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Music & Medicine | 2016 | Volume 8 | Issue 4 | Pages 199 – 206 Foster, Pearson & Berends | 10 Domains of Music Care
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Introduction
This paper introduces a developing framework for
understanding music care, which is a developing approach to
care that draws on the inherent health-promoting effects of
music for overall well-being. The paper introduces and defines
music care; it presents the rationale for a conceptual
framework of music care delivery; and it discusses the impact
and possibilities this framework offers.
Culture of Care
In today’s healthcare system in Canada, an emphasis on
relational care [1,2], also known as “person-centered care” [3-
4], “patient-centred care” [6-9], and “whole person care” [10-
13], are increasingly being embraced as standards of care.
There are various models of relational care nuancing certain
aspects of human experience in care i.e. human beingness,
relational autonomy, and cultural factors [14-19]. What is
clear in each model or emphasis is that the focus of the care
professional is on an individual’s needs, preferences, and
quality of experience rather than on the pathology of the
disease or condition.
This is reflected in Canadian public health care settings,
and can be seen in various sectors of Canadian health care. For
example, Cancer Care Ontario recently published a Person-
Centered Care Guideline, in which they state that the goals of
this emerging care approach are to “give patients a voice in
the design and delivery of the care they receive, and enable
patients to be more active in their journey in order to deliver
better health outcomes” [20]. The report also states that
“although the Person-Centred Care Guideline is cancer
specific, many of its principles are relevant to any and all
health care (and other) professionals that interact with
patients, their family members and caregivers.”
McGill University’s Faculty of Medicine in Montreal has
pioneered “Programs in Whole Person Care” to promote this
emerging approach to care through conferences, workshops,
publications and continuing education opportunities. The
program’s mission statement promises “to transform Western
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PRODUCTION NOTES: Address correspondence to:
Bev Foster MA, BEd, BMus, ARCT, AMus E-mail:
bfoster@room217.ca | COI statement: The author declared that
no financial support was given for the writing of this article. The
author has no conflict of interest to declare.
Copyright © 2016 All rights reserved.
International Association for Music & Medicine (IAMM).
Full-Length Article
10 Domains of Music Care:
A Framework for Delivering Music in Canadian Healthcare Settings (Part 3 of 3)
Bev Foster1, Sarah Pearson1,2, Aimee Berends1
1Room 217 Foundation, Ontario, Canada
2Wilfrid Laurier University, Waterloo, Ontario, Canada.
Abstract
Music care is a developing approach to care that allows the therapeutic principles of music to inform caring practices in both
formal healthcare settings and community or home-based contexts, and to create an integral role in developing more relational
and person-centered cultures in caregiving. A significant part of the music care approach is a conceptual framework describing
10 domains of delivery. This article is the third in a three-part series on the theory and applications of a music care framework.
Music is increasingly being recognized in health care communities as an effective psychosocial and rehabilitative intervention,
increasing many aspects of quality of life. Currently, there is little standardization as to how music may best be integrated into
individual care goals and care settings, though a growing body of literature supports the important impact of music in health
care. It is this absence of standardization that has led the authors to develop a music care conceptual framework, so the varying
scopes of practice that integrate music can be distinguished from one another and new possibilities for optimizing music in care
can be identified. While the first study in this series examined how music care is understood in Canadian long term care facilities
(1), the purpose of the second study explored how music could be optimized in complex continuing care environments, using
one such facility in Ontario, Canada, as an exploration site (2). The 10 Domains of Music Care presented in this paper can be
used as both a research tool and a practical, actionable tool for healthcare providers, managers, and decision makers. The paper
discusses the 10 domains of music care delivery, need for a music care conceptual framework, and the implications and
applications the framework provides.
(1) Foster, B., Bartel, L. (2016) Understanding music care in Canadian facility-based long term care. Music Med, 1(8) 29-35.
(2) Nelson, M., Foster, B., Pearson, S., Berends, A., Ridgway, J., Lyons, R., Bartel, L. (2016) Optimizing music in complex
rehabilitation and continuing care: A Community Site Facility Study (Part 2 of 3), Music Med, 8(3) 128-136.!
