Experiences and Perspectives of Music Therapists Working with Families Experiencing Poverty: A Qualitative Investigation

Families Experiencing Poverty

Forty-three percent of children in the United States experieinced poverty with their families in 2015 (Jiang, Granja, & Koball, 2017). Children from low-income families frequently encounter traumatic events such as persistent hunger, anxiety, and witnessing or experiencing violence among others. The effects of trauma often accumulate over time, intensifying reactions to stress with each compounding event. The culmination of adverse events puts low-income children and teens at higher risk than their peers for mental health and developmental challenges. (Buckner, 2008; Cowan, 2014; Donlon, Lake, Pope, Shaw, & Haskett 2014; Guarino, 2014; Samuels, Shinn, & Buckner, 2010).

Parents experiencing poverty often face a number of economic and emotional stressors that can detract from their ability to provide consistent and supportive parenting. These stressors may include singleparenthood, social ioslation, substance abuse, and mental illness (Bolen, McWey, & Schlee, 2008). These factors can leave their children at-risk for developmental difficulties (Foley, 2010). Additionally, poor parent-child interaction, including child abuse and neglect, during infant and toddler years can adversly impact social and emotional development (Bolger, Patterson, Thompson, & Kupersmidt, 1995; Samuels, Shinn, & Buckner, 2010; Sroufe, 2005). Chronic negative parenting and frequent exposure to traumatic events can lead to behavior issues (i.e., difficulties with impulse control, self-regulation, and sustatined attention) that can negatively impact children’s success in school (Herbers, Cutuli, Monn, Narayan, & Masten, 2014; Herbers, Cutuli, Supkoff et al., 2014; Masten, 2012; Narayan, Herbers, Plowman, Gewirtz, & Masten, 2012; Obradovic et al., 2009; Smith, Stagman, Blank, Ong, & McDow, 2011).

Families experiencing poverty in the United States are disproportionally people of color. In 2015, 63% of black children, 61% of Hispanic children, and 61% of American Indian children lived in low-income families. Immigrant families also represent a disproportionately high population of low-income families, as 52% of children of immigrant parents experienced poverty in 2015 (Jiang, Granja, & Koball, 2017). Linguistic and cultural differences can become barriers that keep families experiencing poverty from the available community resources, thus limiting their opportunities to receive mental health services and developmental supports (McCabe, Gilchrist, Harris, Afridi, & Kyprianou, 2013). Particularly in the United States, systems of discrimination towards families of color over many decades have left urban areas segregated, often isolating families of color from educational resources and physical and mental health services (APA Taskforce on Socioeconomic Status, 2007; Cooper & Masi 2007).

Current Best Practices to Meet the Needs of Families Experiencing Poverty

Guarino (2014) suggested that service providers working with families experiencing poverty be aware of how trauma impacts behavior, emotions, and attitudes. Trauma-informed practice comprises understanding the specific trauma, promoting safety, supporting the client’s sense of control/choice/autonomy, sharing power, integrating care, and ensuring cultural competence. Masten (2015) identified that interventions specifically geared towards improving executive functioning and self-regulation skills among children experiencing poverty can reduce problem behaviors and increase school success. It is important to support parents experiencing poverty by teaching positive parenting practices and by offering direct engagement opportunities that promote parent-child bonding (Smith et al., 2011). Parent education groups that teach parents positive control and active listening improve outcomes among their children (Herbers, Cutuli, Supkoff et al., 2014; Yang, 2016). Additionally, there is a growing body of research that has identified mindfulness interventions to improve self-awareness among children and adults with greater self-awareness correlating with improved ability to adapt in adverse situations (Masten, 2015).

Music Therapy and Families Experiencing Poverty

Music therapists have reported working with low-income families in various settings including homeless shelters (Fairchild, Thompson, & McFerran, 2017; Iliya, 2011; Straum & Brotons, 1995; Yates & Silverman, 2016), other community-based organizations (Austin, 2007; Kowski, 2007), schools (Camilleri, 2007; Montello & Coons, 1998; Snow & D’Amico 2010), and state-operated facilities (Lotter, 2010). Music therapists have also reported working with at-risk families to support parent-child interaction among parents and their infants and toddlers (Abad & Williams, 2007; de l’Etoile, 2006; Jacobsen, McKinny, & Holck, 2014; Nicholoson, Berthelsen, Adad, Williams, & Bradley, 2008).

