Summary of the impact

Odell-Miller's music therapy work has benefitted residents and produced demonstrable alterations in policy and the environment at Methodist Homes for the Aged (MHA). MHA is a well-established care provider for older people, delivering a range of high quality services to 16,000 individuals across Britain. Since Odell-Miller's pioneering, controlled music therapy trial in residential settings, focusing on live music interaction with older people with dementia, MHA has changed its policy and care provision to offer music therapy to 1,500 of its clients. MHA has also recruited twelve qualified music therapists in the last five years to support this policy change.

Underpinning research

The key research that initiated this work was undertaken by Odell-Miller, Professor of Music Therapy and Director of the Music for Health Research Centre (1994-current). This research (1995), the first systematic outcome study in music therapy and dementia in the UK, investigated the use of live interactive music therapy techniques, which were used for the first time with people with dementia. Previous research had only advocated the use of structured improvisation or composed music in these instances (e.g., Bright's work (1972)). Where cognitive faculties are declining, Odell-Miller's work showed that older people with dementia were more engaged through music making than when undergoing reminiscence therapy, a talking-based therapy. Outcomes from systematically measuring engagement for eleven people over two sixteen-week periods, whilst having music therapy and reminiscence therapy, and using observational methods of time sampling, suggested that mean levels of engagement were higher during music therapy than in reminiscence therapy. `Engagement' was measured in six categories, including `eye direction', `use of musical instruments' (in music therapy), `use of objects' (in reminiscence therapy), and `smiling'.

Odell-Miller subsequently undertook a multi-disciplinary research case study in an NHS community setting in collaboration with Professor Hodges and the Cambridge University Cognition and Brain Sciences Unit. Through single case study narrative research with a musician with dementia, Odell-Miller (2002) showed the importance of a psychoanalytical understanding of the work, using concepts, originally developed by Odell-Miller, such as musical countertransference (2001). This enabled an understanding of the patient's mind and actions during the music making through the musical process. Further developing this relationship, Odell-Miller discovered that rich communication could take place through joint music making, when words are no longer available. In this single case study medical staff and the patient's wife reported that the patient was brighter and more relaxed following music therapy sessions at home. Odell-Miller's sustained research, through clinical projects, family work, case examples and research from subsequent collaborations, including implementing the protocol in the training of music therapists, has successfully demonstrated that this method is an effective way of communicating for older people with dementia.

More recent joint research with MHA (Hsu and Odell-Miller 2012) carried out a new clinical evaluation exploring the correlation between the therapist's bodily expressions and the client's participation. This used two evaluation tools, Dementia Care Mapping and Music Therapy Microanalysis. Both involve quantitative documentation and data analysis and, with results indicating promoted levels of the client's well-being and a strong correlation between the therapist's spontaneous movements and the client's communicative responses, resulted in increased levels of participation. Consequently, the importance of incorporating movements as part of the therapist's musical expression has been identified and developed. Odell-Miller was collaborator for these research projects, commissioned by the MHA and supported by the Lottery Fund. The newly identified presentation techniques of the music therapist serve as a strategy resource to enhance the client's participation in the day-to-day practise of music therapy.

References to the research

Details of the impact

Odell-Miller's findings and research outputs in the field of live music interaction with older people with dementia resulted in:

a) Direct implementation, from 2008, of Odell-Miller's music therapy method in MHA, by ARU graduate Hsu's research collaboration, reaching 1,500-clients across 40 care homes in Britain. Hsu was invited to present the joint research at the MHA manager's conference and, as a result, was employed in the first, full-time music therapy post in the MHA. Hsu deployed a model of music therapy based on the music therapist's PGDip training at Anglia Ruskin University and Odell-Miller's research in dementia care (Odell-Miller, 1995). This can also be seen on The Royal College of Psychiatrists' CPD website as an established method, further demonstrating impact beyond our immediate HEI (5e).

b) Adoption and development of music therapy in the MHA practice was demonstrated by the recruitment of twelve qualified music therapists between 2009-2013, leadership of these developments being overseen by Hsu. In 2009 a pilot evaluative music therapy study formed the basis of Hsu's MA Music Therapy thesis at ARU. Results successfully helped MHA obtain Big Lottery `Reaching Communities' fund, which enabled the further expansion of music therapists to cover care homes, 49 homes in total receiving music therapy, making a difference to over 2,000 older people's lives.