Keywords: music care, person centered care, health arts, music therapy
10 domains of music care.
multilingual abstract
| mmd.iammonline.com
Music & Medicine | 2016 | Volume 8 | Issue 4 | Pages 199 – 206 Foster, Pearson & Berends | 10 Domains of Music Care
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MMD | 2016 | 8 | 4 | Page 200
medicine by synergizing the power of modern biomedicine
with the potential for healing of every person who seeks the
help of a health care practitioner” [21]. McGill University is
among other Canadian medical schools acknowledging a
whole person care approach.
Relational care is also reflected in the long term care
(LTC) sector and in care for older adults. A compelling report
from the Canadian Healthcare Association in 2009 [22] called
on the government to address the larger issue of quality of
care, specifically in LTC, de-emphasizing the sole focus on
tasks of physical care and prioritizing emotional, cognitive,
social and spiritual care. The Canadian Alzheimer’s Society
released a briefing in 2012 calling for new language to be used
when discussing persons with dementia that would help
validate personhood rather than victimhood [23].
The very title of Canada’s Mental Health Commission’s
2012 national strategy for mental health is called “Changing
Lives, Changing Directions”, indicating change is occurring in
this sector as well. A tendency towards person-centered
approaches towards mental health are the basis of this change.
The opportunity is for everyone’s efforts—large and small,
both inside and outside the formal mental health system—to
help bring about change. One of the calls to action encourages
every Canadian to “promote mental health in everyday
settings and reduce stigma by recognizing how much we all
have in common—there is no ‘us’ and ‘them’ when it comes
to mental health and well-being” [24]. Personhood calls for
mutual respect and human dignity as strong tenets of this
strategy.
Canadian hospitals and community health agencies are
emphasizing person-centered approaches to care at the end-
of-life. In 2005, the Government of Ontario initiated an
advisory committee to improve access to palliative care that
was integrated and interdisciplinary, that would both improve
access to pain and symptom management protocol, and focus
on addressing whole person values [25].
Music Care: A Developing Approach to Care
Music is an intensely and inherently human activity [26],
relational in nature, and can be used as a method of validating
the whole person within healthcare systems. Music therapy is
recognized in many Canadian hospitals and LTC settings as a
respected allied health practice. The healing power of music
can be experienced beyond the clinical relationships of music
therapy, and there is potential for other healthcare
professionals, community musicians, volunteers and family
members to integrate music effectively into their care.
Understanding the myriad of possibilities of how music may
be delivered in care settings is essential for administrators and
program leaders in order to responsibly and effectively
navigate and steward resources wisely for optimal impact.
The increasing value being placed on relational care is a
natural context from which the music care approach can
emerge. “Music care” has been developing as a working
umbrella term by the authors, as an approach that integrates
the use of music into care goals. Situated within the context of
relational care standards, and within a wider appreciation
towards arts in health, music care is aligned with an overall
change in the culture of care taking place in Canada.
The music care approach allows the therapeutic principles
of sound and musical effect to inform caring practices in both
formal healthcare settings and community or home-based
contexts. Music care is not a specific practice, rather a
paradigm within which music enhances quality of life and
well-being, and plays an integral role in care and care settings
[27].
In 2013 the authors were invited to collaborate on a
research study with an Ontario complex rehabilitation and
continuing care hospital on the optimization of music in this
facility [28]. In order to conduct this research, the researchers
recognized that they would need to develop a tool for defining
and assessing music care. This became the basis for a
conceptual framework for music care delivery. This
framework was called “10 Domains of Music Care”, and is the
foundation of this paper. It has also been used by one of the
authors in 2014 as a mapping tool in a pan-Canadian music
care study in Canadian long term care [29].
Among the authors are two music therapists working
within interdisciplinary, medical teams as well as a music
educator who has performed music in long term care settings.