Among the limited music therapy literature for families experiencing poverty, the most common interventions were songwriting (Austin, 2007; Camilleri, 2007; Fairchild, Thompson, & McFerran, 2017; Kim, 2015; Straum & Brotons, 1995), music listening (Kim, 2015; Montello & Coons, 1998), singing (Iliya, 2011), and improvisational instrument playing (Austin, 2007; Kim, 2015; Kowski, 2007; Lotter, 2010; Montello & Coons, 1998; Snow & D’Amico 2010). The goals and objectives addressed by music therapists often mirrored the recommended objectives made in related literature; expressing and regulating emotions (Fairchild, Thompson, & McFerran, 2017; Kim, 2015; Kowski, 2007; Montello & Coons, 1998), reducing impulsive behaviors (Austin, 2007; Montello & Coons, 1998), improving social skills (Austin, 2007; Camilleri, 2007; Straum & Brotons, 1995; Yates & Silverman, 2016), improving communication (Austin, 2007; Camilleri, 2007; Kim, 2015; Snow & D’Amico 2010; Yates & Silverman, 2016), and building academic skills (Yates & Silverman, 2016).

Due to a lack of empirical research in relation to music therapy and families experiencing poverty, Yates and Silverman (2016) set out to establish a base for future research by conducting a qualitative investigation to understand the needs of children experiencing homelessness as perceived by staff at a homeless shelter. Yates and Silverman (2016) identified four themes: (a) staff need to be positive role models and provide trusting and affectionate relationships, (b) older children require programming and opportunities for communication and emotional support, (c) well-being must be screened and monitored, and (d) routine and expectations are needed to promote a calm living environment. These themes provide insights that music therapists working with families experiencing poverty may use to develop goals, objectives, and interventions.

The existing accounts of music therapists working with families experiencing poverty are found in case studies (Austin, 2007; Camilleri, 2007; Kowski, 2007; Lotter, 2010; Snow & D’Amico 2010), a book chapter (Jacobson, 2016), and empirical research studies (Fairchild, Thompson, & McFerran, 2017; Montello & Coons, 1998; Straum & Brotons, 1995). Although Yates and Silverman (2016) studied the perspectives of homeless shelter staff, there remains a gap in the literature concerning the perspectives and experiences of music therapists who work with this population. Investigation concerning how music therapists work with this specific population is needed to determine appropriate directions for future music therapy research with families experiencing poverty. Therefore, the purpose of this study was to gain an understanding of the experiences and perspectives of board-certified music therapists who work with families experiencing poverty. The primary research question guiding the study was as follows: What are the experiences and perspectives of music therapists working with families experiencing poverty?

Participants

Participants were five board-certified music therapists who have previously or are currently working with families experiencing poverty in urban areas in the United States. Three participants had previously worked for a community based non-profit organization that provided services at a multicultural therapeutic preschool and with low-income parent education/support groups. One participant had previously worked at an emergency homeless shelter, providing services to children ages 3-12. One participant currently works in the special education department of a large urban school district and treats many children experiencing poverty. Despite some variance in the specific settings, all participants worked as music therapists with service users who were experiencing poverty in the same city. All participants were female, three were Caucasian, one was black, and one was Japanese-American. In this initial investigation, all participants were previously known to the researchers and had provided music therapy services to families experiencing poverty in the same geographic location in the US. These five music therapists were approached for participation due to their experiences and their familiarity with the researchers. Each participant was individually approached by the principal investigator (PI) and introduced to the study before providing consent to participate in a semi-structured interview which would be audio-recorded, transcribed, and used as qualitative data after removing names to maintain confidentiality. The Institutional Board of Review of the researchers’ affiliated university approved the project.

Procedure

The investigators developed a semi-structured interview (Appendix A) to engage the participating music therapists in conversation about their perspectives and experiences. The interview questions were discussed and conceptualized among a class of music therapy graduate students who provided feedback to help develop the questions, to ensure the interview focused on and addressed the research question, and to minimize biases by identifying and modifying questions that may have been leading or assumptive. The PI conducted four interviews in-person in a quiet, public space, and in order to make the interview more convenient for one particular participant, one interview over the phone. Each interview lasted approximately 60-min. During the interviews, the PI asked the participants to elaborate on and clarify statements to fully understand the participants’ experiences and perspectives. All interviews were audio recorded and transcribed by the PI and undergraduate student transcribers. After transcription, the PI initially reviewed the transcripts and identified clarifying questions and statements. The PI then shared the transcripts with the participants and asked them to review the data for member checking purposes. At this stage, participants were encouraged to add additional information to the transcripts to ensure the data accurately reflected their experiences and perspectives.

