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Lindsey Wilhelm, Kyle Wilhelm, Telehealth Music Therapy Services in the United States With Older Adults: A Descriptive Study, Music Therapy Perspectives, Volume 40, Issue 1, Spring 2022, Pages 84–93, https://doi.org/10.1093/mtp/miab028
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Abstract
In response to the COVID-19 pandemic, many music therapists in the United States turned to telehealth music therapy sessions as a strategy to continue services with older adults. However, the nature and perception of telehealth music therapy services for this age group are unknown. The purpose of this study was to describe music therapy telehealth practices with older adults in the United States including information related to session implementation, strengths and challenges, and adaptations to clinical practice. Of the 110 participants in the United States who responded to the survey (25.2% response rate), 69 reported implementing telehealth music therapy services with older adults and responded to a 32-item survey. Quantitative and qualitative analyses were conducted. Results indicated that while all participants had provided telehealth music therapy for no more than 6 months, their experiences with telehealth varied. Based on participant responses, telehealth session structure, strengths, challenges, and implemented changes are presented. Overall, 48% of music therapists reported that they planned to continue telehealth music therapy with older adults once pandemic restrictions are lifted. Further study on the quality, suitability, and acceptability of telehealth services with older adults is recommended.
Introduction
During the COVID-19 pandemic, aging adults have been encouraged to refrain from interacting with others in person. While reducing the risk of exposure, decreased social interaction can lead to increased depression and reduced quality of life (Zubatsky et al., 2020). Telehealth services can improve access to health care, especially for those in rural areas or with limited transportation and reduce the risk of exposure (Kruse et al., 2020; Sorinmade et al., 2020). In response, many music therapists in the United States have turned to telehealth music therapy as a strategy to continue services with older adults (Gaddy et al., 2020). However, the nature and perception of telehealth music therapy services for this age group in the United States are unknown.
Older Adults and Telehealth
Telehealth has been defined as “the use of telecommunication techniques for patient care and medical education, usually remotely and with minimal or no direct patient contact from the health professional” (Sorinmade et al., 2020, p. 1427). While older adults have demonstrated an interest and ability to use telehealth for healthcare services (Guo & Albright, 2018), some experience barriers due to cognitive, sensory, and motor changes, and a lack of technical literacy collectively referred to as telehealth unreadiness (Kruse et al., 2020; Lam et al., 2020; Sorinmade et al., 2020). Telehealth unreadiness is defined as a difficulty with hearing or vision, difficulty speaking or making oneself understood, possible cognitive issues (e.g., dementia), or lacking internet-enabled electronic devices or understanding of how to use them (Lam et al., 2020). Based on 2018 Medicare data, 38% of older adults in the United States—13 million total—were not ready for telehealth visits; this percentage increased to 72% of individuals 85 or older (Lam et al., 2020).
Music Therapy and Telehealth
Knott and Block (2020) identified three approaches to the development and delivery of telehealth music therapy services. First, music therapists can use pre-existing online resources to meet their client’s needs. Second, music therapists can create original recorded audio and video content that clients can access asynchronously. Third, music therapists can implement music therapy services using a telehealth platform to address client goals and objectives.
Examples of telehealth music therapy in the literature included music therapists working with veterans (Levy et al., 2018; Lightstone et al., 2015; Spooner et al., 2019; Vaudreuil et al., 2020), autistic adolescents (Baker & Krout, 2009), children with sensory impairments (Ahessy, 2021; Fuller & McLeod, 2019), premature infants (Negrete, 2020), and adults with Parkinson’s disease (Stegemöller et al., 2020). Exploration of this topic continues to evolve in the work of Clements-Cortés et al. (2021) and Dassa et al. (2021). In both articles, the authors shared clinical experiences and perspectives on the provision of telehealth music therapy for persons with dementia and their caregivers and provided recommendations for best practice.
Two survey studies have been found assessing telehealth music therapy. Agres et al. (2021) surveyed music therapists (n = 112) from Asia, Europe, and North America regarding technological considerations of telehealth music therapy. The most important factors related to the choice of technology were ease of use, cost effectiveness, and accessibility/availability. Most participants found telehealth sessions to be as effective as in-person sessions. Cole et al. (2021) evaluated the translation of neurologic music therapy (NMT) techniques from in-person to telehealth sessions. The researchers found that clinicians continued to use techniques from all three NMT domains (sensorimotor, cognitive, and speech/language) with the caveat that rhythmic auditory stimulation was used less frequently than in in-person sessions due to concerns for client safety.
Researchers in these studies reported information about the music therapy interventions being used, challenges, strengths, and adaptations made with telehealth sessions. Examples of both active music making (Clements-Cortés et al., 2021; Dassa et al., 2021; Lightstone et al., 2015; Spooner et al., 2019; Vaudreuil et al., 2020) and passive or receptive interventions such as relaxation and movement/action songs were found in the literature (Clements-Cortés et al., 2021; Dassa et al., 2021; Fuller & McLeod, 2019; Negrete, 2020; Sasangohar et al., 2020; Vaudreuil et al., 2020). Common challenges in telehealth music therapy included audio/video lag (Agres et al., 2021; Clements-Cortés et al., 2021; Cole et al., 2021; Dassa et al., 2021; Sasangohar et al., 2020; Vaudreuil et al., 2020) and maintaining privacy/confidentiality (Bates, 2014; Levy et al., 2018; Lightstone et al., 2015; Sasangohar et al., 2020; Vaudreuil et al., 2020). Ease of accessibility was by far the most identified strength to telehealth sessions in the literature (Clements-Cortés et al., 2021; Cole et al., 2021; Levy et al., 2018; Lightstone et al., 2015; Sasangohar et al., 2020; Vaudreuil et al., 2020). Identified strengths also included the ability to integrate family and community members (Clements-Cortés et al., 2021; Negrete, 2020; Vaudreuil et al., 2020) and a potential reduction in travel time (Bates, 2014). Several adaptations were made by music therapists after shifting to telehealth. These included increasing the number of sessions per week (Negrete, 2020; Sasangohar et al., 2020), implementing shorter sessions (Agres et al., 2021; Negrete, 2020), changing the goals addressed (Clements-Cortés et al., 2021; Cole et al., 2021; Negrete, 2020), and types of music interventions being implemented (Clements-Cortés et al., 2021; Dassa et al., 2021).