These authors have recognized ongoing misconceptions about
using music for wellness (music therapy vs. other therapeutic
practices), and also see how the use of music can be more
effectively leveraged for care goals in healthcare settings. This
developing framework is motivated by addressing these needs.
Based on the authors’ professional experiences as well as
the music care research projects which have tested the
working structure in two different healthcare settings, the
music care delivery conceptual framework is grounded in
both practice and research theory.
Why Do We Need a Music Care Delivery Framework?
With growing acceptance of using music in healthcare, as well
as current interest in music in health and wellbeing from
varied disciplines, there is a need for understanding and
conceptualizing relationships among them. McDonald, Kreutz
and Mitchell compiled a book of multidisciplinary articles
“echoing the huge interest in the relationships between music,
health and wellbeing”[30]. In this book, they recognize the
need to be able to categorize different types of health-
musicking activities, and propose a conceptual framework
which they define as “a multitude of [health-musicking]
approaches and many different epistemologies”. They
integrate them into four general, overlapping categories,
including music education, music therapy, community music,
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and everyday uses of music, all of which have positive
outcomes for health and wellbeing [31].
A music care delivery framework addresses needs that are
emerging in caregiving practices and professional issues
relating to music in health. This framework addresses a need
for clearer terminology around music therapy and music care.
As of 2016, there is no scope of practice defined by the
Canadian Association for Music Therapy. While some
provinces are beginning to establish government-regulated
colleges that control the act of psychotherapy, the terms
“music” and “therapy” are not protected terms. Meanwhile,
many other self-regulating practices and programs that use
music as a modality for care are emerging, such as Music for
Healing and Transition [32], and the Music and Memory
“iPod project” [33]. This presents a challenge for the public
receiving music care services, and for employers/managers
seeking music care specialists, in understanding what services
they are receiving.
The misunderstanding about music therapy and other
music care-related services reflects the reality that music is
and can be used by health care providers or other community
members outside the context of music therapy, and other self-
regulated practices, and that sometimes there can be a lack of
clarity between the ways music is used in care. The music care
conceptual framework may help clarify confusion, or lack of
knowledge and understanding by identifying areas of music
care delivery with more precise meaning and clearer language.
In this way, music care practices can be distinguished from
one another by healthcare providers and by the general public.
The music care framework provides a navigational tool
through which to locate oneself or other practitioners of music
care within a particular domain. By introducing the 10
Domains of Music Care, one can map more specifically and
easily the type of music care being delivered. In this way,
healthcare settings can appraise what sort of music care
delivery is being offered at any given time.
The music care framework can also expand ways that
healthcare providers consider using music in their care, giving
them a structure for generating new ideas. It provides a
method of assessing how music care is already being delivered
in a context, and the different domains can act as prompts for
considering new music care options. It gives guidance to
administrators, managers and other decision- makers, and
helps healthcare workers think “outside the box” of what has
been traditionally included in care settings.
The Framework: 10 Domains of Music Care
The music care delivery framework was developed as a
research tool to support a hospital-based research study on the
feasibility of music optimization [34]. It emerged through the
research team of music care experts triangulating the different
perceived aspects of music care delivery with current research
and grey literature. It was then tested against the collected
data. The music care approach posits that music care consists
of 10 domains of music delivery, which are shown below in
Table 1.
For the purposes of this paper, the individual care receiver
in whatever healthcare context is referred to as “person(s)”.
Care partners refer to all members of the circle of care,
including persons, healthcare providers, volunteer and family
caregivers, and other community members.
Domain
Key delivery activity
Community
Accessing music performance between
healthcare site and community-at-large
Specialties
Performing therapeutically-intended music
by practitioners with certified training
Music Therapy
Providing treatment using music within a
therapeutic relationship as an accredited
scope of practice
Musicking
Engaging informally and spontaneously with
music
Programming
Integrating music formally in programs
Technology
Incorporating technology to deliver music for
a care-related goal
Sound
Environment
Bringing intentionality to sounds made in the
care environment
Music Medicine
Administering prescriptive music-based
interventions for medically related outcomes
Training
Training to integrate music into regular care
practice
Research
Investing in evidence-based research using
music and music strategies to enhance care
Table 1. 10 Domains of Music Care
Each music care domain presents a way that music care
can be distinctly used and delivered in health care settings.
