Goals and Objectives in Music Therapy

Goals and Objectives

• Completing an assessment provides information about the client’s:
  • Needs
  • Strengths
  • Interests
• From the assessment, the music therapist formulates a treatment plan that is relevant and meaningful to the client.
• The first part of a treatment plan is to determine the long-range intent or purpose of the treatment.
• The next step is to establish goals with accompanying objectives for treatment.
• Objectives are rooted in the musical experiences used in the session.
• Not all music therapists work in a concrete manner; some approach treatment with an open-ended intent but without specified measurable goals and objectives.
• The open approach is not common in healthcare institutions or schools, where measurable outcomes are often needed to meet administrative and reimbursement goals.
• Whether a music therapist operates within a framework that uses concrete goals and objectives or works to help the client evolve through the musical interaction without having predetermined goals and objectives, it is essential that the music therapy have a focus or intent.
• This focus often forms the basis for the goals for music therapy.

Establishing Goals

• Music therapy goals may be established in several ways:
  • Base them on the findings of the assessment.
  • In some settings, the treatment team establishes goals for the client.
    • In these cases, the music therapist does not do a formal assessment but formulates goals for music therapy based on the team’s assessment and goals, together with a less formal assessment gleaned from the first contacts with the client as well as what is found in the client records.
• The task of writing goals has been developed not only by healthcare professionals but also by business managers.
• The SMART (specific, measurable, attainable, realistic, and time-based) mnemonic grew out of the MBO (management by objective) process and was originally associated with business guru Peter Drucker (Bogue, 2005).
• SMART was first published in a management journal by Doran in 1981.
• Wade (2009) suggests that goal-setting is a complex process but that SMART and SMARTER (ethical and recorded) can be helpful in designing goals that are meaningful and relevant for persons receiving rehabilitative care.
• The letters in SMART and SMARTER have been assigned various words over the years, but the intent remains constant: to help goal writers clarify the language of a goal.
• The American Music Therapy Association Standards of Clinical Practice defines a goal quite broadly as “a projected outcome of a treatment plan” while defining an objective as “one of a series of progressive accomplishments leading toward goal attainment” (2013b, n.p.).
• Thus, in music therapy, a goal may be a long-range outcome (or purpose statement) or it may be a goal for a specified period of time.
• If the work is being done in a school setting, the goal may be for the academic year.
• The music therapist might set short-term goals (sometimes referred to as “benchmarks”) leading to the accomplishment of that overall goal but which are still stated in general terms, followed by specific objectives as steps toward the achievement of the goal(s).
• An effectively written goal statement includes a level of specificity about the direction in which change is sought but without being too precise.
• It states the type of change that it is hoped that the client will make with enough precision that it establishes a focus and also communicates this to others who are concerned with the treatment process.
• The authors’ preference is to be more specific than, for example, “improve socialization” or “develop communication,” since such broad goals can elicit a myriad of responses.
  • The goal “improve socialization” could mean anything from an infant focusing a gaze on a caregiver to a young adult becoming more comfortable with interpersonal relationships appropriate in dating.
• Therefore, such goals as “learn to take turns” or “decrease anxiety in a social situation” in the social realm and “increase frequency of eye contact” or “increase topic-based verbalizations” in the area of developing communication are more desirable.
• Broad goals are useful in helping the therapist understand the area of treatment to be addressed.
  • These might be thought of as purpose statements that help to define the overall intent of the therapy process.
• More specific goals help to define the desired outcome of the therapy.
  • These goals provide a focus for the development of objectives that can be used to measure progress toward goals for each individual client.
• Since goals may be stated somewhat differently in various settings, the music therapist will need to adapt the style of writing goals to what is appropriate in his or her setting.
• In some situations, therapists find it useful to have long-range as well as short-term goals.
  • In this situation, the long-range goal may be for a year, with short-term goals for a period of several months or a semester.
  • In some settings, these short-term goals may be for as little as 1 week or one session; thus, it becomes very important that these goals be stated clearly.
• These additional goal levels are not elaborated here but can be developed when the need arises using the principles discussed here.
• One of the best ways to learn how to write effective goals is to study the goal statements written by other music therapists and those in the particular treatment setting.
• A useful goal conveys the direction of the desired change (e.g., improve, increase, decrease) and describes the targeted responses with a moderate degree of specificity.
• Goals will generally be appropriate for a period of time ranging from a single session to several months or more.
• In many treatment settings, goals have specific target dates based on the pattern of treatment plan review for that setting.
  • For example, students in school have Individualized Education Plans (IEPs) that are reviewed annually, while residents of long- term care facilities have care plans that are reviewed quarterly.
  • Therefore, goals for practicum work may continue for the entire semester or be altered according to the pattern of the treatment setting.
• Some sample goals include:
  • Improve visual tracking
  • Develop one-word response
  • Follow two-step command
  • Increase reality orientation
  • Increase verbal interaction
  • Improve range of motion
  • Increase creative self-expression
  • Increase independent use of leisure time
  • Increase appropriate verbal responses
  • Increase verbalization of thoughts and feelings regarding the current medical situation.
• Still another perspective is that of music-centered music therapy and the premise that establishing purely musical goals is clinically valid.
  • Certainly changes in musical response (such as the ability to synchronize with the basic beat, to follow changes in music, to recall and imitate melodic lines, and so on) are easy enough to observe and document.
  • The historical foundations of this way of thinking can be found in the works of music therapy pioneers Helen Bonny, Paul Nordoff, and Clive Robbins.
  • Some current resources that we recommend if you are interested in reading and learning more about this include two books by Aigen, Music-Centered Music Therapy (2005b) and The Study of Music Therapy: Current Issues and Concepts (2014b), and the articles “Music-Centered Dimensions of Nordoff-Robbins Music Therapy” by Aigen (2014a) and “Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders (IMCAP- ND): New Developments in Music-Centered Evaluation” by Carpente (2014).