Prior to the COVID-19 pandemic, Bates (2014) discussed ethical considerations for clinicians interested in “computer-mediated (music) therapy” (p. 138). Ethical considerations included legal and interstate jurisdiction issues, therapeutic issues (e.g., technology competence and effectiveness of music therapy interventions), and clinical practice issues (e.g., confidentiality and ease of session recording). While telehealth music therapy sessions were not as common when this article was published, the current landscape of music therapy practice in the United States has changed.
Purpose Statement and Research Questions
While older adults benefit physically, emotionally, and cognitively from music therapy (Diaz Abrahan et al., 2019; Wilhelm & Cevasco-Trotter, 2018; Zhao et al., 2016), literature related to the delivery of telehealth for older adults indicate that these individuals may have unique needs (Kruse et al., 2020; Lam et al., 2020; Sorinmade et al., 2020) that can impact the effectiveness of music therapy telehealth services (Clements-Cortés et al., 2021; Dassa et al., 2021). Although some studies have been published regarding music therapy and telehealth, there have been no descriptive studies looking solely at the practice of music therapy telehealth with older adults. Identifying current practices related to telehealth music therapy with older adults can help music therapists who work with or who want to work with older adults virtually. The purpose of this descriptive survey study was to provide a picture of music therapy telehealth practices with older adults in the United States. Specific research questions were (1) What is the descriptive profile of music therapists implementing telehealth sessions with older adults? (2) How are music therapists implementing telehealth sessions with older adults? (3) What are perceived strengths and challenges to implementing music therapy telehealth sessions with older adults? and (4) How have music therapists adapted their practice when implementing telehealth sessions with older adults?
Methods
As no previous survey could be found regarding the topic of music therapy telehealth with older adults, we created a cross-sectional descriptive survey (Lavrakas, 2008) to explore the topic. A draft of the survey was reviewed by two music therapists and suggestions for clarity and thoroughness were incorporated. The final survey consisted of 33 questions, 30 of which were closed-ended with dropdown menus, and three questions were open-ended. Several of the closed-ended questions were structured, so participants could make additional comments.
The survey included questions regarding participant demographics, session rates, technology use, clinical considerations, and evaluation of telehealth. Survey questions asked participants to compare session rates for telehealth and in-person sessions and about the technology used by the therapist and client(s) as well as technological issues experienced during sessions. Questions related to clinical considerations in telehealth music therapy included therapeutic areas of focus, an evaluation of music therapy interventions, and instruments and equipment used by both the music therapist and the client. Finally, open-ended questions asked participants to identify strengths and challenges of providing telehealth music therapy services with older adults.
Parts of the survey were taken from previous literature. The list of music therapy interventions with older adults in the survey was drawn from Belgrave et al. (2011). The list of 59 therapeutic areas of focus came from the Certification Board for Music Therapists (CBMT) Board Certification Domains (Certification Board for Music Therapists, 2020, III.A.2). The list of instruments and props used by music therapists was taken from Wilhelm & Knight (2020). The resultant survey was distributed using Qualtrics and anticipated to take 12 min to complete and is presented in Supplementary Material A. The survey received approval from the Institutional Review Board of the university where the survey originated (IRB approval 20-10189H).
Procedure
Eligible participants were board-certified music therapists who provided telehealth services for older adults in the United States. Because there was no available list of music therapists who provide telehealth music therapy with older adults, we sought out music therapists who self-identified as working with older adults in hopes of capturing those who do so using telehealth. This strategy was necessary due to the exploratory nature of the survey but may have impacted our final response rate as it is likely that many music therapists were contacted who were ineligible to complete the survey. A list of music therapists was obtained from the American Music Therapy Association (AMTA) of the following work setting categories: Adult Day Care, Geriatric Facility—not nursing, Geriatric Psychiatric Unit, Home Health Agency, Hospice/Bereavement Services, Music Therapy Business Owner, Nursing Home/Assisted Living, Private Music Therapy Agency, Self Employed/Private Practice, and Veterans Affairs. The list also included music therapists who self-identified as working with the following population groups: Alzheimer’s/Dementia, Bereavement/Grief, Elderly Persons, Hospice/Palliative Care, Parkinsons, and Terminally Ill. We sent an email invitation for survey participation to 439 music therapists in the United States on July 13, 2020. Reminders were sent 2 and 4 weeks after the initial email. Three surveys were returned as undeliverable resulting in a total of 436 potential participants. In all, 107 music therapists completed at least a portion of the survey, and three music therapists stated via email that they provided telehealth services with children, but not older adults. Therefore, the response rate was 110 out of 436 music therapists (25.2%). This response rate is similar to average response rates for web-based surveys (Lindemann, 2021).
Data from the closed-ended questions were compiled and analyzed using descriptive statistics and frequency counts. We grouped responses from the open-ended questions into common themes based on the qualitative analysis approach as outlined by Braun and colleagues (2019). First, we became familiar with the participants’ responses individually using a combination of inductive and deductive approaches. Next, initial codes were generated that were then combined into themes. These themes were then reviewed and refined by both researchers. Finally, example quotes were drawn from the data representing each of the themes (Braun et al., 2019).
Results
Of the 107 music therapists who began taking the survey, 38 stated in a screening question that they did not provide telehealth services to older adults. Results were compiled from the remaining 69 respondents. Participants were not required to answer every question, and the median response time was 13 min. Sixty participants self-reported as female (86.96%), seven as male (10.14%), one as non-binary/non-conforming (1.45%), and one did not answer (1.45%). Ages ranged from 24 to 71 years (M = 41.3, SD = 13.3) with one participant not reporting, and the number of years as a music therapist ranged from 1 to 45 (M = 13, SD = 11). All participants reported providing telehealth services for 6 months or less. Almost half of participants (48%) responded that they plan to continue with telehealth sessions, 11% indicated that would not continue telehealth sessions, and 41% were unsure. Additional demographic data of participants are presented in Table 1.
