A Survey of Music Therapists' Work with Speech ...

JoiiruBl ûl Music Therapy. XLV (4), 3008, 405-426 © 2008 by the American Music Therapy Association

A Survey of Music Therapists' Work with Speech-Language Pathologists and Experiences with Augmentative and Alternative Communication John McCarthy, PhD, CCC-SLP Kamile Geist, MA, MT-BC Rashida Zojwala, MA Molly Z, Schock, MA Ohio University Although music therapists may work with a variety of professionals in interdisciplinary teams, there is a lack of information about the specific nature of their work with speech-language pathoiogists (SLPs). Using an internetbased tooi, Board Certified Music Therapists (r\ = 1834, 1675 deliverable) were surveyed regarding their work with speech-ianguage pathologists and experiences with augmentative and alternative communication (AAC). Specifically, participants were asked about: (a) demographics; (b) populations worked with professionally; (c) past and present work with speech-ianguage pathologists; (d) goals addressed; (e) benefits and challenges encountered; and (f) work with AAC. Responses (H = 847) indicated the majority of participants (73.6%) had worked with SLPs at some point in various roies and in various settings. Fewer participants reported currently working with SLPs (42.8%), although 50.1 % reported currentiy working with someone requiring lohn McCarthy, Srhool of Hearing, Speech and Language Sciences. Kamile Geisi, Dt'paiLmeni ol Music Therapy, Rashida Z()jwala, and Molly Z. Schock, School of HearinR. Speech and language Sciences. Ohio University. Thank you lo all iht- Music Therapists who parlicipaied In this sui-vey and special ihanks lo those on Lhe review panel who gave iheir feedhack on the sui-vey during the development process. A ponion of this paper was presented al the annual convention of ihe American Music Therapy Association in November, 2006 and at the annual convertion of the American Speech-Langiiage-Hearing Association in Novemher. 2007. This research was made possible in part by a grant from the Ohio University Research Council Discretional")' Fund for 2006. (xirrespondence concerning ihis article should be addre.s.sed to John McCarthy, Assistant Professor of Hearing Speech and language Sciences, W218 Grover Center, Ohio University, Athens, OH, 45701.

Joumal of Music Therapy some form of AAC. Participants reported a mean level of expertise with AAC of 3.9 on a scale of 1-7. Sharing knowledge was noted as a top benefit of working with SLPs, while scheduling was reported as the most frequent challenge. Other benefits and challenges as well as future research directions are discussed.

Music therapists' work in multi-disciplinary treatment may often include work with Speech-Language Palhologists (SLPs). Potentially the working relationship is mutually beneficial. Music therapists are trained to recognize communication goals already created by an SLP that would be appropriate for music tberapy interventions and would lend themselves to adding musical elements to support. For the SLP, Zoller (1991) stated, "Musical activities stress nonverbal forms of communication and often surpass physical, cultural, intellecttial, and emotional limitations" (p. 272). In a further illustration of the mutual benefit, Pellitteri (2000) offered, "when the music therapist creates a comfortable psychological environment children tend to feel relaxed and to decrease any inhibitions related to speaking, and natural language is allowed to emerge (p. 384)." Tbese benefits span individuals across a wide range of clients served by MTs and SLPs alike. Michel and May (1974) reviewed a series of student projects at Florida State University wbere MTs and SLPs collaborated to tbe mutual benefit of a variety of children witb speech and language impairments. A research review by Cohen (1994) summarized tbe relative effectiveness of singing for individuals with a range of speech disorders due primarily to neurological impairments. In another narrative review, Humpal (1990) outlined the various means (including communication) with whicb music therapy services could be included in early intervention. Tbrougb a meta-analysis of 10 studies with variables tbat included communication, Whipple (2004) found notbing but positive effects for the use of music witb children and adolescents with autism. Collaborations can take several forms. Hobson (2006) defmed three collaborative treatment approaches. In the muitidisciplinary approach the SLP and MT conduct separate assessments and determine separate goals for the client. Tbe collaboration is

