How effective is music as medicine? Very effective, to judge from feedback about a program Wisconsin’s Madison Symphony has operated since 2005. The Madison Symphony is making a strong case for the healing power of music with HeartStrings, a music-therapy-based program for people with developmental disabilities, long-term illnesses, and dementia. And they’re showing other orchestras how, with a new toolkit just published.
In the HeartStrings program, a string quartet of MSO musicians presents monthly interactive sessions for participants, caregivers, family members, and staff at partner locations, where they lead activities to improve motor skills and social interaction, as well as relaxation. There is plenty of demand: for the 2012-13 season the orchestra has had to create a waiting list of potential partners—the MSO’s size and budget mean they can commit to only ten to twelve partner locations per season. The four-color, 96-page spiral-bound toolkit is called HeartStrings: A Guide to Music Therapy-Informed Community Engagement for Symphony Orchestras, and it covers everything from how to apply for funding for this type of program to setting up lesson plans and hiring and training staff, and includes detailed sample sessions and evaluation forms.
SymphonyNOW recently caught up with Michelle Kaebisch and Laurie Farnan, two of the key people who worked behind the scenes developing, implementing, and evaluating the MSO’s HeartStrings program. Michelle Kaebisch is director of education and community engagement at the Madison Symphony Orchestra, in which she has played violin since 1993. Laurie Farnan (music therapist, MMT, MT-BC, WMTR) coordinated the music therapy program at Central Wisconsin Center in Madison, Wisconsin from 1975 until her retirement in 2011.
Here, Kaebisch and Farnan speak about why the orchestra decided to publish the toolkit, what benefits classical music can provide for people who are nonverbal, and the surprising impact the program can have for musicians as well as families, staff, and caregivers.
Jennifer Melick: When did you decide to publish the toolkit? This is a pretty unusual and remarkable endeavor for an orchestra.
Michelle Kaebisch: It was not on my bucket list to write a book! But we got this three-year grant from Johnson & Johnson and the Society for Arts in Healthcare. Each year has different benchmarks; the first year we had to intensively evaluate the program and create a curriculum that would be geared toward kids with disabilities; the second year we implemented that program; in the third year of the grant, they wanted a toolkit to be available for dissemination.
Many toolkits out there are just PDFs that you can download from a website, with maybe a couple of pictures. Our feeling was, since we have the money to do a really beautiful book, we might as well do it to the best of our ability. We thought it was important for people to have all the tools they needed: How do you write a case statement for a program like this? How do you go about hiring and training musicians? It was kind of hard for me as a former teacher to hand over all the session plans—the rep lists and everything—because it’s like handing over your lesson plans to someone else, and you hope that they use it as you intended. Each session is in the book, and so are our evaluation forms.
Melick: Who do you see as the ideal reader of this book?
Kaebisch: The target audience is a symphony staff member, because you’re talking about fundraising, grant-writing, and hiring musicians, and you need an organization like a symphony to spearhead a project like this. The goal of the toolkit is to help other orchestras set up programs on their own.
Melick: How many copies did you print?
Kaebisch: We printed 500—that was what we had enough for in the grant. We’ve already distributed about 100 copies. We want to get it in people’s hands, so we’re selling the toolkit for $25. We wouldn’t have enough money to reprint and cover shipping for more than 500 if needed. We do have a low-res version of Chapter 1 available as a PDF download, so people at least can get a taste for what’s in it. When people buy the toolkit, they’ll get a passcode, and then at our website all the documents in the appendix section—the last 40 pages, which is the nuts and bolts they need to set up a program—they’ll be able to print those off for their use.
“This is a truly participatory activity. People actually are making music, playing the therapy bells, the egg shakers, hand drum, rhythm sticks—whatever percussion instruments the quartet members hand out. They’re not just on the receiving end; they’re making music together.”—Michelle Kaebisch
Melick: How did the Madison Symphony’s HeartStrings community engagement program start its partnership with the Central Wisconsin Center?
Laurie Farnan: In 2005, I was approached by the then education director at the Madison Symphony—we chatted about setting up a program. There were four or five initial sessions, and they were really well received. There’s the multisensorial stimulation of vibration, auditory—and the live element adds the visual, which is a whole other level of attention and sensory input. It’s a pretty powerful combination. The program just continued to grow, especially under Michelle’s leadership.
Melick: Is there anything about classical music itself that provides special benefits?
Farnan: Classical music is nonverbal communication. It’s a perfect match for people who are nonverbal. The 234 residents at our facility have a primary diagnosis of intellectual disability—in the old terminology they would have been described as having a profound level of mental retardation. Most residents do not speak on their own. Classical music evokes delight, an emotional response, a level of engagement through a nonverbal medium. People who are nonverbal are allowed the opportunity to have an emotional response that is not dependent on speech.
Kaebisch: There’s something about the sonority of strings, too. When I observe the quartet playing Rusalka’s “Hymn to the Moon,” it’s so calm and peaceful.
Melick: The book includes instructions on when to play which music selections, what to say, and so forth. How important is it to have a script?
Kaebisch: It depends. Some instrumentalists are naturally gifted at talking to crowds and would just need to have bullet points, for example, “I’m going to talk a little bit about West Side Story,” or what have you. When you’re sending new musicians out into a new program, they should have some kind of script that shows them how to interact. If you have an adult with severe intellectual disabilities, you don’t talk to them like they’re a baby. They need to know how to talk to people who are aging adults with dementia or Alzheimer’s, or to little kids.