1. Community
This domain represents individuals or organizations from the
community-at-large who partner with the onsite
programming teams to provide live musical services or
entertainment within the facility. School groups, community
bands, church choirs may volunteer their time to share music.
Professional entertainers may be hired for special occasions.
Community music may also include access for persons to
attend musical events outside the facility, in the community-
at-large e.g. symphony concert, fiddle club, musical theatre.
2. Specialties
Music care specialists are individuals who bring their training
and experience in music care to a healthcare setting, such as
music thanatologists at end of life [35] or harp therapists [36-
39]. These two specializations have formal training and
certification requirements, though are not regulated by any
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government agency. Music care specialists perform
therapeutically-intended music, often at the bedside. Music
educators and professional musicians can also be considered
music care specialists, particularly if they have extensive
experience applying their musical training to care
relationships and settings like the Health Arts Society [40],
Artists in Healthcare Manitoba [41], or Music Can Heal [42].
3. Music Therapy
Music therapy is a specific scope of music care practice that
uses music and musical tools to address clinical goals and
objectives within a therapeutic relationship. Music therapists
practice in a variety of settings e.g. palliative care, long term
care, schools, hospitals, mental health, and are accredited by a
regulating body [43]. In certain Canadian provinces,
legislation is being passed to make therapies, including music
therapy, a controlled government-regulated activity. In
Ontario, for example, music therapists are regulated under the
College of Registered Psychotherapists and Counsellors.
4. Musicking
The term “musicking” was coined by ethnomusicologist
Christopher Small, who suggests that music as a verb, is an
inclusive activity that can be participated in regardless of skill
[44]. Musicking may involve playing a musical instrument,
singing, dancing, and humming. According to Small, it also
includes being a listener or audience member, helping
organize musical experiences, teaching, etc. [28] In the music
care context, musicking refers to informal or spontaneous
music-making within person-centered care models, where
persons, families of persons, facility staff and volunteers all
participate in the act of musicking, and where musicking
activities are specific to the interest, ability and personal
relationship to music of each care partner. For the purposes of
the 10 domains, musicking is distinguished by its spontaneity
and lack of being “programmed”.
5. Programming
Programming implies the use of staff or volunteers within a
facility, or care partners in the community or at home, who
plan for and employ the use of music into recreational or
therapeutic programs that are delivered individually or in
groups [45]. Programming may include music appreciation
e.g. music of Latin America, Beatles’ music, learning about the
polka; games e.g. music bingo, music crosswords, name that
tune; or sing-alongs e.g. live or recorded. Programming might
mean that music is central to the activity itself e.g. going to a
concert, playing piano, or integrated, where music
complements the main activity e.g. peer support groups [46]
adding music to an exercise class [47], singing during
procedures such as bed transfers or dressing changes [48],
playing a selected music program to cue mealtimes [49].
6. Technology
This domain refers to the intentional use of technology to
deliver music for particular therapeutic intention.
Personalized music may be delivered through personal devices
like iPods or iPads [50]. Patient engagement systems which
bring various media together on a single digital platform make
music available right at the bedside [51]. Virtual music
instruments are technologically designed to improve
functionality of music-making where there may be a deficit i.e.
technology for quadriplegics who have lost use of arms and
make music by head movement or eye blinking [52].
7. Sound environment
Sound environments refer to the aural climate of a care space.
It can include ambient healing sounds set intentionally in the
facility such as running water, music, and/or protocol put in
place by the facility or personal home to regulate ambient
noises, such as radio, call bells, appliances, volume of speaking
levels [53]. Environmental psychologists state that audio
environment is an environmental factor in health care, one
that influences health outcomes and can increase or decrease
stress of patients [54,55]. This domain can also include
infrastructural considerations, such as consideration of
acoustics when designing a space, PA systems and general
sound equipment in a space that will impact overall sound
environment.