Establishing Objectives

• Once goals have been established, the music therapist usually identifies objectives.
• These objectives define outcomes expected to occur in the session and will indicate whether or not the goal is being achieved.
• Objectives are thus small, observable, and measurable.
• Since objectives are responses that you expect to observe in the session, they will be specific to the musical strategies that you plan to employ and will change from session to session as your procedures change.
• A way of thinking about formulating objectives requires an analysis of the musical experiences planned for a session.
  • How do the elements of the music address the goals?
  • What responses will the client(s) display to demonstrate that they are moving toward the achievement of the goals?
• Goodman (2007) suggests that the music therapist needs to have a grasp of the goals and objectives and how they are embedded into the musical experiences of the session in order to respond spontaneously in the session while remaining focused on the goals and objectives.
• Berger (2009) also argues for this perspective:
  • “Goals and objectives developed from [a] comprehensive (scientific and clinical), in-depth understanding of causes and deficits from both the physiological and music treatment perspectives help target the work specifically as treatment with music”.
• In addition, objectives will often change from session to session as the client accomplishes each objective and comes closer to reaching the goals.
• Unlike objectives, goals are unlikely to change quickly.
• One format for establishing objectives consists of three parts:
  • Conditions
  • Behavior
  • Criteria
• The conditions refer to what is expected to occur in the session that will provide the opportunity for the behavior to be observed, the behavior is what is targeted for the client to do at that time, and the criteria indicate how well or how many times the behavior is expected to be performed.
• Sample objectives, defined under the previously listed goals that they support, include:
  • Goal: Improve visual tracking
    • Objectives:
      • When instrument is moved horizontally in front of child’s face, child will follow instrument with eyes 80% of the time.
      • When instrument is moved vertically in front of child, child will follow with gaze 2 out of 3 times.
  • Goal: Increase verbal interaction
    • Objectives:
      • During planned break in lyrics of song, client will face another client and answer the question posed by the song with a maximum of one prompt.
      • When requested by therapist, client will verbally state how she feels.
  • Goal: Increase independent use of leisure time
    • Objectives:
      • When offered a list of resources available, the client will choose one musical activity for use during leisure time.
      • When provided with a preferred musical resource, the client will report use of the resource between sessions, along with a log to document use.
• As mentioned above, the objectives are expected to change over time.
• Keeping in mind that many clients (as well as nonclients) do not change quickly, the changes may be slow and gradual.
• In short-term settings where contact with the client is brief, the objectives need to be constructed to allow the therapist to identify a small change that can be defined as a step toward the desired goal.
• While some objectives will typically change over time (an objective may change from “when therapist plays an instrument, child will turn in the direction of the sound 30% of the time” to “when therapist plays an instrument, child will reach for the instrument 30% of the time), in other cases only the percentage of desired responses will change to reflect an improvement (the objective may change from “when therapist plays an instrument, child will turn in the direction of the sound 30% of the time” to “when therapist plays an instrument, child will turn in the direction of the sound 60% of the time”).
• In the case of people with progressive illnesses such as dementia, the objectives may not yield changes in a positive direction; indeed, the client may lose ground in a number of areas.
  • The goal of the music therapy in this latter case might be to preserve functioning for as long as possible.
• Part of the value of having objectives is that they help the music therapist focus on how much of the behavior should be sought or how well the client is expected to do at any particular time.
• Properly set objectives will be achievable over a period of time.
• If the client is consistently not meeting the objectives that have been set, it is likely that the objectives were not set correctly.
  • In these cases, the therapist should reevaluate the expectations and set new objectives.
• Once the objectives are properly stated, they are not difficult to measure.
• It is through measuring objectives that we determine when to change them and also whether the goals are being met.
• It is important for goals and objectives to be reviewed regularly and changed as the client’s responses warrant.
• The following illustrations provide a detailed example of two different formats for writing goals and objectives.
• The first example below describes a purpose statement and long- and short-term goals that might be found in a long-term care setting (nursing care facility), and the second offers specific goals and objectives written for a music therapy session with preschool children.
• Note that the objectives written for a session are much more specific than those written for the overall treatment plan in long-term care.
• Both, however, meet the SMART criteria.