Farnan: Talking to different populations is an acquired skill. It’s hard.
Kaebisch: What makes our program special is that it is a partnership for an entire season. Our quartet goes to each partner location once a month for nine months. We have ten partner locations, so our quartet is doing 90 sessions throughout the season! You’re establishing relationships with the staff, with the clients or residents.
Melick: Who are the musicians participating in HeartStrings?
Kaebisch: They are our co-concertmaster, Suzanne Beia; violinist Laura Burns; principal violist Christopher Dozoryst and principal cellist Karl Lavine—the highest level of players from our orchestra. This is a truly participatory activity, not like when people go into a retirement home and the musicians play, the audience claps, and then the musicians leave. The people actually are making music, playing the therapy bells, the egg shakers, hand drum, rhythm sticks—whatever percussion instruments the quartet members hand out. They’re not just on the receiving end; they’re making music together.
Melick: What have you learned over the years collaborating on HeartStrings?
Kaebisch: For me it was a huge learning curve, because even though I was a public school teacher and we shared the same hallway with the special-ed classes at the school I taught at, we almost never interacted. So I didn’t know much about disabilities. Laurie helped me a lot, explaining how to talk to people; you can’t use sarcasm, for instance. There are just so many things I wouldn’t have instinctively known. Musicians generally have this expectation that there will be no sound during the performance, and the “audience” will be totally enraptured. But then you go into a facility where people are not speaking words but are making sounds. They can startle you. We need to prepare the musicians for that.
Farnan: We learned how to refine sessions around themes. At the center we’ve got a wide range instruments, so I wanted to know what key everything was going to be in, in case we would play step bells, or resonator bells—a pitched percussion instrument. Now the session plan has the key in it, and it lists the composers.
We also learned a lot about evaluation, how to measure and quantify these very difficult things: whether somebody liked it, became more relaxed, what degree of change was observed. It’s very nice to have evidence to validate what you observe.
Kaebisch: When the program started we had a very clear idea of our target audience—it was the residents, the clients. We didn’t really give much thought to the effect it was going to have on the musicians—or on staff and caregivers. We found that caregivers were having a very positive response, and the feelings toward the people they worked with were improved after attending a session with them, which is huge, because if they’re feeling better about their job, you hope that will carry over to the kind of care they’re giving.
“You need to have an evaluation tool that fits into the healthcare model. Therapists set goals, keep data, see if someone’s improving or staying the same, maintaining skills, or whatever. The need for evidence is a pretty important part.”—Laurie Farnan
Melick: Evaluations are also critical for you in terms of funding, right?
Kaebisch: Absolutely! Funders like the warm, fuzzy touchy-feely stories, but the quantitative data is what makes it a home run.
Farnan: You need to have an evaluation tool that fits into the healthcare model. Therapists set goals, keep data, see if someone’s improving or staying the same, maintaining skills, or whatever. The need for evidence is a pretty important part.
Kaebisch: As a music organization you have to know what the healthcare lingo is. That is how we were able to get a grant from the Society for Arts in Healthcare. It’s something that’s addressed in the toolkit. For a while arts funders were saying, well, this is really a healthcare program. And then healthcare funders said, that’s an arts program because it’s an orchestra implementing it. But once you know how to speak the language, you can say, yes, this is an arts organization, but providing healthcare-type services because of X, Y, and Z. Then you’re able to get the crossover funding.
Melick: Laurie, you mentioned that most people in the Central Wisconsin Center don’t speak. But do they sing or keep a beat?
Farnan: There is one person at the center who doesn’t talk but fills in the last note of the closing song, perfectly in pitch, no matter what key we play it in, and no matter which closing song we use! There are some people who can maintain a tempo. Some will hold the mallet and play a drum—they won’t be in rhythm, so we use mallets that are pretty soft so that it won’t be as large a distraction to the musicians. But it’s still a grasp skill, a motor movement, a functional life skill of responding to something in the environment. You see people smile—they know they’re playing! They know they’re part of something larger than themselves, and that’s very rewarding.
“The response to rhythm is in the brain stem area. People don’t decide to clap along to a Sousa march, it just happens. It’s not a conscious decision to say, ‘I’m going to have a psychomotor response to rhythm now!’ ”—Laurie Farnan
Kaebisch: When you’re working at a retirement facility with adults that have dementia, many of them sing along to old songs like “As Time Goes By.” In some cases, it brings back memories. Our quartet was just out at a residential facility, and this one woman was talking about how she was a musician younger in life. They had no idea that she was a musician in her younger years, because she never talked about it. But because the quartet had played a certain song that she had remembered singing, that brought back those memories. That was pretty cool.
Farnan: The response to rhythm is in the brain stem area. People don’t decide to clap along to a Sousa march, it just happens. It’s not a conscious decision to say, “I’m going to have a psychomotor response to rhythm now!” People tap on the steering wheel, they don’t “decide” to do that. The field of neuroscience is just starting to scratch the surface of all the areas of the brain and nervous system that are impacted with music, especially live music. We wouldn’t see all these things if we gathered the same group of people and we played a CD of the exact same program!
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Michelle Kaebisch and Laurie Farnan will give a presentation about HeartStrings at the League of American Orchestras National Conference in Dallas, June 5-8. For more information on Conference and to register, visit http://www.americanorchestras.org/conference_2012/schedule.html.