8. Music Medicine
Music medicine is an umbrella term to describe the
prescriptive use of music-based strategies in interventions for
medically related outcomes [56]. Examples of music medicine
are Rhythmic Auditory Stimulation [57] which stabilizes gait;
Melodic Intonation Therapy [58] a musical intervention to
improve language reacquisition, and low-frequency sound
stimulation [59] which uses sound waves to treat pain from
fibromyalgia.
9. Training
This domain focuses on educating care providers, caregivers
and other stakeholders in the integration and implementation
of music in care. Music care training helps caregivers gain
confidence to integrate music into regular care practice [60-
62]. Music care training may occur at the corporate or facility
level, in the community, online or as a continuing education
course of study at a college or university. While providing
training opportunities for music care in a facility is not
directly a mode of music care delivery to persons, it does
signify an organizational value in a healthcare context that
music is important and relational care is prioritized.
10. Research
Research includes the use of systematic evidence for music
and its use in health care, embracing a range of topics, fields of
study and applied contexts. Music-based research institutes
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exist in Canada including the Music and Health Research
Collaboratory [63], McMaster Institute for Music and the
Mind [64], Conrad Institute for Music Therapy Research [65],
S.M.A.R.T. Lab (Science of Music, Auditory Research and
Technology) [66], Laboratory for Music Perception,
Cognition and Expertise [67]. Peer-reviewed journals about
arts in health is increasing, making it easier to build a case for
funding academically- and/or scientifically-rigorous studies
on the impact of music in care. Examples of such journals
include: Music and Medicine, Arts in Health Care, Music
Perception, Journals of Music Therapy, and The Arts in
Psychotherapy. Similar to the previous domain, while research
in music care areas is different than direct care using music,
engaging in this research indicates the presumed or perceived
value of music in the care culture of that setting.
Discussion and Implications
The 10 Domains of Music Care is meant to be used for three
purposes: for clarification, mapping and optimization. The
framework gives us clearer language for talking about how
music is being used, and helps to clarify the difference
between, for example, music delivery by a community
entertainer, a recreation therapist facilitating a “Remembering
Frank Sinatra program” and a speech pathologist working for
language reacquisition.
The 10 domains provides a mapping tool to help locate
music care delivery that already is taking place in a setting. In
this way, current music care delivery can be identified,
supported and celebrated. Furthermore, the 10 domains
provide a reporting structure for key accountabilities in music
care.
The framework stimulates ideas and possibilities for
music care optimization. It may never have occurred to a care
provider to consider changing the sound environments in a
setting, or adding music medicine interventions to a
rehabilitation program, or providing baseline music care
training for staff and volunteers. The 10 domains can prompt
these ideas as well as provide a strategic planning tool for
growth.
Each of the domains can stand alone, or could be
organized and grouped to reflect aspects of music care
delivery in healthcare settings. The domains may especially
affect person-centered care when grouped into objective areas
by decision-makers. The following discussion speculates on
groupings based on delivery: who delivers music care, who
music care is delivered to, focus and care proximity of
delivery.
Who delivers music care? While music care is something
we can all deliver at some level, musical competencies are
associated with each domain. Musical performance skills and
music care training are two determinants in who delivers what
type of music care. For example, a staff member untrained in
music may decide spontaneously to hum with a person, thus
engaging in musicking. A harp therapist with extensive
musical and therapeutic training may be engaged to play in a
palliative care unit.
To whom is music care delivered? While all care partners
may be the recipients of music care delivery, the music care
domains primarily target one of these three primary groups:
person, caregiver, all care partners. For example, a hospital
sets up a new environmental sound protocol to limit the
amount of distressing noises in the space, thus impacting all
care partners in the facility. By contrast, a self-care program
for family caregivers may be delivered by a music therapist.