In November 2012, the English Community Care Association published Coming alive with the sound of music on its website. This reports:

`The largest charitable care provider for older people in Britain, MHA provides accommodation, care and support services to 16,000 older people nationwide. Priding itself on innovation, it has long provided Music Therapy from qualified professionals to people with dementia, free of charge, watching them thrive as they find an alternative way of engaging with the world and expressing themselves. Now the charity has commissioned independent research, assisted by Professor Helen Odell-Miller of Anglia Ruskin University, to test the hypothesis that Music Therapy can improve quality of life for people with dementia. Helen Nairn, a manager in MHA further commented, "We have seen some astonishing changes in our care homes when people with dementia receive Music Therapy — they become so much more responsive and joyful, and it seems to have a wonderful calming effect on people who experience anxiety, as a lot of people with dementia do'. The same report also comments: `Over 1500 people in MHA care homes have been able to enjoy Music Therapy and the charity estimates that it will spend £350,000 a year of its charitable income to support the therapy.' (5a). In 2013, in a corroboration statement for this case study (5g) the Group Director Operations for MHA writes `Odell-Miller's early pioneering research with older people (Odell-Miller 1995) underpins the approach delivered within our homes, using live interactive music therapy methods to enable better communication, well- being and contentment for our residents. Regular advice, consultation and project design in-put from Professor Helen Odell-Miller on research projects we have carried out and are currently undertaking in MHAhas contributed to our work environment and quality of care.'

The MHA website refers to a recent prestigious award they received as the Best Care Provider in Laing and Buisson's Independent Healthcare Awards 2012. Laing and Buisson, UK's leading healthcare intelligence provider cited the establishing of music therapy in the homes as one of the main reasons for the award (5d). Impact on their policy and practice is further demonstrated by the commissioning of a dementia research project by MHA and ARU, between 2010 and 2012. Later, in 2013, MHA funded a research assistant for £25,000, held by ARU graduate Roz Pendrey, investigating the impact of music therapy upon carers and those with dementia in reducing Behavioural and Psychological Symptoms of Dementia (BPSD). Three MHA care homes have now embarked on the five-month cluster randomised controlled trial investigating the impact of music therapy on caring for people with dementia, who have behavioural symptoms. The clinical trial is a joint research project and a PhD study supervised by Odell-Miller. MHA funded Hsu to do the PhD.

The impact of the research and its on-going value to older people is demonstrated through international invitations to speak about the work. The Norwegian government, in collaboration with The University of Bergen, invited Odell-Miller and Hsu to advise on similar community-based care homes and music therapy in November 2012, which will lead to further international partnerships in the future. The impact is best summed up in an article published on the MHA website, effectively demonstrating the embedding of the music therapy service at MHA, not only in the music therapy activities, but throughout the whole organisation:

`MHA's Dementia Care Home in Birmingham, have celebrated not only the Home's recent refurbishment but also the impact music therapy has made on all their lives by renaming its four wings: Symphony, Harmony, Melody and Rhapsody. Now the plan is for MHA to employ a full team of therapists. "It's very exciting," says Ming. "With a team we can discuss, plan and develop our work across the UK.' (5c)

Sources to corroborate the impact

a) http://www.ecca.org.uk/?article_type=1480
Coming alive with the sound of music (2012) on the news site for the English Community Care Association: This describes Odell-Miller's influence on and collaboration with the Methodist Homes for the Aged.

b) Twyford, K. & Watson, T. (2008) Integrated teamwork: music therapy as part of trans-disciplinary and collaborative approaches. London: JKP. Several references in this clinical book are written by clinicians working in older persons services, and demonstrating the impact of Odell-Miller's 1995 research.

c) http://www.mha.org.uk/getcomponent.aspx?c=Music Therapy.pdf
Example of music therapy implementation and the impact of the now established method for people with dementia.

d) http://www.mha.org.uk/getcomponent.aspx?c=BestCareProvider.pdf
Example and evidence of the establishing of music therapy services at MHA being sited as a main reason for the award of Best Care Provider being awarded to MHA in 2012.

e) http://www.psychiatrycpd.co.uk/PDF/Music_Therapy_THN.pdf
Example of Odell-Miller's 1995 methodology now being part of established CPD training for psychiatrists on the Royal College of Psychiatrist's website

f) http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=99
Odell-Miller and Hsu's main research is now centred around verbal, movement-orientated and musical expressions regulating residents' emotional arousal levels during individual music therapy sessions, and communicating how this is achieved to carers. Following the earlier impact of Odell-Miller's collaborative work as music therapist in the television documentary Malcolm and Barbara (1999), and still repeated regularly, this describes the impact of dementia on a musician who was the patient in Odell-Miller's 2002 case study research.

g) Corroboration statement from the Group Director, Operations, Methodist Homes for the Aged