worked part-time or full-
time with high-risk youth within the previous 10 years and having one of
the following music therapy credentials: Music Therapist Accredited (MTA),

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 70

Music Therapist–Board Certified (MT–BC), Certified Music Therapist (CMT),
and Registered Music Therapist (RMT).

In light of the fact that neither the Canadian Association for Music
Therapy (CAMT) nor the American Music Therapy Association (AMTA) listed
which music therapists were working with high-risk youth in their respective
membership directories (Member Sourcebook, 2006; Membership Directory,
2006), it was not possible to determine the actual population size or to
form a representative sample. AMTA members listed in the sourcebook as
working in the following areas were contacted as they were considered most
likely to work with high-risk youth: abuse/sexual abuse, AIDS, behaviour
disorders, dual diagnosis, eating disorders, emotional disturbances, forensic,
non-disabled, other, PTSD, school age, and substance abuse. All members of
CAMT were contacted because the membership directory does not indicate
populations served by individual music therapists. Those without email
addresses listed in either the AMTA or CAMT directories were not included
in the study as the survey format was online. A total of 1,151 credentialed
music therapists were identified as potential participants and received an
email inviting their participation.

Survey Tool
As part of a larger thesis study (Clark, 2007), a questionnaire was
designed as a survey tool to collect demographic data as well as information
about clinical practices. The questions related to demographics were
created to align with demographic data published in the AMTA sourcebook.
No previous surveys on practice with high-risk youth were identified,
necessitating the creation of a new survey tool. Questions about clinical
practice were derived from the review of literature. Assessment methods,
presenting issues, treatment goals, and interventions found most frequently
in the literature were used to develop questions with multiple-choice options.
Space was included for free responses so that participants were not limited
by the multiple-choice options. It was hoped that response rates would be
enhanced by creating a tool that was easy and efficient to complete.

The process of generating the multiple-choice options involved recording

and categorizing all assessment methods, treatment goals, and interventions
found in the review of literature. For example, more than one hundred goals
were identified in the literature. Once similar terms were combined and
goals found in only one study were eliminated, ten goals were identified for
use in the survey tool: self-expression, self-esteem/identity, self-awareness,
coping skills, decision-making skills, behaviour management skills, social
interaction skills, communication, interpersonal relationships, and cultural
awareness.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 71

 The survey tool was piloted with four music therapists experienced
in practising with high-risk youth and in conducting research, evidenced
by successful completion of one or more thesis-based graduate degrees.
The questionnaire was judged to be thorough, clear, and concise by the
participants in the pilot phase, and therefore no changes were made as a
result of the pilot study. Approval was obtained through the research ethics
board of Western Michigan University.

Procedure
The free online survey software Survey Monkey was selected for this
study. The questionnaire was posted online for two weeks. An email requesting
participation in the survey was sent out to 1,151 potential participants with
a link to the online survey. The request included a statement informing
participants that choosing to complete the survey served as giving consent.
An email reminder was sent one week after the initial email. The anonymity
of the participants was preserved as the responses were not linked to any
identifying information.

Analysis
Descriptive statistics were collected for age, gender, ethnicity, years in
practice, degrees held, advanced training completed, country of practice,
primary clinical theoretical orientation, hours practising music therapy,
hours practising with high-risk youth, funding sources, treatment settings,
subpopulations, presenting issues, assessment methods, treatment
interventions, practicum experience, internship experience, training program
adequacy, and information-seeking behaviour. Mean, median, mode, and
variability were calculated as appropriate.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 72

 Results
Sixty credentialed music therapists responded to the survey. One
participant completed only demographic data and one did not provide her
age. Available data from these two participants were included. The number
of responses was acceptable for the purposes of gaining insight about an
emerging new area of specialization in music therapy practice.

Research Question 1
What are the ages, gender, countries of practice, education, and theoretical
orientations of clinicians practising with high-risk youth?