. | N . | % . |
---|---|---|
Age | ||
21–25 | 4 | 5.88% |
26–30 | 16 | 23.52% |
31–35 | 9 | 13.23% |
36–40 | 10 | 14.70% |
41–45 | 7 | 10.29% |
46–50 | 6 | 8.82% |
51–55 | 2 | 2.94% |
56+ | 14 | 20.58% |
Did not report | 1 | 1.45% |
Years as a music therapist | ||
1–5 | 23 | 33.33% |
6–10 | 15 | 21.73% |
11–15 | 7 | 10.14% |
16–20 | 11 | 15.94% |
21–25 | 2 | 2.89% |
26–30 | 5 | 7.24% |
31–35 | 2 | 2.89% |
36–40 | 1 | 1.45% |
41+ | 3 | 4.34% |
Level of education | ||
Bachelor’s degree | 30 | 43.47% |
Master’s degree | 38 | 55.07% |
Doctoral degree | 1 | 1.45% |
AMTA Region | ||
GLR | 17 | 24.63% |
MAR | 17 | 24.63% |
MWR | 5 | 7.24% |
NER | 2 | 2.89% |
SER | 14 | 20.28% |
SWR | 3 | 4.34% |
WR | 11 | 15.94% |
. | N . | % . |
---|---|---|
Age | ||
21–25 | 4 | 5.88% |
26–30 | 16 | 23.52% |
31–35 | 9 | 13.23% |
36–40 | 10 | 14.70% |
41–45 | 7 | 10.29% |
46–50 | 6 | 8.82% |
51–55 | 2 | 2.94% |
56+ | 14 | 20.58% |
Did not report | 1 | 1.45% |
Years as a music therapist | ||
1–5 | 23 | 33.33% |
6–10 | 15 | 21.73% |
11–15 | 7 | 10.14% |
16–20 | 11 | 15.94% |
21–25 | 2 | 2.89% |
26–30 | 5 | 7.24% |
31–35 | 2 | 2.89% |
36–40 | 1 | 1.45% |
41+ | 3 | 4.34% |
Level of education | ||
Bachelor’s degree | 30 | 43.47% |
Master’s degree | 38 | 55.07% |
Doctoral degree | 1 | 1.45% |
AMTA Region | ||
GLR | 17 | 24.63% |
MAR | 17 | 24.63% |
MWR | 5 | 7.24% |
NER | 2 | 2.89% |
SER | 14 | 20.28% |
SWR | 3 | 4.34% |
WR | 11 | 15.94% |
. | N . | % . |
---|---|---|
Age | ||
21–25 | 4 | 5.88% |
26–30 | 16 | 23.52% |
31–35 | 9 | 13.23% |
36–40 | 10 | 14.70% |
41–45 | 7 | 10.29% |
46–50 | 6 | 8.82% |
51–55 | 2 | 2.94% |
56+ | 14 | 20.58% |
Did not report | 1 | 1.45% |
Years as a music therapist | ||
1–5 | 23 | 33.33% |
6–10 | 15 | 21.73% |
11–15 | 7 | 10.14% |
16–20 | 11 | 15.94% |
21–25 | 2 | 2.89% |
26–30 | 5 | 7.24% |
31–35 | 2 | 2.89% |
36–40 | 1 | 1.45% |
41+ | 3 | 4.34% |
Level of education | ||
Bachelor’s degree | 30 | 43.47% |
Master’s degree | 38 | 55.07% |
Doctoral degree | 1 | 1.45% |
AMTA Region | ||
GLR | 17 | 24.63% |
MAR | 17 | 24.63% |
MWR | 5 | 7.24% |
NER | 2 | 2.89% |
SER | 14 | 20.28% |
SWR | 3 | 4.34% |
WR | 11 | 15.94% |
. | N . | % . |
---|---|---|
Age | ||
21–25 | 4 | 5.88% |
26–30 | 16 | 23.52% |
31–35 | 9 | 13.23% |
36–40 | 10 | 14.70% |
41–45 | 7 | 10.29% |
46–50 | 6 | 8.82% |
51–55 | 2 | 2.94% |
56+ | 14 | 20.58% |
Did not report | 1 | 1.45% |
Years as a music therapist | ||
1–5 | 23 | 33.33% |
6–10 | 15 | 21.73% |
11–15 | 7 | 10.14% |
16–20 | 11 | 15.94% |
21–25 | 2 | 2.89% |
26–30 | 5 | 7.24% |
31–35 | 2 | 2.89% |
36–40 | 1 | 1.45% |
41+ | 3 | 4.34% |
Level of education | ||
Bachelor’s degree | 30 | 43.47% |
Master’s degree | 38 | 55.07% |
Doctoral degree | 1 | 1.45% |
AMTA Region | ||
GLR | 17 | 24.63% |
MAR | 17 | 24.63% |
MWR | 5 | 7.24% |
NER | 2 | 2.89% |
SER | 14 | 20.28% |
SWR | 3 | 4.34% |
WR | 11 | 15.94% |
Telehealth Implementation
Session rate
Of the 67 participants who provided a rate comparison of telehealth sessions to in-person sessions, the vast majority (80.6%) charged the same amount as for in-person services, whereas 8.9% charged less and 2.9% charged more. Figure 1 presents the amount charged per hour for telehealth group and individual music therapy sessions.
Technology use
Figure 2 shows the devices used by the participants and clients as well as the source of microphone and camera used (e.g., external). The type of devices used by the participants (n = 68) varied with 87% using a laptop computer, 63% using a smartphone or tablet, and 10% using a desktop computer. Participants (n = 67) reported that clients used a smartphone or tablet (84%) most frequently followed by a laptop computer (46%), and a desktop computer (25%). Five participants were unaware of the type of device(s) used by their client(s).
Figure 3 shows the platform(s) used by participants (n = 67) with just over half using more than one platform. Sixteen different video platforms were identified with Zoom being used twice as much as any other. One participant also indicated using Ava, an app that captions dialogue during telehealth sessions. Factors that influenced platform choice included facility/organization preference (37%), client preference/ease (29%), therapist preference/ease (28%), security (16%), video/audio quality (10%), accessibility (6%), affordability (3%), and availability (3%). Several participants reported more than one factor.
Participants (n = 61) identified the type of technological issues occurring during sessions with audio issues being the most common (40%) followed by video issues (36%). Participants reported technological issues occurring between 0-11 times per hour with the majority (61%) reporting 1–3 issues per hour. Other types of technological issues hampering sessions included poor internet connectivity (8%), user error (2.4%), and batteries dying or computer needing updates (1.6%). Participants (n = 63) also described how they connected to the internet. Most participants used WiFi to connect to the internet (95%), followed by being hardwired (14%), and using cellular data (5%). Participants were able to choose more than one option.