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defined as agreeing to work with the same client but ibrougb different modalities. Tbe interdisciplinary model is described as the MT and the SLP developing assessment and treatment on tlie same goals for tbe clients, hut collaborating only on tbe writing of tbe goals as tbe therapy is ct>nducted separately. The transdisciplinary model involves the therapists treating tbe client at tbe same time, integrating the modalities. This may involve only one therapist being present but using botb modalities in the treatment. Register (2002) found that 36.3% of MTs reported consulting with SLPs and 44.6% reported collaborating with SLPs. She further noted that 47.1% of MTs reported goals of consultative work as "communication." Because tbe focus of tbe survey was on all professional collaborations and consultations, the specific nature of the work witb SLPs was not detailed in Register's (2002) survey. Similarly, Smith and Hairston (1999) surveyed MTs working in the schools and found tbat many of tbem worked with children who might also require speech and language services. Specific information on their work together was not included. They did note that 71% of MTs worked with children witb multipk- di.sabilities. Not only do cbildren witb multiple disabilities often require speecb and language therapy, but tbey may also benefu from augmentiitive and alternative communication (AAC). This is another area wbere there are clear benefus to MT expertise in the area, bin wbere documentation of experiences is limited. Augmentative and Alternative Communication {AAC) and Music Therapy

There are over 3.5 million Americans whose natural speecb is not adequate to meet their daily communication needs (Boukclman & Mirenda, 2005). These individuals may have developmental or acquired disabilities, degenerative diseases, or they may be temporarily unable to speak because of surgery or other medical conditions. In any of tbese cases, this heterogeneous group can benefu from a variety of AAC systems including gestures, eye gaze and signs, picture communication boards, and electronic systems with speech output. Binger and Light (2006) found tbat almost one quarter ol caseloads for SLPs working in prescbools consisted of students

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requiring some form of AAC. AJihough Binger and Light had a question about the number of children receiving other special education provider services, music therapy was not included. Music therapists may need to use AAC systems when working with individuals with severe disabilities (Coleman, 2002). McCarthy, O'Donnell, Reese, and Steele (2005) reported on four different ways that MTs and SI.Ps could collaborate to improve services for children requiring A/\C through a set ofca.se studies including consultation by the MT, consultation by the SLP, cotreatment in a MT session, and co-ireatment in an SLP session. Geist, McCarthy, Rodgers, and Porter (in press) documented collaboration in finding, practicing, and utilizing assistive technology- to enhance the participation of a child with a global developmental delay in his preschool classroom. Ultimately, technology makes it possible for students who are non-speaking to have a voice and participate musically (Humpal & Dimmick, 1995). Despite its potential benefits, AAC represents another domain for MTs to be knowledgeable about to work effectively with their clients and with other professionals. Unfortunately there is little information about the current status of MTs and their professional interactions with individuals requiring AAC. Helping individuals become more effective commiuiicators, whether through speech and language goals or through assistive technology, is of major importance to both MTs and SLPs. To date, there is a lack of information about the experiences of MTs and SLPs working together and the experiences of MTs witJi AAC. The current study was undertaken to (a) assess the amount and nature of collaboration currently taking place between Music Therapists and Speech-Language Pathologisis, (b) describe the benefits and challenges in this joint work, and (c) de.scribe the use of augmentative and alternative communication (AAC) methods and devices used in music therapy. Partidpants

The investigators applied for and obtained the e-mail addresses of professional members who were board certified music therapists of the American Music Therapy Association (AMTA). Participants' e-mail addresses were entered into a secure, online master mailing list which tracked solicitations, replies, absten-

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tions, or undeliverable messages. Members (n = 1834) were invited to participate during the months ofjime and July of 2006. It is important to consider whether populations of interest in surveys have access to e-mail to prevent siii-vey bias (Fowler. 2002). Because AMTA members provide e-mail addresses along with membership the use of an electronic survey appeared reasonable. Materials

AMTA member mu.sic therapists were surveyed, using an Internet-based tool', on their experiences working with speechlanguage pathologists and augmentative and alternative communication (AAC). Surveys were divided into 3 sections: (a) demographic information, (b) work with speech-language pathologists (past, current, & overall), and (c) woik with augmentative and alternative communication (AAC). The majority of questions were closed, with two open-ended questions asking about the top three challenges and benefits to collaborating with SLPs (see Appendix for a complete list of questions). Proœdures

The survey utilized for this investigation was developed in a series of stages, as recommended by Dillman (2000). The stages included the following: (a) developing an initial sui^vey draft; (b) obtaining review by an expert panel; (c) .soliciting participation of music therapists via e-mail; (d) sending reminder e-mail messages after 2 weeks and 4 weeks to individuals who did not respond. The expert panel consisted of a two university professors in speechlanguage pathology, a practicing board certified music therapist, and two university professors in music therapy. Although Register (2002) had participants distinguish between their role as collaborator versus consultant in her survey, we chose to ask participants broadly about iheir "work" with SLPs to help gain the broadest picttire of different kinds of collaborations. ' The Inicnift-based lool used was SuiTcyMonkey® For a fVf. surveys using both closed and open-enilfd quesiions types can be crealcd using a t iistnnii/able web interface. PartieÍpanLs' e-mails are added lo a database and a form e-mail can be sent to invitees wilh a clickable web link tbat assigns each participant a unique identifier to track boih individual and group responses. IdentiHei^s wilh individuals e-mail addresses were eliminated for ihe purposes of data analysis in tbe cunent study, http://www.surveymonkey.com