Long-Term Care Treatment Plan Goals and Objectives

• The overall purpose of music therapy treatment for this group of residents in long-term care is to improve the quality of life for those living within the community.
• Long-range goals can be established that are more specific than the overall purpose, defining what a better quality of life in long-term care means.
• These long-range goals would be broken down into short-term goals that are more specific, measurable outcomes.
  • These are the goal-oriented statements that best match the SMART style of goal-setting.
• The therapist might then also create specific objectives for the music therapy session that could yield weekly data after each session.
• Richard is newly admitted to a long-term care community and has been isolating himself in his room.
  • The staff referred him to music therapy because the only thing that brings him out of his room is musical entertainment.
  • After assessing Richard’s strengths and needs, you decide to invite him to your weekly self- expression group.
    • The group consists of 10–12 residents who are invited to sing, play instruments, and do songwriting and improvisation together as a platform for sharing themselves with one another and building relationships.
    • You establish the following goals for Richard:
      • Purpose of treatment
        • Decrease stress of living in long-term care community.
      • Long-range goals (related goals that are time-specific)
        • Increase participation in scheduled events by (date could be 3–6 months away).
        • Build social relationship with peer(s) by (date could be 3–6 months away or longer, depending upon the music therapist’s knowledge of the environment)
        • Increase self-expression through arts programming by (date could be 3–6 months away).
• Short-term goals would be the more specific, measurable outcomes.
  • For example:
    • Increase participation in scheduled events by (date).
      • Richard will attend a minimum of one music-related program per week by (date).
        • Richard will participate in weekly music therapy session(s) by actively engaging in one experience (singing, playing, creating, moving to music).
    • Build social relationship with peer(s) by (date).
      • Richard will build a social relationship with at least one peer by (date).
        • (This might a good place to think about how you will know if this has occurred. In some settings, the phrase “as evidenced by” [AEB] is used to delineate the specific observable behaviors that will be the indication that the goal has been met.)
          • In this case: Richard will build … AEB self- report that he enjoys doing activities with Mr. X or by his desire to sit with specific residents at events.
        • Richard will interact with peers in weekly music therapy group by sharing a memory or offering an idea for a group song.
    • Increase self-expression through arts programming by (date).
      • Richard will participate in a choir or small singing group with peers by (date).
        • Richard will use songs or instruments to express himself in weekly music therapy sessions.
• In this case, the music therapist is working toward specific nonmusical goals but has specific musical tasks for each weekly music therapy session that are leading toward those nonmusical goals.
  • These tasks include those listed above as the basis of the group: singing, playing, improvising, and songwriting.