As the goal of the research was to understand and interpret participants’ experiences, the researchers used a phenomenological approach. The researchers believed the participants’ perceptions were consequential and the goal of the study was to reveal the meanings based on their perceptions of those lived experiences (Laverty, 2003) in working as music therapists with people experiencing poverty.

Qualitative Analysis

The investigators analyzed the interview transcripts for emerging themes using Braun and Clarke’s (2006) six phases of thematic analysis including 1. familiarization with the data, 2. generating initial codes, 3. searching for themes, 4. reviewing themes, 5. defining and naming themes, and 6. producing the report. The investigators implemented the six phases as follows: 1. the investigators repeatedly read the data, 2. the PI created initial codes, 3. the related codes were organized into themes in a separate document, 4. the themes were repeatedly reviewed and refined to best represent the data and answer the research question, and 5. themes were named and defined after trustworthiness was obtained via the second author who separately reviewed transcripts and created codes and themes. After the themes emerged, the participants were also contacted to provide feedback on the emerging themes and the quotes used to depict them. Results were then presented at a research poster session at a professional music therapy conference and the authors integrated suggestions made by attendees into the paper. As this was a poster session, some suggestions that attendees made were already in the paper but not on the poster. Other suggestions were included when applicable.

Authors’ Lenses and Biases

At the time of data-analysis, the PI was a board-certified music therapist with six years of experience working with families experiencing poverty, who primarily uses a variety of interventions, including experience-oriented improvisation and songwriting (Baker, 2015) paired with a cognitive behavioral music therapy approach. The second author is a published music therapy educator, researcher, and clinician who specializes in cognitive behavioral music therapy with adult mental health populations. Issues related to poverty are frequently a concern with these clients. Both authors are Caucasian, both live and work in the United States. The current study is specific to families experiencing poverty in the United States and the authors recognize that other countries may have different circumstances and contextual parameters that influence programming, treatments, and poverty. It would be impossible to separate those experiences from the researchers’ way of knowing, interpreting, and understanding the data (Edwards, 2012; Stige, Malterud, & Midtgarden, 2009).

Music therapy facilitates the development of parenting skills via education and interaction

Codes: structure; interaction; reunification; modeling; engagement; provide parent support; positive feedback; enjoyment; comfort

Participants noted that music therapy interventions facilitated positive parenting skills and appropriate parent/child interaction during the reunification process, during which parents had supervised visits with their children who had been removed from the home due to child protection cases. The participants indicated that low-income parents who engage in group music therapy sessions with their children may successfully practice positive parenting skills and build healthy attachment, while receiving the benefits of peer modeling and positive feedback. Additionally, participants articulated that music therapy groups engaged parents at their developmentally appropriate level, allowing them to comfortably participate and gain parenting and self-care skills.

Children and adults generalize skills from music therapy sessions to daily life

Codes: Transfer, generalize, interactive music activities; practical; take home; adapt

In addition to supporting parenting skills, the participants noted that music therapy interventions also provided an opportunity for siblings to practice healthy interactions that generalized to what may be a chaotic home life. The participants expressed that music therapists can provide practical music-based interventions that can directly transfer to use at home to improve relationships/attachments for parents/children and siblings. By creating song books or CDs, families can receive a tangible resource to transfer skills from music therapy sessions to home or other settings. The participants expressed that music therapists can engage parents by brainstorming ways to adapt music games and activities for use at home or other settings. Also, the participants noted that a music therapist can suggest “homework” for children and adults to practice non-music skills outside of the music therapy session.