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Register noLed ihat making definitive distinctions may have been difficult. Closed-ended responses to the survey were stored by question using the Internet-based survey tool. Open-ended responses were recorded and available for download and review. Open-ended ("other") responses were reviewed and a decision between the authors was made to either include responses in existing categories or develop new categories. Open-ended questions regarding benefits and challenges were separated into distinct thought units and analyzed for emerging themes and subthemes (Vaughn, Schumm, &c Sinagub, 1996). To ensure that all participants were responding to the same idea of an SLP and augmentative and alternative communication, the following definitions were provided before each major section of the survey: For the purposes of this sui-vey, a Speech-Language Pathologist is a health professional trained to evaluate and treat people who have voice, speech, language, or .swallowing disorders, including hearing impairment, that affect their ability to communicate. (Adapted from Children's National Medical Center, 2006) Questions in this section refer to Augmentative and Alternative Communication (AAC). Individuals who cannot use their natural speech to meet their daily communication needs require AAC. For the purpose of this survey. Augmentative and Alternative Communication can include things like using a voice output communication aid to talk to a friend, pointing to pictuies in a communication book to order at a restaurant, or using a computer to type and send e-mail. It is anything that can improve someone's ability to communicate. (Adapted from Binger 8c Light, 2006) The survey included "logic" links such that if a participant noted he or she did not work with an SLP or with AAC, subsequent questions related to that topic were skipped and the participants was taken to the next set of potentially relevant questions. All participants completed the demographic section and the questions related to wbether or not they ever or currently worked with an SLP or with AACl

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Results Response Rate

Of the 1834 e-mails sent, 159 were returned as undeliverable, 180 individuals declined to participate, 805 did not respond, 16 required an anti-spam application (which was completed), and 847 responded. The response rate of total members (1834) was 46.2% while the response based on total deliverable messages (1675) was 50.6%. The rate is comparable to other surveys of music therapists including Register (2002) with a 42.8% response rate and 56.5% of "usable surveys" for the survey by Smith and Hairston (1999). Neither of the previous surveys was done electronically. Dernographicji

The mean age of respondents was 38.79 years {SD ^ 11.53, Man = 36, Range 19-74) with 10% being male and 90% female. The majority of respondents (93.2%) identified themselves as White (not Hispanic or Latino), with the following other groups including Asian-Pacific Islander (3.2%), White (Hispanic or Latino) (1.3%), Black or African American (not Hispanic, L8%), or Other (0.6%). In terms of edticational background the majority of participants had a Bachelor's Degree (51.4%), with a smaller percentage having a Master's Degree (41.6%). Other educational credentials included a PhD (5.6%) with degrees such as PsyD, DMA, and MT equivalency making up the remainder of the sample (1.4%). Respondents' mean number of years working as an MT was 11.85 (.S/) = 9.8, Mrfn = 9, Range = 0.7-52). The majority reported working full time (58.5%) while others worked part-time (32.8%) or did not currenUy work as MTs (8.fi%). The MTs in this survey reported currently working with a wide variety of groups of individuals with disabilities including developmental delay (children) (54.1%), autism spectrum (52.8%), behavioral disorder (40.7%), multiply disabled (40.6%), language/learning disabled (35.2%), Alzheimer's/dementia (32.1%), neurologically impaired (28.5%), developmental delay (adults) (26.7%), hearing impaired (24.1%), stroke (21.5%), terminally ill, (21.5%), medical/surgical (20.4%), head injury (20.1%), psychiatric (16.2%), Parkinson's disease (15.4%), and other (6.6%).

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m Past Work D Current Work

Given help/adyce

help/advice

Co-Treat during SLP

Co-Treat during MT

Type of Collaboration FIGURE 1.

Music therapists' past and current work with speech-Iangu^e pathologists.