Session-Specific Goals and Objectives for a Preschool Group

• Goal: To develop expressive language
  • Objectives:
    • Child will sing at least six phrases (two words or more) along with the MT, using intelligible speech during the session.
    • Child will speak at least four phrases (two words or more), using intelligible speech during the session with cues from the MT.
• Goal: To increase self-control
  • Objectives:
    • Child will play the drum softly for one verse of the song sung by the MT.
    • Child will clap only twice at phrase ends in “Let’s make music now,” with modeling by the MT.
    • Child will clap up to three out of the six claps during “The Very Hungry Caterpillar,” as cued by the MT.
• Goal: To increase attention
  • Objectives:
    • Child will sing along with the MT during four out of the eight interventions.
    • Child will verbally respond to at least three questions asked by the MT during “The Very Hungry Caterpillar” and “Wheels on the Bus.”
    • Child will follow directions given by the MT during 100% of interventions.

Different Formats for Different Settings

• It is of crucial importance to develop your abilities to establish appropriate and meaningful music therapy goals and objectives, to create effective methods for implementing goals, and to design workable strategies for obtaining data and documenting your work.
• Once you have developed these skills, you may find yourself delivering services in settings that have very different requirements and needs related to the development, implementation, and ongoing documentation and evaluation of clinical intervention.
• One example of this is the recent increase of music therapists working in settings where service providers focus on determining the desires and interests of clients.
• While the goals (outcomes) may ultimately be the same (e.g., to increase verbal interaction, improve range of motion), rather than establishing one goal and several objectives that may concentrate on what the client will do, the therapist may establish one plan or goal that encompasses several objectives (skills) that the client wants to do.
• If the therapist is working in a setting where clients are able to actively participate in the development of their plans, this can be an exciting and interesting addition to the process of establishing a relationship and creating a truly meaningful method to help the person reach his or her goals.
• If, on the other hand, the therapist is working in a setting in which clients are unable to participate in this process due to cognitive, physical, communicative, and/or emotional challenges, the actual process of developing the plan may resemble that of developing the more traditional goals and objectives but will result in a different format.
• Some examples of client-driven music therapy outcomes and skills are provided to help you familiarize yourself with the different formats.
• Always be aware that regardless of the format of documentation required by various agencies and regulations, as the person providing music therapy services, you need to have a focus in mind of how to implement the goals and document the responses of the client and the effectiveness of your strategies.
• Music Therapy Outcome: Client wants to participate in music experiences that offer opportunities to engage in structured relaxation training, development of enhanced self- esteem, and further development of effective communication skills in social and learning experiences.
  • Skill-Building Areas for Documentation:
    • Increase the length of time the client remains still (physically and verbally) during use of the Somatron® Wedge;
    • Increase client’s positive self-statements in response to questions from the therapist relating to client’s effective use of the Somatron® in therapy, as well as relating to other experiences in therapy;
    • Increase ability to engage in social and learning experiences with peers and adults immediately following therapy.
• Music Therapy Outcome: Client wants to participate in music experiences that offer opportunities for further development of receptive and expressive communication skills, basic cognitive concepts, and enhanced self-expression.
  • Skill-Building Areas for Documentation:
    • Learn and sing question/answer learning songs dealing with a variety of academic and social concepts;
    • Increase independence in writing answers to question/answer learning songs;
    • Increase the amount of time client sustains tones either vocally or through playing the single-reed horn;
    • Increase frequency of participating in instrumental improvisations.
• Music Therapy Outcome: Client wants to learn how to express herself more effectively and feel better about herself, as well as improve her ability to relax.
  • Skill-Building Areas for Documentation:
    • Learn and sing new songs from the standard and popular repertoire, concentrating on breath support and articulation;
    • Practice already-known question/answer learning songs as well as learn new