The mean age of the participants was 37.2 years (Mdn 34, mode 27, range
24 to 59 years, SD 10). Forty-two participants (70%) in the current study
were under the age of 40. There were 54 females (90%) and 6 males (10%).
Fifty-three (88%) participants were practising in the United States and 7
(12%) in Canada. As their highest degree earned, 32 participants (53%) had
a bachelor’s degree, equivalency degree, or diploma; 25 had master’s degrees
(42%); and three had doctorates (5%). Participants were asked to indicate
one primary clinical theoretical orientation. The most common orientation
reported was eclectic/integrated (n = 19, 32%) followed by cognitive-
behavioral (n = 16, 26%), and client-centered/family-centered (n = 8, 13%).

Research Question 2
What is the length of time these clinicians have practised music therapy,
and how long have they worked with high-risk youth?

The mean length of time the participants had practised music therapy
was 11.1 years (Mdn 9 years, mode 4 years, range 1 to 32 years, SD 8). The
mean length of time participants had practised with high-risk youth was 6.7
years (Mdn 4.5 years, mode 1 year, range 1 to 32 years, SD 6.6). The majority
of music therapists surveyed (n = 38, 63%) were practising with high-risk
youth at the time of the survey. Figure 1 depicts this data grouped into 5-year
segments.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 73

 Number of music therapists (N = 60) 40
35
30
25
18 19
20
15
10
10
5
5 3 3 2
0
1 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31+
Years in practice

40 39
Number of music therapists (N = 60)

35
30
25
20
15 12
10
5 3 2 2 1 1
0
1 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31+
Years in practice with high-risk youth

Figure 1: A comparison of total years in practice with number of years working with high risk
youth

Information was also collected from the music therapists on weekly

hours of practice at the time of the study: how many hours per week they
were practising music therapy and how many of those hours were spent
with high-risk youth. The mode for hours per week worked in music therapy
practice was 36 to 40 hours per week (n = 19, 32%). In contrast, 1 to 5 hours
per week was the mode for work with high-risk youth (n = 29, 48%). These
data are shown in 5-hour segments in Figure 2.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 74

 Number of music therapists (N = 60) 35

30 29

25

20

15
10 9
10
5 4
5 2
0 0 1
0
1 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31 to 35 36 to 40 41+

Hours of practice per week with high-risk youth

20 19
Number of music therapists (N = 60)

18
16
14
12
10 9
8 7
6
6 5 5 5
4 3
2 1
0
1 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 31 to 35 36 to 40 41+

Hours of practice per week in music therapy

Figure 2: A comparison of total hours of practice per week with total hours working with high-risk
youth

Research Question 3
What are the treatment settings, presenting issues, goals, assessment
methods, and interventions most commonly identified by music therapists
practising with high-risk youth?

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 75

 As seen in Table 1, participants indicated that they worked in a variety
of settings, with 19 (32%) working in multiple settings with high-risk youth
and 41 (68%) doing this work in a single setting. Schools were the most
common setting (n = 24, 40%) and corrections/forensic settings the least
common (n = 3, 5%).

�������

���������� �������
�����������������������������������������������������������������������
������� �� ������������
�������������������
�����������������������������������������������������������������������
������ ��
�������� !
"���#������������ ��� $
%� ����&'����# $
(��)������������ �
%����������*+������� ��,

������
The types of presenting issues selected by participants included all of
the��������������������������������������
subpopulations identified in the survey (see Figure 3).
�����������������������������������������������������������������������
-����)������ �� ������������� �� �����������������������
Mental health�����������.���� �/�#����������0��������� 52
��1��.��#
Trauma/Abuse 43
����������������������������������������������������
Substance use
����������������������������������������������������������������������� 37
����*2&����1������ $�� 3�
Street-involved 33
4�� ��� $�� 5�
- ���)������� Bereavement �!� 25 �
2&��������&��� �$� ��
Corrections 25
2�������� ��� ����
�������*"������Sexual Offending �,� 17 ��$�
����������� � � ��$�
Refugee
-����� ���������&��� ,$�4 ��3�
���������� �� 0 ,�� 10 20 ��3�30 40 50 60
"���6�����*- ����& ,�� ��3�
Number of music therapists (N = 60)
-��������#�������)������ ,�� ��3�
"�������&��� �� ����
Figure 3: Presenting issues identified
+������������7�"����#��� �� � by participants ��
+������������7�0���� ��� ���

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 76

 Each of the 10 goal areas listed in the questionnaire was selected by
multiple participants as a goal addressed in their work (see Figure 4). Ten
participants shared additional goals, including self-regulation, forgiveness,
use of imagination and creativity, leisure skills, respect for authority, respect
for self, plan of action, relapse prevention, teamwork, leadership, anger
management, music education, and music technology proficiency.

Self-expression 57
Self-esteem 56
Coping skills 53
Social skills 51
Behaviour management skills 50
Interpersonal relationships 50
Communication skills 48
Self-awareness 47
Decision-making 45
Cultural awareness 19
0 10 20 30 40 50 60
Number of music therapists (N = 60)

Figure 4: Treatment goals identified by participants

All of the assessment methods included in the questionnaire were

identified as methods used in the participants’ practices. The methods
identified the most were observation in the music therapy setting (n = 46,
78%), information provided by the treatment team or professional referral
(n = 46, 78%), review of records (n = 41, 69%), interview/self-assessment
(n = 34, 58%), observation in non–music therapy setting (n = 20, 34%), and
formal music therapy assessment (n = 15, 25%). Seven of the participants (12%)
indicated they used assessments other than those provided in the questionnaire,
and two (3%) reported conducting no formal assessment.

Each participant was asked to identify the two goals most frequently
addressed in their work. The two goals mentioned most frequently were
self-expression (n = 23, 39%) and coping skills (n = 22, 38%). Other goals
identified by 10 or more participants were self-esteem (n = 16, 28%), social
skills (n = 16, 28%), decision-making skills (n = 14, 24%), and behaviour
management skills (n = 12, 21%).

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 77

 �������

���������� �������
�����������������������������������������������������������������������
������� �� ������������
�������������������
�����������������������������������������������������������������������
The list of interventions generated from the review of literature was
������ ��
presented
�������� in the survey along with an opportunity
! to supply additional
responses. The participants were asked to indicate
"���#������������ ��� $ all of the interventions
used in their practice with high-risk youth as$ well as the two interventions
%� ����&'����#
(��)������������ �
that they used most frequently. The four interventions selected by the most
%����������*+������� ��,
participants for use in practice—song/lyric writing, drumming, improvisation,
and lyric analysis—were also the four interventions identified as most
frequently used although, as seen in Table 2, the ordering was different.

������

��������������������������������������
�����������������������������������������������������������������������
-����)������ �� ������������� �� �����������������������
�����������.���� �/�#����������0���������
��1��.��#
����������������������������������������������������
�����������������������������������������������������������������������
����*2&����1������ $�� 3�
4�� ��� $�� 5�
- ���)������� �!� �
2&��������&��� �$� ��
2�������� ��� ����
�������*"������ �,� ��$�
����������� � � ��$�
-����� ���������&��� ,$� ��3�
���������� �� ,�� ��3�
"���6�����*- ����& ,�� ��3�
-��������#�������)������ ,�� ��3�
"�������&��� �� ����
+������������7�"����#��� �� � ��
+������������7�0���� ��� ���

Research Question 4
Which assessment methods are identified as most effective?

In order of endorsement, the most effective assessment methods cited

by the 58 participants who used assessment methods were observation, client
interview, treatment team consultation, and record review. Observation was
endorsed as the most effective method of assessment by 17 participants.

Research Question 5
Do the types of presenting issues, assessment methods, goals, and
interventions identified by music therapists differ from those identified in the
literature?

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 78

 All areas of need drawn from the literature were endorsed by four or
more of the participants in the survey with mental health needs identified
by the largest number (n = 31, 53%). Open-ended responses about youth’s
areas of need yielded additional areas including palliative care, social skills
in school settings, educational needs, sexual health, sexual orientation, and
gender identity.