The ages of individuals currently served by the MT's covered people across the lifespan including 0-2 (23.2%), .V5 (49.8%), 611(55.8%), 12-21 (60%),22-60(56.6%),and 61 and older (49.4%). Work xvith Speech-Language Pathologists

Tbe results of this survey indicate that a large amount of collaboration is taking place between MTs and SLPs. Projections from tbe survey suggest that about 3 out of eveiy 4 MTs can expect to work with an SLP at some point in their career. A summary of past and current work with SLPs is shown in Figure 1. while a summary of past and current locations of collaborations is displayed in Figure 2. Collaborations were most often initiated by MTs, but in over 50% of cases SLPs also initiated joint work. A summary of the ways that MTs typically get involved working with SLPs in shown in Figure 3. MTs noted a variety of ways in which they worked with SLPs including co-treating during MT and SLP sessions as well as giving and receiving advice. Additionally. altbi)ugb MTs often worked to help individuals speak more clearly in their collaborations, MTs were responsible for coverirïg a wide range of goal areas witb individuals with multiple types of disabilities. A stimmary of the proportion of responses for a variety' of communication goal areas is shown in Table 1. Goals were taken from the Peters (2000) text.

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WttbMUDn Euly CvMr OMhoal OanMi

FUHo

aeuaa

Tt«alnvil

Location of Cdlf^xtration FltiL-RK 2 .

Music therapists' past and current locations of collaboraiions with speech-language pathotogists.

Benefits and Challen^s Working unth Speech-Language Pathologists

Participants reported a variety of benefits and challenges in working witb SLPs. A simimai-y of tbe themes and subtbemes along witb example quotes are shown in Table 2 (benefits) and Table 3 (challenges). Benefits oi' working with SLPs included the following themes: Enhancing Knowledge, Enhancing Goals, Enhancing Client Progress, Enhancing Professional Support, Enhancing Ingenuity, and Once SLPs see tbe benefit, they keep Ciiming back. In terms of enhancing knowledge, participants reported the sharing of knowledge was bidirectional. MTs shared knowledge about music tberapy with SLPs, and MTs gained knowledge about speecb.

MT contacts SLP

Asked by SLP

Part of initia assessment

Asked by teacher

Asked by parent

Asked by sctiool administrator

Method Collaboration Initiated Fials mth SLPs Communicaúon giial

Prrtrnl icpiining work on EOHI when collabonning with SU'a

Speak more clearly Improve sounds they are not able to say Use AAC along with speech as a clarification strategy Use AAC as an alternative communication strategy Learn to follow directions Have a better rhythm when they speak Improve how loudly or softly they are talking ' improve their vocabulary Improve the content of what they are saying Slow down or speed up how fast tliey talk Lengthen their sentences Improve the pitch of their voice Understand what others are saying . Reading skills

67.7% 67.2% 57.9% 57.9% 53.9% 45.1% 44.1% 41.5% 41.1% 38.3% 35.8% 35.3% 29.9% 14.1%

language, articulation, swallowing, AAC, anatomy, and different tberapeutic tecbniques from SLPs. Goals were enbanced by collaboration in setting goals and by designing effective cotreatment strategies to address goals. Once goals were set, participants also noted tbat client progress was enhanced throtigh increased insight about tbe client tbat led to more meaningful and motivating activities. With a bigher level of motivation came better carryover of skills outside of tberapy enbanced by tbe multiple modalities (speaking, singing, gesttiring, facial expressions) encouraged in the jointly designed activities. MTs also reported feeling supported professionally through tbeir SLP collaborations as SLPs belped witb data collection, validated tbeir ideas, gave feedback and offered advice on management and successful integration of communication goals. The different approacbes in the two fields belped some MTs to break out of establisbed patterns and take new approaches. They reported SLPs also became more innovative as they brainstormed new ideas and shared resources to foster further creativity. Finally, MTs surveyed reported tbat once they convinced SLPs of benefits, the SLPs took more initiative in fostering partnerships by requesting MT services again or making referrals. Although many benefits were identified, participants also noted several challenges to working with SLPs. Challenges included the

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TABI-K 2

Benefits of Working vnth SIJ's according to MTs Surveyed Thcnn

knowledge

Enhancing goals

Enhancing client progress

Enhancing professional support

Enhancing ingenuity

Sharing knowledge about music therapy with SLPs Gaining knowledge about speech, language, articiilaiion, swiillowing AAC'.. anatomy and difierent therapeutic techniques Collahoration on goal development Co-treatnieni on similar goals Overall progress improved Belter insight about (he client and his/her needs leading to increased motivation hnproved carryover of skills Multiple modalities encouraged Data-based support Validation of posilive ideas Getting constjuctive feedback Advice on integration and management Creative ideas Brainstorm ing Increased resources

Willingness to work again Once SLPs Referrals from SLPs see the benefit, they keep coming back