Session implementation
Seventy-eight percent of participants (n = 67) provided individual sessions with the client in a private space supported by another person followed by individual sessions with only the client (49%), group sessions with clients in a single gathering space (38%), and group sessions with clients in their own individual spaces (37%). Participants (n = 67) reported using a wide variety of interventions with older adult clients using telehealth ranging from 3 to 12 per participant (M = 5.8). Interventions identified most frequently were therapeutic singing, music listening, and life review/music-cued reminiscence. Figure 4 shows music therapy interventions that participants rated as working well and not working well in telehealth with older adults. One intervention, gait training, was not used by participants and is not included in the figure. Additional interventions identified by participants that work well in telehealth included improvisation (2), song/memory recall (2), body rhythm (1), lyric discussion (1), music video production (1), oral motor exercises (1), and song choice (1).
Participants identified therapeutic areas of focus addressed in music therapy telehealth with older adults. Table 2 shows the areas identified by at least 50% of participants who answered the question (n = 65). Each of the 59 areas of focus from the CBMT Board Certification Domains was addressed by at least one participant with over 90% of participants focusing on quality of life and participation/engagement. Additional areas of focus included social isolation (7), sensory stimulation (2), spiritual support (2), expression, sense of normality, and terminal agitation. A complete list of the therapeutic areas of focus identified by participants with frequency counts is presented in Supplementary Material B.
Area of Focus a . | n . | % b . |
---|---|---|
Quality of life | 63 | 96.9% |
Participation/engagement | 61 | 93.8% |
Affect, emotions and moods | 58 | 89.2% |
Relaxation | 57 | 87.7% |
Anxiety | 48 | 73.8% |
Attention | 46 | 70.8% |
Spirituality | 46 | 70.8% |
Memory | 45 | 69.2% |
Adjustments to life changes or temporary or permanent changes in ability | 44 | 67.7% |
Interactive response | 44 | 67.7% |
Depression | 43 | 66.2% |
Coping skills | 42 | 64.6% |
Musical and other creative responses | 42 | 64.6% |
Social skills and interactions | 41 | 63.1% |
Wellness | 40 | 61.5% |
Support systems | 39 | 60.0% |
Verbal and non-verbal communication | 37 | 56.9% |
Group cohesion and/or feeling of group membership | 34 | 52.3% |
Sense of self with others | 33 | 50.8% |
Area of Focus a . | n . | % b . |
---|---|---|
Quality of life | 63 | 96.9% |
Participation/engagement | 61 | 93.8% |
Affect, emotions and moods | 58 | 89.2% |
Relaxation | 57 | 87.7% |
Anxiety | 48 | 73.8% |
Attention | 46 | 70.8% |
Spirituality | 46 | 70.8% |
Memory | 45 | 69.2% |
Adjustments to life changes or temporary or permanent changes in ability | 44 | 67.7% |
Interactive response | 44 | 67.7% |
Depression | 43 | 66.2% |
Coping skills | 42 | 64.6% |
Musical and other creative responses | 42 | 64.6% |
Social skills and interactions | 41 | 63.1% |
Wellness | 40 | 61.5% |
Support systems | 39 | 60.0% |
Verbal and non-verbal communication | 37 | 56.9% |
Group cohesion and/or feeling of group membership | 34 | 52.3% |
Sense of self with others | 33 | 50.8% |
aCBMT Board Certification Domains (2020, III.A.2);
b Participants could select more than one goal area.
Area of Focus a . | n . | % b . |
---|---|---|
Quality of life | 63 | 96.9% |
Participation/engagement | 61 | 93.8% |
Affect, emotions and moods | 58 | 89.2% |
Relaxation | 57 | 87.7% |
Anxiety | 48 | 73.8% |
Attention | 46 | 70.8% |
Spirituality | 46 | 70.8% |
Memory | 45 | 69.2% |
Adjustments to life changes or temporary or permanent changes in ability | 44 | 67.7% |
Interactive response | 44 | 67.7% |
Depression | 43 | 66.2% |
Coping skills | 42 | 64.6% |
Musical and other creative responses | 42 | 64.6% |
Social skills and interactions | 41 | 63.1% |
Wellness | 40 | 61.5% |
Support systems | 39 | 60.0% |
Verbal and non-verbal communication | 37 | 56.9% |
Group cohesion and/or feeling of group membership | 34 | 52.3% |
Sense of self with others | 33 | 50.8% |
Area of Focus a . | n . | % b . |
---|---|---|
Quality of life | 63 | 96.9% |
Participation/engagement | 61 | 93.8% |
Affect, emotions and moods | 58 | 89.2% |
Relaxation | 57 | 87.7% |
Anxiety | 48 | 73.8% |
Attention | 46 | 70.8% |
Spirituality | 46 | 70.8% |
Memory | 45 | 69.2% |
Adjustments to life changes or temporary or permanent changes in ability | 44 | 67.7% |
Interactive response | 44 | 67.7% |
Depression | 43 | 66.2% |
Coping skills | 42 | 64.6% |
Musical and other creative responses | 42 | 64.6% |
Social skills and interactions | 41 | 63.1% |
Wellness | 40 | 61.5% |
Support systems | 39 | 60.0% |
Verbal and non-verbal communication | 37 | 56.9% |
Group cohesion and/or feeling of group membership | 34 | 52.3% |
Sense of self with others | 33 | 50.8% |
aCBMT Board Certification Domains (2020, III.A.2);
b Participants could select more than one goal area.
Figure 5a shows instruments used by participants and their clients. Every participant indicated using guitar followed by keyboard/piano and drums. Additional instruments used by participants included flute (2), cabasa, claves, dulcimer, harmonica, harp, marimba, Q-chord, singing bowls, trumpet, ukulele, and violin. Most participants reported that their clients did not use instruments. Additional instruments used by clients included found sounds created from household items (e.g., pots and pans; 7), body percussion (2), rhythm sticks (2), claves, frog guiro, harmonica, and ukulele.
Figure 5b presents equipment/props used by the participants and their clients. Nearly half of the participants used a smartphone and one-third indicated not using equipment or props. Additional equipment/props used by participants included visuals (5), external speaker (2), antiques, lyric sheets, small flags, a smartphone stand with light, and YouTube/Spotify. Most participants indicated that their clients did not use any equipment or props during telehealth sessions. Additional equipment/props used by clients included lyric sheets (2), small flags, and worksheets for songwriting.