Fifteen or more participants identified each of the assessment methods

found in the literature as methods used in their practice with high-risk youth,
and seven indicated using methods other than those found in the literature.
Two stated that they did not conduct formal assessments.

The goals addressed by the participants were similar to those cited

most frequently in the literature. They included self-expression, self-esteem,
and coping skills.

The interventions reported in the literature were also consistent with the
responses given in the present survey. More than 10 authors in the literature
review and more than 30 participants in this study reported using each of
the following interventions: song/lyric writing, improvisation, song choice,
drumming, listening, lyric analysis, instrumental instruction, and relaxation/
imagery. Participants also generated free responses for interventions used
in practice, which included recording (audio and video), exploring family
systems with instruments, and using songs with books and other visual
aids.

Research Question 6
How do clinicians rate the adequacy of their undergraduate training
experience?

When asked if practicum or internship experiences with high-risk youth

were part of their undergraduate training in music therapy, 40 participants
(69%) reported completing one or more practicum or internship experiences
with high-risk youth. Of these, 20 participants (35%) had both practicum
placements and internships, 7 participants (12%) had practicum placements
but not internships, and 13 (22%) had internships but not practicum
placements. When asked to rate the adequacy of the undergraduate training
experience in preparing them to work with high-risk youth, 14 (24%) selected
inadequate, 32 (56%) adequate, and 12 (20%) superior.

The relationship between positive ratings of training program adequacy

and completion of undergraduate practicum experiences with high-risk
youth was explored. Sample sizes did not permit chi-square tests; however,

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 79

we did note the relatively high numbers both in the inadequate category by
participants without practicum experience and in the superior category by
participants with practicum experiences.

Research Question 7
Where do clinicians seek information related to their work with high-risk youth?

Clinicians identified sources of information that guide their practice

with high-risk youth. A majority of the participants reported consulting with
non–music therapy professionals (85%), reading music therapy journals
(72%), attending music therapy conferences (70%), and consulting with
other music therapists (65%) (see Figure 5). Participants reported three
other resources in the free response section of the survey: textbooks, youth
interviews, and youth literature.

Non-music therapist consult. 51

Music therapy journal 43
Music therapy conference 42
Music therapist consultation 39
Counselling journal 24
Arts journal 20
Internet search 18
Non-music therapy conf. 17
Music therapy website 14
Free medical website 11
Subscription databases 8
Dissertations/Theses 2
0 10 20 30 40 50 60
Number of music therapists (N = 60)

Figure 5: Resources used by music therapists working with high-risk youth.

Discussion
The intent of this study was to provide a clearer picture of the current
practices of Canadian and American music therapists working with high-risk
youth. The responses to the survey helped form a preliminary profile of the
typical music therapist practising with this population as well as to identify
educational needs and areas for future research.

Clinician Profile
Based on the information collected, a typical music therapist practising
with high-risk youth is 37 years old, female, and has completed undergraduate
level training in music therapy including either a practicum or internship

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 80

experience with high-risk youth. She rates her training as adequate in
preparing her to work with this population and has been in practice for 11
years including 7 years with high-risk youth. This therapist works in music
therapy 35 to 40 hours per week and spends 1 to 5 of these hours practising
with high-risk youth. Her approach to treatment is eclectic or integrated,
and she works in more than one treatment setting. Client assessments
are frequently completed through observation, and she uses drumming,
improvisation, songwriting, and lyric analysis most often in her practice.

Educational Needs
Therapist ratings of the adequacy of undergraduate experiences in
preparing them for work with high-risk youth suggest that training could
be more effective. As this study suggests that practicum experiences may
be a predictor of the perceived adequacy of undergraduate training, more
practicum opportunities at the undergraduate level would be one way to
increase the effectiveness of undergraduate training programs.