"More knowledge for the MT about language development and techniques; more knowledge for the SLP about creative ways to use music to foster language development.' "It is helpful to work along side another professional to find the best way of addressing goals," "Obvious henelit is to clients who receive a more well rounded treatment that utilizes the skills of a team of therapists/ professionals" "Provide client with consistency of communication across therapeutic settings" "Adds credibility to the inusif therapy practice when the Sl.P validates lo medical professionals and family the progress made using MT." "Keeps us creative, helps tis develop fresh ideas and activities for the student.s" "They usually have a lot of books/ information to share with me." "The SLPs I have worked witli have been very interested in music therapy and how such intervendons can assist iu their goals." "Their openness, after many years of encouraging, to incorporating music"

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i TABLE 3

Challenges in Workitig ¡uith SLPs according lo MTs Surveyed

Scheduling

Time to plan/ coordinate Availability of SLP

Different orientation in addressing goals

Different approach Different vocabtilary

Lack of knowledge SLPs knowing about about music MT a.s an option Üierapy Misunderstanding ol their services Skepticism about music Uierapy

SLP Uck of comfort/ experience with music Funding

Effective and efficient integration

Not getting credit/ gaining respect Recogiiiiion of MT as a profession SLP not open to music therapy/no interest in music C-onvincing effectiveness of music therapy Educating SLP with instrumen ts/(^tti iig SLPs comfortable with singing Fund ing/ex pensive/ reimbursement Pliinning/creating sessions that effectively integrate both disciplines Incorporating music into SLP session Working speech into MT sessions Distracting for children

"Finding time to update SLP— they are contracted with our facility and may come any day at any time." "They can get too task oriented losing the whole person" "Their professional lingo is unfamiliar and sometimes it requires patience on both parts" "SLP misunderstanding music therapy as simply entertain mem/'fun' rather than addressing measurable outcomes and speech goals" "Passing the te.st of credibility by proving that MT interventions have high success rate."

"Some SLP's are not willing to incorporate song into their work because of their discomfort with singing." "Collaboration can be difficult due to billing issties (who gets paid for the session, because you both can'l get paid)." 'Not having them take over the session btit rather assist you with what yoti the MT is doing."

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T,\BLE 3

Continued F.xamplr

Thi-inr

Professional boundaiies

Interpersonal issues

Willingness to share "In recent years, I have clients/turf issues experienced instances where Professional boundaries/ an SLP feels threatened that their sei"vice may be cut or is stepping on toes Division of responsibilides/ not as valued in comparison leading ihe session to MT, especially when Compeiitioii parents are pressured by Administrative problems school districts to reduce range/freqtiency of services their child." Inability to coordinate/ "Strong personalities can collaborate compete/take over." Commimication Personality is.sues

following themes: Scheduling, Different Orientation in Addressing Goals, Lack of Knowledge about Music Therapy, Skepticism about Music Therapy. SLP Lack of Comfort/Expetience with Music, Funding, Effective atid Efficient Integration, Profe.ssional Boundaries, and Interpersonal Issues. Scheduling made up the largcsl nttmber of responses from participants. MTs noted thai scheduling interfered with time to jointly plan activities or even to meet with an SLP in the same facility. Although participants noted creativity was sotnetimes encouraged through the differing approaches of MTs and SLPs, several found the difference in orientation to be a liability. Specifically, participants noted that SLPs may be too tiarrowly focused on specific goals to the detriment of the whole person's quality of life. Professiotial jargon also created problem in successful communication either in reading assessment reports or discussing treatment. Beyond orientation, several participants also noted that SLPs had a lack of knowledge of music therapy often seeing it as recreational or not even an option. For those with knowledge of music therapy, MTs reported skepticism from SLPs on benefits. MTs expressed a need to justify their field to gain lespect or adoption of services. SLPs who were open in some cases may not have been comfortable with tiutsic. MTs noted that they may have needed

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to spend time helping SLPs become comfortable with singing or with other instruments before any kind of MT could even begin. Even witb SLP support, funding was something that created barriers. Cballenges with funding included who would get reimbursement in co-treatment sessions or outright lack of lunds to support MT, Even with funding, effective integration of services was not always easy. MTs noted that continually planning and creating sessions that effectively integrate botb disciplines, incorporating music into SLP .sessions, and working speech into MT sessions were also ongoing challenges. Additionally, some participants felt it was distracting for children to have multiple professionals working in a session at once. Several MTs stated that disputes had arisen over SLPs feeling "protective" of tbeir domains and not wishing to share in treatment. Professional boundaries also included individuals in academia trying to collaborate on research. Some MTs claimed eacb researcber might be more focused on building a research base in their own field rather than working toward a joint end. Einally, personality conflict and other interpersonal issues, ratber than professional issues, also represented challenges for some MTs surveyed. Work xmth AAC