What is the delivery focus? Leadership may choose to
focus music care delivery on a person’s leisure time, or on a
specific goal through intervention, or on systemic change. For
example, a person’s care plan might include listening to
familiar music during unstructured time, training gait during
physiotherapy, or elevating mood at all times by integrating
ambient sound into the care environment. It may also focus
on improving morale and strengthening relationships between
all care partners by generally supporting more live musicking
in the space.
What is the care proximity of delivery? Leadership may
also choose to direct resources according to the proximity of
music’s effect on the person, which can be described in three
ways: direct, situational and corroborative. The direct
domains represent domains that come face to face with the
care receiver. Situational domains are present in the care space
and have more of an indirect impact on the care receiver.
Corroborative domains represent delivery domains that
support using music in care. For example, if leadership
decides to integrate music care more effectively into direct
care goals, they may target direct proximity domains.
Meanwhile, research investment into the impact of music on
care goals and culture, or developing technological music
interventions are examples of corroborative proximity.
Table 2 is an example of how the 10 domains can be
mapped according to these different factors. This mapping
may vary depending on the context of care. Specific delivery
methods can fall under more than one domain. For example,
using iPods in memory care falls under the category of
technology and can also be used as programming and to
encourage musicking. A symphony musician playing at a
children’s hospice is an example of community music that
may also be mapped to programming and might generate
musicking.
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Table 2. Example of Domain Groupings Based on Music Care Delivery
The music care framework may serve as a basis for a
strategic comprehensive approach to integrating music into a
care setting. In this way, initiatives can be planned and
budgeted for by administrators as clearly defined budget lines
for music care. Currently, music care practices are often
buried in budget lines such as “programming” or
“recreational therapy”. Strengthening music care’s credibility
and versatility as defined in the 10 Domains of Music Care
may, in fact, persuade administrators towards innovation and
commitment to sustain music care delivery in all of its facets
in regular operational budgets.
Further research and application of the music care
delivery framework could be explored. For example, does
music care delivery function similarly in other countries?
Does this framework suit healthcare best, or could it be used
to deliver music care in other settings as well i.e. schools?
Could the 10 Domains of Music Care provide a model for
framing dimensions of delivery in other health arts?
Conclusion
Initially designed to meet research needs, the 10 Domains of
Music Care can be used as a tool for music care delivery in
healthcare settings by providing clarifying language, a
mapping tool, and a format to generate new ideas for ways of
incorporating music into care. As the importance of music in
care gains more recognition, so does the importance of having
standardized language to discuss and understand it. Having a
music care delivery conceptual framework with which to
locate, understand, and optimize the practice of music in care
not only aligns itself with the changing culture of care in
Canada, but may itself, be an agent of transformation.
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Domain
Who Delivers
Delivered to
Leadership Delivery Focus
Delivery Proximity
Musician
Musician
+
Training
Health Care
Professionals
+
Training
Any
one
Person
Care
Giver
All
Care
Professional
s
Leisure
Inter-
vention
Systemic
change
Direct
Situatio
- nal
Corro-
borative
Community
X
X
X
X
Specialities
X
X
X
X
Music Therapy
X
X
X
X
Musicking
X
X
X
X
Programming
X
X
X
X
Sound
Environment
X
X
X
X
Technology
X
X
X
X
Music
Medicine
X
X
X
X
Training
X
X
X
X
Research
X
X
X
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Music & Medicine | 2016 | Volume 8 | Issue 4 | Pages 199 – 206 Foster, Pearson & Berends | 10 Domains of Music Care
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Biographical Statement
Bev Foster, MA, is the Founder and Executive Director of the
Room 217 Foundation, an organization dedicated to care
through music.
Sarah Pearson, MMT, MA, is a Music Therapist specializing in
inpatient oncology and palliative care, the program
development coordinator at the Room 217 Foundation, and a
clinical music therapy supervisor at Wilfrid Laurier University,
in Waterloo, ON.
Aimee Berends, MMT, MTA, MT-BC, is a Music Therapist and
Musician in Vancouver, working predominantly in mental
health and addictions.