The information-seeking behaviour of music therapists is a new area

of inquiry, one that may best be addressed by examining the information
needs of music therapists working across all areas of clinical practice and
all treatment settings. Determining what online tools and resources music
therapists engage with both inside and outside of work might help in
developing resources that will reach music therapists through platforms
with which they are already familiar.

Assisting music therapy clinicians and students in finding relevant

resources to inform their practice could be another avenue for improving
training. Music therapists reported seeking information from colleagues who
were not music therapists, music therapy conferences, and music therapy
journals. In the past few years the dissemination of information regarding
the therapeutic use of music with high-risk youth has expanded from North
American music therapy journals to literature published worldwide and in
some cases distributed online and in open access formats. Given that the
majority of participants were working just a few of their professional hours
with high-risk youth, music therapy resources specifically developed for
these clinicians need to be easily accessible to assist them in their clinical
work.

Networking is an issue that emerged from clinician responses related

to information-seeking behavior. Only 65% of clinicians indicated consulting
with other music therapists when looking for information about practising
with high-risk youth. The possibility that this suggests isolation of some music
therapists leads to the question of how to provide networking opportunities

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 81

for music therapists who serve high-risk youth. An online forum could provide
a virtual resource through which questions and opportunities for jobs,
funding, and research could be shared. Another arena for sharing ideas and
resources could be roundtable discussions at music therapy conferences.

Limitations of Study
The low number of returned surveys limits generalization of findings to
the larger population of music therapists practising with high-risk youth in
Canada and the United States. Similarly, due to the small sample of participants
responding from Canada, there was insufficient statistical power to compare
music therapy practices in Canada and the United States. The anonymity of
the survey method is both a strength, as it may reduce social desirability
bias, and a limitation, because there was no way to verify the identity or
responses of the participants. Last, self-selection bias and the online survey
format disseminated via published email addresses made it impossible to
determine whether or not the participants formed a representative sample
of the population of interest.

Future Research
Much of the data collected in this investigation can be related to trends
found in the review of literature. The findings both reflect and add to the
literature published to date. Furthermore, many opportunities for future
research have emerged.

While many clinicians in this study worked with youth experiencing

bereavement (42%) and youth identified as sexual offenders (17%), these
types of presenting issues have received relatively little attention in the
extant literature. Likewise, there were issues raised in the survey responses
and in the non–music therapy research literature on high-risk youth that
have not appeared in the music therapy literature to date, including sexual
health, sexual orientation, and gender identity. All of this indicates potential
for further inquiry.

A recent publication by McFerran (2010) included a comprehensive

literature review of music therapy studies with all adolescent populations.
There are similarities between McFerran’s review of the literature and
findings of the present study such as the large number of youth served in
hospital and educational settings as well as goals relating to sense of self,
identity formation, and social skills. A contrast was noted in the theoretical
orientations. McFerran found that most of the studies used a psychodynamic
or humanistic approach in music therapy practice, though a trend toward a
blended/eclectic approach was noted. Participants in the present survey most

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 82

frequently identified their theoretical orientations as eclectic/integrated,
followed closely by cognitive-behavioural, and then client-centered. Whether
this contrast is related to the specific clinical population or the influence of
North American training programs on the participant pool, the impact of
these variations in theoretical orientation on the therapeutic process has yet
to be addressed.

Conclusion
This study reveals that music therapists in Canada and the United States
are using a broad range of therapeutic approaches in their work with high-
risk youth. Whether through drum circles or songwriting, music therapists
are encouraging high-risk youth to use their strengths and talents to share
their stories and achieve their goals. The growing body of music therapy
literature pertaining to youth provides evidence of the efficacy of this modality.
Continued research efforts, greater accessibility to relevant resources, and
increased educational opportunities for students and practising music
therapists are important to the further development of music therapy with
high-risk youth.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 83