The majority of respondents (50.1%) reported they work with individuals requiring some form of AAC in their current practice. The mean numbers of individuals requiring some form of AAC on MT's caseloads was 14.6 {SD = 27.84, Mdn = 5, Range = 1300). The ages of individuals requiring AAC served by MTs was .skewed toward school aged individuals with the breakdown covering 0-2 (8.6%), 3-5 (42.6%), 6-11 (56.7%), 12-21 (52.6%), 22-60 (30.2%), 61 and older (17.1%). Individuals requiring AAC used a variety of systems including gestures (pointing, head nod, etc.) (84.6%), signs (76.1%), real objects (48.4%), picture communication boards (88.4%), and electronic systems with speech output (67%). The largest portion of individuals requiring AAC on MT caseloads was made up of individuals witb autism/pervasive developmental disorder (67.5%). Individuals witb developmental delay (55.5%) and multiple disabilities (54.7%) made up the next largest portions with individuals with a non-specified speech/ language impairment following (46.1%). Individuals with trau-

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Extensive 7

None1 Level of Expertise with AAC FlCDRF 4.

Music therapists' reported expertise with augmentative and alternative communication {AAC).

matic hrain injury (24.3%) and those who are deaf or blind made up the smallest proportions (16.8%). The average level of expertise reported by MTs working with individuals requiring AAC was 3.9 on a scale of 1-7, with 1 indicating no expertise and 7 indicating extensive expertise. A summary of the breakdown of reported expertise is displayed in Figure 4. MTs reported a range of goals addres.sed with individuals requiring AAC. Table 4 shows the frequency with which their therapy with individuals reqttiring AAC addressed several goal areas (Peters, 2000). The highest frequency (on a scale of 1-7, with 1 being never & 7 being always) of goals included those addressing expressive communication (mean of 5.86) and receptive communication (mean of 5.19). TABLK 4

Percent and Average Rating Score of the Frequency with which Surveyed MT-BCs Working with Individuals Requiring AAC Addressed the Following Goal Areas Always (1)

tixpre.ssive communication Receptive communication Fine/gross motor Socialization Emotional/behavioral Academic

1 3 5 7 3 10

0)

?i 6 4 9 14 10 11 16 4 7 U 10 10 36 12 10 lH

26 19 24 17 21 17

15 25 21 27 24 21

36 26 14 26 16 II

Avérant li OUI of

5.86 5.19 4.62 5.15 4.76 4.24

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Few music therapists reported frequently following the divisions oudined in an earlier table by Blackstone and McCarthy (1997), suggesting a different orientation to musical areas and integration. Consequently, these data (question #28) are not included in tbe current summary. Discussion Work with SLPs

It is critical tbat preparation of future MTs include training in working in a variety of roles witb other professionals. The results suggest that potentially more referrals could be made in both directions by increasing MT contact with local SLPs or by increasing SLP's awareness of MT services. Further, given that a challenge noted was professional Jargon, it is also important tbat MTs have opportunities to learn about SLP treatment. Participants noted several other challenges in working witli SLPs. A variety of strategies may be reqtiired to overcome tbese challenges. For example, scheduling difficulties could require administrators to be involved in allowing time for planning or for insurance providers to recognize tbe challenges but ultimate value in interdisciplinary service delivery. The benefits noted in the current study cotild be an effective starting point for negotiating extra time. Education of SLPs both to increase their knowledge of music therapy and to decrease their skepticism could be a way to increase effective collaborations. Increased efforts at publication in eacb otiier's journals could be belpful. Grant opportunities that reward interdisciplinary work could also be effective vehicles. Certainly, efforts tbat highlight evidence-based practice would be persuasive in the current climate for SLPs. It seems possible that increased education could help to address challenges such as professional boundaries and effective integration as well. Interpersonal issues may best be solved tbrougb training in collaborative problem solving (Blackstone, 1995) or team building techniques. Experiences with AAC

The results were consistent uith Binger and Light (2006) in terms of the top two groups making up caseloads of individuals requiring AAC (autism and developmental delay). Smith and