Strengths and Challenges of Telehealth
Participants (n = 56) identified 82 strengths of telehealth music therapy with older adults. Table 3 shows these strengths grouped into six themes with example participant comments. The most frequently mentioned strengths were interpersonal advantages such as improved client connection due to being unmasked and the ability to invite other family members from different states or countries to join the session.
Theme . | n . | % a . | Comments . |
---|---|---|---|
Interpersonal advantages | 22 | 26.8% | “Sometimes if privacy allows, family members can join in the zoom meeting and see their loved ones since they are not allowed into the communities as well.” |
Improved efficiency/ flexibility of therapist | 18 | 21.9% | “No driving, hauling. Flexibility with appointment times for clients. Increased number of appointments during the week.” |
Ability to continue services | 17 | 20.7% | “It seems to be our only way ‘into’ the communities at this time. Without Zoom and FaceTime, we could not lay eyes on our patients in hospice. Only nurses are allowed into the communities.” |
Improved safety | 15 | 18.3% | “Clients can be at their home in a comfortable place without worry about their health.” |
Accessibility | 10 | 12.2% | “Participants with limited mobility can access services from home.” |
Using features of technology | 7 | 8.5% | “Using screen share to share visuals to prompt discussion/musicking.” |
Theme . | n . | % a . | Comments . |
---|---|---|---|
Interpersonal advantages | 22 | 26.8% | “Sometimes if privacy allows, family members can join in the zoom meeting and see their loved ones since they are not allowed into the communities as well.” |
Improved efficiency/ flexibility of therapist | 18 | 21.9% | “No driving, hauling. Flexibility with appointment times for clients. Increased number of appointments during the week.” |
Ability to continue services | 17 | 20.7% | “It seems to be our only way ‘into’ the communities at this time. Without Zoom and FaceTime, we could not lay eyes on our patients in hospice. Only nurses are allowed into the communities.” |
Improved safety | 15 | 18.3% | “Clients can be at their home in a comfortable place without worry about their health.” |
Accessibility | 10 | 12.2% | “Participants with limited mobility can access services from home.” |
Using features of technology | 7 | 8.5% | “Using screen share to share visuals to prompt discussion/musicking.” |
a represents % of total comments for theme
Theme . | n . | % a . | Comments . |
---|---|---|---|
Interpersonal advantages | 22 | 26.8% | “Sometimes if privacy allows, family members can join in the zoom meeting and see their loved ones since they are not allowed into the communities as well.” |
Improved efficiency/ flexibility of therapist | 18 | 21.9% | “No driving, hauling. Flexibility with appointment times for clients. Increased number of appointments during the week.” |
Ability to continue services | 17 | 20.7% | “It seems to be our only way ‘into’ the communities at this time. Without Zoom and FaceTime, we could not lay eyes on our patients in hospice. Only nurses are allowed into the communities.” |
Improved safety | 15 | 18.3% | “Clients can be at their home in a comfortable place without worry about their health.” |
Accessibility | 10 | 12.2% | “Participants with limited mobility can access services from home.” |
Using features of technology | 7 | 8.5% | “Using screen share to share visuals to prompt discussion/musicking.” |
Theme . | n . | % a . | Comments . |
---|---|---|---|
Interpersonal advantages | 22 | 26.8% | “Sometimes if privacy allows, family members can join in the zoom meeting and see their loved ones since they are not allowed into the communities as well.” |
Improved efficiency/ flexibility of therapist | 18 | 21.9% | “No driving, hauling. Flexibility with appointment times for clients. Increased number of appointments during the week.” |
Ability to continue services | 17 | 20.7% | “It seems to be our only way ‘into’ the communities at this time. Without Zoom and FaceTime, we could not lay eyes on our patients in hospice. Only nurses are allowed into the communities.” |
Improved safety | 15 | 18.3% | “Clients can be at their home in a comfortable place without worry about their health.” |
Accessibility | 10 | 12.2% | “Participants with limited mobility can access services from home.” |
Using features of technology | 7 | 8.5% | “Using screen share to share visuals to prompt discussion/musicking.” |
a represents % of total comments for theme
Common challenges of telehealth were provided in a dropdown menu with eye strain (n = 21) and vocal strain (n = 17) being selected most frequently followed by longer prep time (n = 11) and lack of confidence (n = 7). Participants (n = 48) also provided 98 additional challenges that were grouped into nine themes and are presented in Table 4 with example participant comments. The most frequently mentioned challenge was reduced connection with or among clients. This was related to the therapist being unable to see the client fully and touch or physically assist the client. Several participants reported that these inherent challenges with telehealth impacted the perceived level of effectiveness of the session and prompted them to make changes to their implementation.