References
Albornoz, Y. (2011). The effects of group improvisational music therapy
on depression in adolescents and adults with substance abuse: A
randomized controlled trial. Nordic Journal of Music Therapy, 20(3),
208-224. doi:10.1080/08098131.2010.522717
Baker, F. A. & Jones, C. (2005). Holding a steady beat: The effects of a music
therapy program on stabilising behaviours of newly arrived refugee
students. British Journal of Music Therapy, 19(2), 57-74.
Barrett, M. S. & Baker, J. S. (2012). Developing learning identities in and
through music: A case study of the outcomes of a music programme
in an Australian juvenile detention centre. International Journal of
Music Education, 30(3), 244-259. doi:10.1177/1255761411422721
Buchanan, J. (2000). The effects of music therapy interventions in short-term
therapy with teens at risk: An opportunity for self-expression in a
group setting. Canadian Journal of Music Therapy, 7(1), 39-50.
Burkhardt-Mramor, K. M. (1996). Music therapy and attachment disorder: A
case study. Music Therapy Perspectives, 14(2), 77-82.
Camilleri, V. A. (2007). Healing the inner city child: Creative arts therapist with
at-risk youth. London: Kingsley.
Cassity, M. D. & Cassity, J. E. (1994). Psychiatric music therapy assessment
and treatment in clinical training facilities with adults, adolescents,
and children. Journal of Music Therapy, 31(1), 2-30.
Clark, B.A. (2007). Music therapy with high-risk youth: An exploration of
current practice. (Master’s thesis). Western Michigan University.
Clendenon-Wallen, J. (1991). The use of music therapy to influence the self-
confidence and self-esteem of adolescent who are sexually abused.
Music Therapy Perspectives, 9, 73-80.
Currie, M. (2004). Doing anger differently: A group percussion therapy for
angry adolescent boys. International Journal of Group Psychotherapy,
54(3), 275-294. doi:10.1521/ijgp.54.3.275.40335
Dalton. T. A.& Krout, R. E. (2005). Development of the grief process scale
through music therapy songwriting with bereaved adolescents.
The Arts in Psychotherapy, 32(2), 131-143. doi:10.1016/j.
aip.2005.02.002
Evans, D. J. (2010). The challenge of treating conduct disorder in low-
resourced settings: Rap music to the rescue. Journal of Child and
Adolescent Mental Health, 22(2), 145-152. doi:10.2989/17280583.
2010.528581
Faulkners, S. (2011). Drumbeat: In search of belonging. Youth Studies
Australia, 30(2), 9-14.
Fouche, S. & Torrance, K. (2005, November 1). Lose yourself in the music,
the moment, yo! Music therapy with an adolescent group involved
in gangsterism. Voices: A World Forum for Music Therapy, 5(3).
Retrieved April 12, 2013, from https://normt.uib.no/index.php/
voices/article/view/232/176
Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 84
Frank, G. (2005). David’s music: An observation of musical interactions with
a schizophrenic adolescent. Nordic Journal of Music Therapy, 14(2),
179-185. doi:10.1080/08098130509478140
Frisch, A. (1990). Symbol and structure: Music therapy for the adolescent
inpatient. Music Therapy, 9(1), 16-34.
Gardstrom, S. (2003). An investigation of meaning in clinical music
improvisation with troubled adolescents. Dissertation Abstracts
International, 64(12), 4261A. (UMI No. 3115962)
Gardstrom, S.C. (1987). Positive peer culture: A working definition for the
music therapist. Music Therapy Perspectives, 4, 19-23.
Gladfelter, N. D. (1992). The effects of music listening and progressive muscle
relaxation on the anxiety level of adjudicated males in a residential
treatment setting. Masters Abstracts International, 31(01), 445. (UMI
No. 1348413)
Goldstein, S. L. (1990). A songwriting assessment for hopelessness in
depressed adolescents: A review of the literature and a pilot
study. The Arts in Psychotherapy, 17, 117-124. doi:10.1016/0197-
4556(90)90021-H
Haines, J. H. (1989). The effects of music therapy on the self-esteem of
emotionally-disturbed adolescents. Music Therapy, 8(1), 78-91.
Hendricks, C. B. & Bradley, L. J. (2005). Interpersonal theory and music
techniques: A case study for a family with a depressed adolescent.
Family Journal: Counseling and Therapy for Couplesand Families,
13(4), 400-405.
Jones, C., Baker, F., & Day, T. (2004). From healing rituals to music therapy:
Bridging the cultural divide between therapist and young Sudanese
refugees. The Arts in Psychotherapy, 31(2), 89-100. doi:10.1016/j.
aip.2004.02.002
Keating, L. M., Tomishima, M. A., Foster, S., & Alessandri, M. (2002) The effects
of a mentoring program on at-risk youth. Adolescence, 37, 717-734.
Keen, A. W. (2004). Using music as a therapy tool to motivate troubled
adolescents. Social Work in Health Care, 39(3-4), 361-373.
McFerran, K. (2010). Adolescents, music and music therapy: Methods and
techniques for clinicians, educators and students. Jessica Kingsley:
London.
McFerran-Skewes, K. (2004). Using songs with groups of teenagers: How does
it work? Social Work with Groups, 27(2-3), 143-157. doi:10.1300/
J009v27n02_10
Member Sourcebook. (2006). Silver Springs, MD: American Music Therapy
Association.
Membership Directory. (2006). Canada: Canadian Association for Music
Therapy.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 85