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Hairston {1999} found 78% of MTs in the schools worked with children with developmental delays and 71% worked witb cbildren with multiple disabilities. The Smith and Hairston number appears higher than tbe number in tbe current sui-vey, however current results were not broken down by disability group and location. Regardless, the nttmbers indicate nol only a need for preparation in working wilb children witb autism and olher developmental disabilities, but also for the role of AAC in working with these individuals. In 57.9% of re.sponses. participants noted addressing AAC goals in their wot k wilh SLPs and r>(). 1 % reported cun eutly working with an individual who required some form of AAC in tbeir cttrrent practice. Given these numbers and given tbat the average level of expertise witb AAC was 3.9 otit of 7, il is critical to find ways to meet the training needs of MTs in serving indi\idttals wbo reqttire AAC. Because tbe majority of MTs reported sei-ving school-aged individuals requiring AAC, in-service options cotild provide an outlet. Since not every SLP may have expertise in AAC (Romski & Sevcik, 2005) il is important that MTs be well informed. The variety of AAC used by individtials served by MTs also creates challenges. High-tech systems that have voice output may have sophisticated music-making or .s\iithesized voice options, however the technical competence reqtured ntay restrict ibeir use. Conversely, low-tech systems such as photos and line drawings, although not technically challenging, may require more imagination to work beyotid their use to solely make lequests. Limitation.s

There are two important limitations to note in the current study. First, there are weaknesses to using Internet-based surveys (Fowler, 2002). Ultimalely, tbe results are limited lo professional AMTA members who use and respond to e-mail. Since l.')9 me.ssages were undeliverable, there are indications that not all MTs have active email accotints. Individuals can be between jobs or residences and not have updated profiles. Furtlier, in an age where people can receive hundreds of e-mails each day and worry about the safety of their personal information, some people may lack the lime or trust to complete Internet-based surveys. Assurances were made about the anonymous nature of responses, but there is little to be done abottt individuals' busy scbedules or mailboxes.

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A second limitation has to do with the representativeness of the sample from a geographic perspective. Although Register (2002) required respondents to note their region, no information was asked abotit where respondents were practicing in the cunentstudy. Consequently, it is possible the results contain ati over-representation of one area of the country. Similarly, no information was obtained about whether individuals were working in rural or urban areas. In addition to assuring rcprest?ntativeness of the sample, such information could also help to determine if individuals in a particular ai ea or location were dcïing more or less work wilh SLPs. Future studies should consider using a combination of e-mail and mail in approaches with stratified random sampling to get the most representative sample (Fowler, 2002). Future directions

The results of the current study indicate a need to find ways to expand the success of interactions between MTs and SLPs. Future research could address effective means to teach SLPs about music therapy which in turn could promote change of attitudes of SLPs toward music therapy. Future research could also analyze the effectiveness of different service deliveiy models with careful documentation of how individual schedules were negotiated in the process. Finally, since MTs reported benefits after SLPs had seen tbe benefits it appears important to find ways to get quicker investment from SLPs so that ultimately it is the clients served who can reap the benefits. References Beukelman, D. R., & Mirenda, P. (2005). Aupnentativf andallmtative communication: Stipfjorling chiltlrey} àf adults with cimtplex communication needs (.Srd cd). Baltimore: Paul H. Brookes. Bingcr, C , & Light, J. (2iH)fi). Demographirs of preschoolers who require AAC. Langua^. Speech, and Hearing Services in the Schools. 37, 200-208. Blackslone, S. (1995). AAC teams: 2, 4, 6, 8, how do we collaborate? AugmentaHve Communication NeiDs, 8(4), 1-8. Blackstone. S.. 8c McCarthy. J. (1997). A/\C users and the aris. Augmentative Communication News. Î0, 1-14. Childrens National Medical Center. (2006). [On-litie]. Available: htip://www. dec hildrens.com/dcchildrcns/forparents/CrcystoneDispUiy.aíipx.^í;rmton eld = P01606 Cohen, N. S. (1994). Speech and song: Implications for therapy. Music Thnapy Perspectives, /2{1), 8-14.


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Colemaii. K. A. (2002), Music therapy for learners with severe dlsahiliiies in a puhlic school selling. In B. L. Wilson (Ed.). Modeh of music tíierapy inimimiion in sihool settings (pp. 197-2()9). Silver Spiing. MD: American Mtisir Therapy Association. Dillman, D. A. ('20(10). Maii and internet surveys: The tailored design method (2nd cd.). New York: John Wiley & Sons. Fowler, F. ). (2OO'¿). Survey research iruthods. Thousand Oaks, ÇA\ SaKC Piiblicalions. Geist. K-, McCarthy. J., Rodgers, A., & Porter, j . (in press), Integrating music therapy seraces and speech-language therapy services for children with severe communication impairments: A co-trealment model. Instnidionnl Psydiohgy. Ilohson. M. (2(10fi). Ihc oard ci-rtitîed music therapists. Joumal of Music Therapy. 59(4). 305-321. Romski, M., & Sevcik, R. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Childnrn. 18, 174. Smith. D. S.. Ä: Hairsion. M. |. (1999). Music therapy in school settings: Current praclice. Joumal of Music Tiieiafyy. 3b(A). 274-292. Vaughn, .S.. Schumm. |. S.. & Sinaguh. J. (1996). Fncwi group interviem in education and psycholofff. Thousand Oaks, C.\: Sage. Whipple.]. (2004). Music in intervention f«r children and adolescents with autism: A meta-analysis.Jowma/ of Mu.sic Therapy, 4¡(2), 90-106. Zoller. M. B. (1991). Use of music activities in speech-langu^e therapy. ¡Jinguage, Speech, and Hearing Services in Schools. 22. 272-276.