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Reduced connection with or among clients | 39 | 39.8% | “There is a removed quality when we are all on our computers … lack of closeness and intimacy which I miss!” |
Delay, lag, poor internet connection | 16 | 16.3% | “[There is a] delay in feedback if they sing along - it can be an almost 15 second delay in me hearing them. It sounds like a round to me! But fine for client.” |
Reliance upon someone else to assist | 16 | 16.3% | “Oftentimes, staff are very busy and do not understand why I cannot go into the room. Sometimes I have received very rude responses and it discourages me. Staff may also not approach the resident the way I would when offering services, so sometimes a resident refuses the music therapy session when approached by a staff member.” |
Difficulty or inability to make music with client | 14 | 14.3% | “You can't follow the clients lead with the beat in a way that you both hear when improvising.” |
Technological difficulties of client | 14 | 14.3% | “Sometimes they are frustrated by having to deal with the technology aspect.” |
Client confusion | 13 | 13.3% | “They get confused and don’t understand that the video is live and they can interact.” |
Inability of therapist to assist | 13 | 13.3.0% | “Not being able to provide prompting and cueing.” |
Poor or unknown sound quality | 7 | 7.1% | “Don't have access to high quality sound equipment; aesthetic quality of music is hindered.” |
Background noise, distractions | 2 | 2.0% | “Singing over noises in the background and staff unaware that TVs are on in neighboring areas and causing distractions.” |
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Reduced connection with or among clients | 39 | 39.8% | “There is a removed quality when we are all on our computers … lack of closeness and intimacy which I miss!” |
Delay, lag, poor internet connection | 16 | 16.3% | “[There is a] delay in feedback if they sing along - it can be an almost 15 second delay in me hearing them. It sounds like a round to me! But fine for client.” |
Reliance upon someone else to assist | 16 | 16.3% | “Oftentimes, staff are very busy and do not understand why I cannot go into the room. Sometimes I have received very rude responses and it discourages me. Staff may also not approach the resident the way I would when offering services, so sometimes a resident refuses the music therapy session when approached by a staff member.” |
Difficulty or inability to make music with client | 14 | 14.3% | “You can't follow the clients lead with the beat in a way that you both hear when improvising.” |
Technological difficulties of client | 14 | 14.3% | “Sometimes they are frustrated by having to deal with the technology aspect.” |
Client confusion | 13 | 13.3% | “They get confused and don’t understand that the video is live and they can interact.” |
Inability of therapist to assist | 13 | 13.3.0% | “Not being able to provide prompting and cueing.” |
Poor or unknown sound quality | 7 | 7.1% | “Don't have access to high quality sound equipment; aesthetic quality of music is hindered.” |
Background noise, distractions | 2 | 2.0% | “Singing over noises in the background and staff unaware that TVs are on in neighboring areas and causing distractions.” |
a represents % of total comments for theme
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Reduced connection with or among clients | 39 | 39.8% | “There is a removed quality when we are all on our computers … lack of closeness and intimacy which I miss!” |
Delay, lag, poor internet connection | 16 | 16.3% | “[There is a] delay in feedback if they sing along - it can be an almost 15 second delay in me hearing them. It sounds like a round to me! But fine for client.” |
Reliance upon someone else to assist | 16 | 16.3% | “Oftentimes, staff are very busy and do not understand why I cannot go into the room. Sometimes I have received very rude responses and it discourages me. Staff may also not approach the resident the way I would when offering services, so sometimes a resident refuses the music therapy session when approached by a staff member.” |
Difficulty or inability to make music with client | 14 | 14.3% | “You can't follow the clients lead with the beat in a way that you both hear when improvising.” |
Technological difficulties of client | 14 | 14.3% | “Sometimes they are frustrated by having to deal with the technology aspect.” |
Client confusion | 13 | 13.3% | “They get confused and don’t understand that the video is live and they can interact.” |
Inability of therapist to assist | 13 | 13.3.0% | “Not being able to provide prompting and cueing.” |
Poor or unknown sound quality | 7 | 7.1% | “Don't have access to high quality sound equipment; aesthetic quality of music is hindered.” |
Background noise, distractions | 2 | 2.0% | “Singing over noises in the background and staff unaware that TVs are on in neighboring areas and causing distractions.” |
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Reduced connection with or among clients | 39 | 39.8% | “There is a removed quality when we are all on our computers … lack of closeness and intimacy which I miss!” |
Delay, lag, poor internet connection | 16 | 16.3% | “[There is a] delay in feedback if they sing along - it can be an almost 15 second delay in me hearing them. It sounds like a round to me! But fine for client.” |
Reliance upon someone else to assist | 16 | 16.3% | “Oftentimes, staff are very busy and do not understand why I cannot go into the room. Sometimes I have received very rude responses and it discourages me. Staff may also not approach the resident the way I would when offering services, so sometimes a resident refuses the music therapy session when approached by a staff member.” |
Difficulty or inability to make music with client | 14 | 14.3% | “You can't follow the clients lead with the beat in a way that you both hear when improvising.” |
Technological difficulties of client | 14 | 14.3% | “Sometimes they are frustrated by having to deal with the technology aspect.” |
Client confusion | 13 | 13.3% | “They get confused and don’t understand that the video is live and they can interact.” |
Inability of therapist to assist | 13 | 13.3.0% | “Not being able to provide prompting and cueing.” |
Poor or unknown sound quality | 7 | 7.1% | “Don't have access to high quality sound equipment; aesthetic quality of music is hindered.” |
Background noise, distractions | 2 | 2.0% | “Singing over noises in the background and staff unaware that TVs are on in neighboring areas and causing distractions.” |
a represents % of total comments for theme
Changes to Clinical Practice
Fifty-six participants provided 69 comments describing changes or modifications they made to their clinical practice since moving to telehealth. These comments were grouped into 10 themes and are presented in Table 5 with example participant comments. The most frequently reported type of changes were adapting the interventions or characteristics of the music and changing the time, length, or structure of the session.
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Adapted interventions or characteristics of music | 16 | 23.2% | “I've used less variety of interventions while on telehealth - stuck more closely to singing familiar songs for reminiscence, emotion regulation, and sensory stim.” |
Changed session time, length or structure | 16 | 23.2% | “Visits with facility patients may be shorter due to the availability of facility staff.” |
Decreased caseload or session frequency | 10 | 14.5% | “I do not have access to many hospice patients. The facilities do not have access to technology or they are prioritizing family virtual visits/calls. Home hospice patients do not … know how to use the technology properly even with instruction. Others are not being seen entirely.” |
Used few or no instruments/props | 10 | 14.5% | “The interactions with instruments are limited because I cannot pass out instruments.” |
More surface level with interactions | 7 | 10.1% | “It has had a significant impact on relational connection with all clients.” |
Increased service range/availability | 6 | 8.7% | “I can be more available for PRN visits for acute needs as I serve a large territory and cannot always get to a patient who is having behaviors or agitation.” |
Changed goals and objectives | 4 | 5.8% | “I've had to discern what kinds of goals are conducive to telehealth and then what the best use of our time is toward achieving those.” |
Used features of technology | 4 | 5.8% | “With several clients I have had them use YouTube to listen to specific music …” |
Increased session frequency | 4 | 5.8% | “One client has become two times for half an hour each so that I can reach different adults and they can keep the population low.” |
Greater level of energy needed | 2 | 2.9% | “Soliciting responses … has been a TON of work for me and the support staff with mostly lackluster results.” |