Nelson, D. L. A. (1997). High-risk adolescent males, self-efficacy, and choral
performance: An investigation of affective intervention. Dissertation
Abstracts International, 58(03), 791. (UMI No. 9725321)
Rickson, D. J. & Watkins, W. G. (2003). Music therapy to promote prosocial
behaviors in aggressive adolescent boys: A pilot study. Journal of
Music Therapy, 40(4), 283-301.
Rio, R. E. & Tenney, K. S. (2002). Music therapy for juvenile offenders in
residential treatment. Music Therapy Perspectives, 20(2), 89-97.
Roth, E. A., & Kees, N. (2007). The use of expressive music therapy techniques
with groups of chemically dependent adolescents. Journal for the
Professional Counselor, 21(2), 41-52.
Ruutel, E. (2004). The experience of vibroacoustic therapy in the therapeutic
intervention of adolescent girls. Nordic Journal of Music Therapy,
13(1), 33-46. doi:10.1080/08098130409478096
Slotoroff, C. (1994). Drumming technique for assertiveness and anger
management in short-term psychiatric setting for adult and
adolescent survivors of trauma. Music Therapy Perspectives, 12(2),
111-116.
Smith, L. (2012). Sparkling divas! Therapeutic music video groups with at-
risk youth. Music Therapy Perspectives, 30(1), 17-24.
Snow, S. & D’Amico, M. (2010). The drum circle project: A qualitative study
with at-risk youth in a school setting. Canadian Journal of Music
Therapy, 16(1), 12-39.
Springer, J. F., Sale, E., Hermann, J., Soledad, S., Kasim, R., & Nistler, M. (2004).
Characteristics of effective substance abuse programs for high-
risk youth. The Journal of Primary Prevention, 25(2), 171-194.
doi:10.1023/B:JOPP.0000042388.63695.3f
Tervo, J. (2001). Music therapy for adolescents. Clinical Child Psychology and
Psychiatry, 6(1), 79-91. doi:10.1177/1359104501006001007
Ungar, M. & Teram, E. (2000). Drifting toward mental health: High-risk
adolescents and the process of empowerment. Youth and Society,
32(2), 228-252. doi:10.1177/0044118X00032002005
Wells, N. F. (1988). An individual music therapy assessment procedure for
emotionally disturbed young adolescents. The Arts in Psychotherapy,
15, 47-54.
Wyatt, J. G. (2002). From the field: Clinical resources for music therapy
with juvenile offenders. Music Therapy Perspectives, 20(2), 80-88.
doi:10.1016/0197-4556(88)90051-2
Zonneveldt, A. (1969). Music therapy with adolescents. Acta paedopsychiatrica.
36(5), 127-130.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 86

Copyright of Canadian Journal of Music Therapy is the property of Canadian Association for
Music Therapy and its content may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.