Awareness of the factors and unique stressors associated with poverty positively impacts the therapeutic process

Codes: Immediate success, context, awareness; diversity; abuse/neglect; choice; linguistic diversity; minorities/immigrants; generational; factors associated with race; cultural sensitivity

The participants noted music therapy group sessions may be particularly engaging for diverse populations because culturally and linguistically specific music can be incorporated while working towards goals. The participants indicated that awareness of common issues related to cultural and linguistic diversity (including English language learners, non-English speakers, or non-English readers) may impact the therapeutic outcomes. As navigating the available community resources can be a frustrating and daunting task for low-income families, the participants noted that because music therapy can be a non-intimidating intervention, both children and adults may benefit from the opportunity to experience immediate success in music therapy. The prevalence of abuse and neglect cases, chemical dependency, and mental health issues is high among the population of families experiencing poverty and the participants indicated that awareness of the social, emotional, and developmental factors related to these issues can also impact the therapeutic process. The participants also expressed that awareness of the barriers was crucial when working across racial, cultural, and socio-economic lines. Participants noted these factors may impact the development of the therapeutic relationship as many families experiencing poverty are people of color and/or recent immigrants, while music therapists in the US are predominantly white.

Music therapy compliments the broader continuum of support services to meet individual needs

Codes: Fills gap, collaboration, unique, holistic, flexible

The participants indicated that music therapy interventions can provide a unique, alternative modality to meet individual and collective needs. The participants noted that music therapy can provide support through direct collaboration between practitioners or through reinforcing goals worked on in different therapeutic modalities. During the interviews, participants articulated that collaboration between service providers may be particularly easy for music therapists due to the inherent flexibility of music. The participants expressed that children and adults benefit from music therapy intervention that supports overall outcomes (i.e., chemical dependency recovery and developmental and educational goals) by bridging the gap between other service providers.

Implications for Music Therapy Practice

Clinicians may use the themes identified in this study to expediently develop working alliance, trust, and rapport with families experiencing poverty. Particularly, the awareness of factors related to poverty and the implementation of trauma-informed practice may help facilitate positive outcomes for this population (Guarino, 2014; Yates & Silverman, 2016). Music therapists may benefit from opportunities to develop cultural competence in relation to issues associated with poverty. This could take place within university curriculum, practicum experiences with this population, or conference presentations on music therapy best practices with families experiencing poverty.

Music therapists may consider how issues of race and culture impact their working alliance and rapport particularly when Caucasian music therapists are engaging with predominately communities of color. Developing an awareness of culturally specific music traditions and connecting with community musicians may positively impact the therapeutic process (Oosthuizen, Fouche, Torrance, 2007).

Based on the emerging themes, there may be potential for the creation of music therapy positions serving this population. The participants outlined specific ways that music therapy can address the goals of parent-support and education groups and early childhood education groups often provided by community-based non-profits and government-run institutions.

Limitations

The five participants in this study all shared experiences working within the same large, Midwestern city. Thus, the current study provided a limited perspective on poverty only within a specific urban context in the United States. Additionally, although all five participants had music therapy experience with families experiencing poverty, their work settings differed and represents a limitation. While the current study provided insights from music therapists who have experience working with families experiencing poverty in a variety of settings in the same city, additional research might provide a broader perspective on the experiences of music therapists working with low-income families.

The study is also limited, as it did not investigate potential disadvantages or contraindications of using music therapy when working with families experiencing poverty. The semi-structured interviews were specifically designed to answer the narrow research question. Moreover, the results are limited by the authors’ biases resulting from their previous practice, research, educational experiences, and geographic location.

Additionally, as race and culture play a significant role in the experience of poverty in the United States, it should be noted that the authors recognize their perspectives as Caucasian individuals results in inherent biases during interpretation and reporting of the data presented in this study.

Suggestions for Future Research

Future researchers may consider investigating how music therapy functions in the context of parent education and parent support with families experiencing poverty. For example, investigators, could observe positive parenting behaviors exhibited within a music therapy session or interview parents to identify how they perceived music therapy to support their parenting skill development. Additionally, researchers could investigate how music therapy impacts working alliance among clinicians and families experiencing poverty. Understanding how to develop a stronger working alliance may lead better outcomes for this population. Researchers may also consider investigating how to best prepare music therapists and music therapy students to meet the multifaceted needs of this unique and marginalized population. For example, researchers may investigate how a music therapy practicum experience with this population impacts a student’s awareness of the factors associated with poverty. Additionally, researchers may compare cultural competency training among related professions such as art therapists, occupational therapists, as well as parent-educators and early-childhood teachers. Future researchers may consider interviewing music therapists from diverse regions to compare their perspectives working with families experiencing poverty. Further research identifying the links between music therapy and positive outcomes among families experiencing poverty could be used as rationale for developing new music therapy positions. Finally, results of this qualitative study could be used in future quantitative studies by designing interventions to target identified factors including parenting skills, interactions between parents and children, and stressors.