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Adapted interventions or characteristics of music | 16 | 23.2% | “I've used less variety of interventions while on telehealth - stuck more closely to singing familiar songs for reminiscence, emotion regulation, and sensory stim.” |
Changed session time, length or structure | 16 | 23.2% | “Visits with facility patients may be shorter due to the availability of facility staff.” |
Decreased caseload or session frequency | 10 | 14.5% | “I do not have access to many hospice patients. The facilities do not have access to technology or they are prioritizing family virtual visits/calls. Home hospice patients do not … know how to use the technology properly even with instruction. Others are not being seen entirely.” |
Used few or no instruments/props | 10 | 14.5% | “The interactions with instruments are limited because I cannot pass out instruments.” |
More surface level with interactions | 7 | 10.1% | “It has had a significant impact on relational connection with all clients.” |
Increased service range/availability | 6 | 8.7% | “I can be more available for PRN visits for acute needs as I serve a large territory and cannot always get to a patient who is having behaviors or agitation.” |
Changed goals and objectives | 4 | 5.8% | “I've had to discern what kinds of goals are conducive to telehealth and then what the best use of our time is toward achieving those.” |
Used features of technology | 4 | 5.8% | “With several clients I have had them use YouTube to listen to specific music …” |
Increased session frequency | 4 | 5.8% | “One client has become two times for half an hour each so that I can reach different adults and they can keep the population low.” |
Greater level of energy needed | 2 | 2.9% | “Soliciting responses … has been a TON of work for me and the support staff with mostly lackluster results.” |
a represents % of total comments for theme
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Adapted interventions or characteristics of music | 16 | 23.2% | “I've used less variety of interventions while on telehealth - stuck more closely to singing familiar songs for reminiscence, emotion regulation, and sensory stim.” |
Changed session time, length or structure | 16 | 23.2% | “Visits with facility patients may be shorter due to the availability of facility staff.” |
Decreased caseload or session frequency | 10 | 14.5% | “I do not have access to many hospice patients. The facilities do not have access to technology or they are prioritizing family virtual visits/calls. Home hospice patients do not … know how to use the technology properly even with instruction. Others are not being seen entirely.” |
Used few or no instruments/props | 10 | 14.5% | “The interactions with instruments are limited because I cannot pass out instruments.” |
More surface level with interactions | 7 | 10.1% | “It has had a significant impact on relational connection with all clients.” |
Increased service range/availability | 6 | 8.7% | “I can be more available for PRN visits for acute needs as I serve a large territory and cannot always get to a patient who is having behaviors or agitation.” |
Changed goals and objectives | 4 | 5.8% | “I've had to discern what kinds of goals are conducive to telehealth and then what the best use of our time is toward achieving those.” |
Used features of technology | 4 | 5.8% | “With several clients I have had them use YouTube to listen to specific music …” |
Increased session frequency | 4 | 5.8% | “One client has become two times for half an hour each so that I can reach different adults and they can keep the population low.” |
Greater level of energy needed | 2 | 2.9% | “Soliciting responses … has been a TON of work for me and the support staff with mostly lackluster results.” |
Theme . | n . | % a . | Example Comments . |
---|---|---|---|
Adapted interventions or characteristics of music | 16 | 23.2% | “I've used less variety of interventions while on telehealth - stuck more closely to singing familiar songs for reminiscence, emotion regulation, and sensory stim.” |
Changed session time, length or structure | 16 | 23.2% | “Visits with facility patients may be shorter due to the availability of facility staff.” |
Decreased caseload or session frequency | 10 | 14.5% | “I do not have access to many hospice patients. The facilities do not have access to technology or they are prioritizing family virtual visits/calls. Home hospice patients do not … know how to use the technology properly even with instruction. Others are not being seen entirely.” |
Used few or no instruments/props | 10 | 14.5% | “The interactions with instruments are limited because I cannot pass out instruments.” |
More surface level with interactions | 7 | 10.1% | “It has had a significant impact on relational connection with all clients.” |
Increased service range/availability | 6 | 8.7% | “I can be more available for PRN visits for acute needs as I serve a large territory and cannot always get to a patient who is having behaviors or agitation.” |
Changed goals and objectives | 4 | 5.8% | “I've had to discern what kinds of goals are conducive to telehealth and then what the best use of our time is toward achieving those.” |
Used features of technology | 4 | 5.8% | “With several clients I have had them use YouTube to listen to specific music …” |
Increased session frequency | 4 | 5.8% | “One client has become two times for half an hour each so that I can reach different adults and they can keep the population low.” |
Greater level of energy needed | 2 | 2.9% | “Soliciting responses … has been a TON of work for me and the support staff with mostly lackluster results.” |
a represents % of total comments for theme
Discussion
The aim of this paper was to provide a descriptive profile of music therapists using telehealth with older adults within the United States. In total, 110 out of 439 music therapists in the United States responded to our survey. Responses from the music therapists who self-reported as implementing telehealth sessions with older adults provided a picture of therapy implementation, strengths and challenges of telehealth, and how they have changed music therapy sessions to a virtual medium.
Music Therapy Telehealth Implementation
Music therapists who completed this survey typically led individual sessions using a laptop or tablet on Zoom with a family or staff member supporting the client. They implemented a variety of music therapy interventions such as therapeutic singing, music listening, and life-review/reminiscence mostly with guitar. The goals of the music therapy sessions most frequently related to quality of life, participation and engagement, client affect, emotions and moods, and relaxation. Nearly half of the participants indicated that they were likely to continue with telehealth services for older adults even after health guidelines allow for a return to in-person sessions.
On the surface, most participants reported that they were providing successful music therapy telehealth services for older adults which is similar to recent surveys (Cole et al., 2021; Gaddy et al., 2020). However, diverse experiences can be observed when looking more closely at these data. Some participants reported experiencing decreased personal interactions with clients while others reported increased interactions with clients and their families. Participants had contrasting views of the effectiveness of music therapy interventions such as therapeutic singing and the iso-principle. Additionally, some participants reported a lower caseload and fewer sessions while others reported maintaining their caseload and increasing the number of sessions per day. Finally, while most participants seemed to accept implementing telehealth music therapy sessions given the current health guidelines, a few participants were deeply unhappy with the medium and questioned the validity of music therapy telehealth services with older adults. As an example, one participant asked, “[I]s this enough? Am I really making a difference? Is the impact and therapeutic effect even comparable to [an] in-person session?”
With regard to session rates, 29% of participants (n = 18) indicated not knowing the group session rate and 21% (n = 14) indicated not knowing the individual session rate for telehealth music therapy. In the remaining participants, a substantial percentage provided free group (n = 10, 22.7%) or individual (n = 14, 26.9%) telehealth music therapy sessions. Twelve of the participants who indicated providing free services also reported that their rate had stayed the same from in-person sessions. We were unable to explore this finding further to identify if the response could be a mistake due to how the survey question was worded or what may have contributed to a decision to offer free services. The AMTA Code of Ethics (2019) advises that music therapists charge what they feel their services are worth and seek remuneration that is “fair and reasonable” (3.4) which will encourage fair competition and reduce potential harm to other music therapists practicing in the same area (Wilhelm, 2020; Wilhelm & Wilhelm, 2021).