Appendix Survey Questions L 2. 3. 4. 5. 6. 7. 8. 9. 10.

11. 12. 13. 14.

15. 16.

What was your age on yotir last birthday? Sex Ethnic Background Highest level of edtication in music completed How many years have you worked (full- or part-time) as a Music Tberapist? Which statement best defines your current work hours? What populations of individuals witb disabilities do you cturendy serve? What ages of individuals with disabilities do you currently serve? Have you ever worked with Speech-Language Patbologists? Check all statements related to any of your PAST work with Speech-Language PathologisLs: Have you ... given help/ advice to an SLP, Received help/advice from an SLP, Worked with an SLP during the scheduled speechlanguage therapy sessions. Worked with an SLP during scheduled music therapy sessions In reference to your PAST work, where did your collaboration with a Speech-Language Pathologist take place? In reference to your PAST work, what populations of individuals with disabilities did you serve when you worked with Speech-Language Pathologists? Are you CURRENTLY working with an SLP? In your CURRENT practice, approximately how many hours per week does yotu- work Speech-Langtiage-PathologisLs include: giving lielp/advice to an SLP, Recei\ing help/advice from an SLP, working with an SLP during .schedtiled speech therapy sessions, the SLP working with me during the scfieduled mtisic therapy sessions, Wliere do you CURRENTLY work/collaborate with a Speech-Language Pathologist? How do you typically get involved with working wilh a speech-language pathologist?

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17. Wliat are the areas that you typically work on when collaborating with a Speech-Language Pathologist? Helping a client ... with understanding, improve content, lengthen sentences, improve vocabulary, speak more clearly, improve sounds ft)llow directions, improve reading skills, improve rhytiim. with rate of speech, improve pitch, improve loudness, use AAC with speech, use AAC to communicate 18. What are the top 3 benefits to working with an SLP? 19. What are the top 3 challenges to working with an SLP? 20. In your CURRENT practice, do you work with people who use some form of AAC? 21. In your CURRENT practice, approximately how many people do you work with that use some form of AAC 22. Of those who need a n d / o r use AAC, how many have the following primary disahilities? (Cannot have hearing impairment as primary- disability) Autism/PDD. Developmental Delay or Mental Retardations, Multiple Disabilities. Deaf-Blindness, Traumatic Brain Injuiy. Speech or Language Impairment 23. Of these children (refen ing to question 22), how many also have: Cerebral Palsy, Hearing Impairment (without deafblindness, or visual impairment (without deai-blindness) 24. Wliat ages of individuals who require AAC do you CURRENTLY serve? 25. Of those who need and/or use AAC, how many use the following AAC; systems? Gestures (pointing, head nod, etc.) signs (including adapted and unique signs), real objects (e.g., holding a cup to indicate desire for a drink, picture communication boards/books containing pbotographs or line drawings and/or individual picture symbols (e.g., PECS), electronic systems that talk (e.g., BIG mack, Tech/Talk, Dynavox) 26. How would you characterize your level of expertise with AAC? 27. To what extent do your music therapy interventions with individuals who use AAC address the following goal areas? NON MUSICAL AREAS Expressive Communication (e.g., requesting items, songs, instruments, or a turn). Receptive Communication (e.g..

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demonstrating an understanding of musical directions or following therapist directions). Fine and/or Gross Motor Movement (operating devices). Socialization (e.g., participation in group music making), emotional/Beha\ioral (e.g., expressing feelings). Academic (e.g., using a device in conjunction with learning specific academic tasks) 28. To what extent do your music therapy interventions with individuals who use AAC address the following goal aieas? MUSICAL AREAS Appreciation of Music (e.g., listening to CDs, going to performances), recreation of music (e.g., playing a song from sheet music or singing/performing a familiar song). Creation (e.g., composing music or improvisation)

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