Strengths and Challenges of Telehealth
Participants reported several strengths and challenges of telehealth music therapy services with older adults, most of which were mentioned in previous literature. The strength most frequently reported by participants was an interpersonal advantage. Being able to see each other’s faces (i.e., not wearing a mask) allowed for an improved connection between client and therapist. However, this interpersonal advantage may not be the same for persons with dementia who may find the virtual format confusing (Clements-Cortés et al., 2021). Another interpersonal advantage reported by participants was the ability to include family members in the session who may not have been able to participate in sessions previously due to distance or safety. Both advantages were also reported in the literature (Negrete, 2020; Sasangohar et al., 2020; Sorinmade et al., 2020).
Additionally, participants reported that telehealth services provided increased flexibility and efficiency due to reduced driving time which allowed participants to see more clients in a day. Increased flexibility was also mentioned by Bates (2014). The ability to continue services, improved safety, accessibility, and the features of the technology were also mentioned as strengths by participants and in the literature (Bates, 2014; Cole et al., 2021; Levy et al., 2018; Negrete, 2020; Sorinmade et al., 2020). One strength of telehealth stated by participants but not in previous literature was increased ease with scheduling and rescheduling client sessions.
While participants identified both strengths and challenges of telehealth services, more challenges were identified than strengths. In fact, more than one participant reported a distinct dislike for telehealth stating no strengths at all. The most frequently mentioned challenge was a reduced connection with or among clients. It may seem contradictory that connecting with clients can be both a challenge and a strength of telehealth. However, this distinction may be dependent upon factors outside of the control of the music therapist such as involvement of a support person or the functional abilities of the client (Clements-Cortés et al., 2021; Dassa et al., 2021). Additional challenges that align with recent literature included audio and video lag, sensory needs of the client, lack of privacy, inability to make music together, and a client’s lack of comfort with technology (Agres et al., 2021; Clements-Cortés et al., 2021; Dassa et al., 2021; Sasangohar et al., 2020; Sorinmade et al., 2020; Vaudreuil et al., 2020).
Another potential challenge with telehealth sessions was foreshadowed in Bates (2014). In the section on computer-mediated therapy, Bates discusses the ease of recording, copying, and disseminating telehealth sessions. A participant in the current survey reported that facilities are “able to record Zoom sessions for replaying without further compensation.” This brings up questions of ownership of the music therapy session video and confidentiality of the client. Implications of this question, whether the therapist feels the video belongs to the music therapist or the client/facility, should be clearly delineated prior to the start of telehealth sessions (Bates, 2014).
Some music therapy researchers and clinicians have reported an equal or greater effectiveness of telehealth sessions for clients than in-person sessions (Dassa et al., 2021). For example, Sasangohar et al. (2020) stated that client engagement improved in some areas with telehealth, and Fay (2020) indicated that “certain clients are thriving in ways that did not happen when seen in person” (Fay et al., 2020, para. 2). However, none of these reports say that these benefits extend to all clients. This is like participants in our study who reported that their older adult clients were not benefitting to the same extent as in-person sessions. While one participant did report greater improvements from telehealth, they attributed this improvement to assistance from family and staff. From previous literature and responses from our survey, it seems that telehealth is not suitable for everyone, and future research is needed to determine who telehealth is most effective with, which client needs are best met via telehealth, and whether there are circumstances in which telehealth is not appropriate (Clements-Cortés et al., 2021).
Changes to Clinical Practice
Participants indicated several ways that they have changed or modified their practice to better fit the telehealth format. Many of these changes were also present in current literature. Like Agres et al. (2021), participants reported that their music therapy telehealth sessions were generally shorter than in-person sessions and more commonly individual sessions than group sessions. Group sessions that did occur were often smaller in size than in-person sessions. The music therapists in this survey identified fewer and mostly receptive music therapy interventions to be effective in a telehealth format.
Older adults may have unique challenges with telehealth music therapy sessions such as confusion, difficulty with hearing or vision, difficulty making themselves understood, and a lack of technological understanding to participate in telehealth sessions (i.e., telehealth unreadiness). Music therapists have addressed these challenges by using features of the technology (e.g., lyric sheets), a greater level of energy, shorter sessions to decrease client fatigue, and utilizing family, friends, and staff to support the client. As this survey was sent out in the first few months of the COVID-19 pandemic, the therapists at the time of the survey may have been still trying to figure out how to improve the effectiveness of telehealth sessions.
Limitations
This paper has several limitations. First, the survey had a fairly low response rate with 16% of potential participants answering beyond the initial screening question. This could be partly because of our approach to finding participants. AMTA does not currently have a list of music therapists who serve older adults using telehealth. Therefore, we had to identify categories of music therapists who may work with older adults in hopes of capturing those who provide telehealth services with older adults. This approach may have limited the scope of responses by excluding potential participants who did not self-report as being in one of the identified categories. Second, all participants were AMTA members. It is possible that the findings from this study were influenced by the decision to survey AMTA members exclusively. Third, the surveys were sent through email, and this may have excluded potential respondents without email access. Finally, the authors are married.
Conclusion and Future Directions
Music therapists in this study reported successfully providing telehealth services to older adults. While participants identified more challenges than strengths of telehealth with this age group, telehealth services have provided therapists and clients the opportunity to continue sessions during periods of mandated isolation. These services looked different from in-person services, but the flexibility of music therapists is evident. Participants reported changing the session length, frequency, structure, interventions, and therapeutic outcomes to fit the telehealth medium. Finally, participants reported variable effectiveness of music interventions and of telehealth sessions in general. Perhaps of greatest importance is the finding that nearly half of the participants reported that they intend to continue implementing music therapy telehealth services with older adults. This shift from solely in-person sessions to both telehealth and in-person sessions will change the landscape of music therapy with older adults. Future research in this area might include a follow-up survey to provide an updated snapshot regarding how and whether telehealth services are being provided. It would be beneficial to ascertain why participants decided to start telehealth music therapy and whether the older adult clients were seen prior to a shift to telehealth sessions or began with telehealth music therapy. Ultimately, further examination of the quality, suitability, and acceptability of telehealth services with older adults is needed.
Lindsey Wilhelm, PhD, MT-BC, is an Assistant Professor at Colorado State University.
Kyle Wilhelm, MA, MT-BC, is an adjunct instructor at Colorado State University.
Conflicts of interest: None declared.
Funding: None declared.