Grand Rounds UVM November 2014: Brian Schreck

1. A Symphony of Life: Creating and Preserving Legacy through Innovative Medical Music Therapy Interventions
Brian Schreck, MA, MT-BC

2. Title of Program: Family Medicine Grand Rounds Title of Talk: A Symphony of Life: Creating and Preserving Legacy through Innovative Medical Music Therapy Interventions Speaker/Moderator: Brian Schreck, MA, MT-BC Planning Committee Members: John King, MD, MPH, Melisa Gibson, MD, Anne Morris, MD, Whitney Calkins, MD Date: November 17 , 2014 Workshop #:15-101-12 Learning Objectives 1. Synthesize current evidence based practices of the role of creative arts therapies in palliative and hospice care. 2. Identify the importance of medical music therapy in palliative and hospice. 3. Share/apply innovative medical music therapy interventions with multidisciplinary psychosocial teams DISCLOSURE: Is there anything to disclose? Yes or No Please list the Potential Conflict of Interest (if applicable): ______________________________________________________________ All Potential Conflicts of Interest have been resolved prior to the start of this program. Yes or No (If no, credit will not be awarded for this activity.) COMMERCIAL SUPPORT ORGANIZATIONS (if applicable): ______________________________________________________________
The University of Vermont College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Vermont designates this live activity for a maximum of 1 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

3. Overview
•“creative arts therapies involve the implementation of an arts intervention by a trained, credentialed creative arts therapist; the presence of a systematic psychotherapeutic process; the use of individualized treatment interventions”
- JAMA vol 173 (no.11) June, 2013

4. Creative Arts Therapies An Overview
•Specialties include art therapy, music therapy, dance/movement therapy, drama therapy, and poetry therapy.
•Can significantly reduce anxiety, depression, pain, and improve quality of life
•Music therapy for cancer patients can reduce anxiety, pain and improve mood
•Dance therapies can improve QOL

5. Individual CAT
Art- uses art media images and creative process to create projects of as reflections of development, abilities, personality, interest concerns and conflict.
A therapeutic means to resolve emotional conflicts, fostering self awareness and reduce anxiety. ( American Music Therapy Association)
Drama therapy is the systemic and intentional us of drama/theatre to achieve therapeutic goals of symptom relief, emotional and physical integration, and personal growth. It is an active approach that helps to tell the patients story, to solve problems, achieve catharsis, extend the breath and depth of the inner experience, understand the meaning of images, strengthen the ability to observe personal roles (National Drama Therapy Association)
Dance/movement therapy is based on the assumption that body and mind are interrelated and is defined as the psychotherapeutic use of movement as a process that furthers the emotional, cognitive and physical integration of the individual. (National Coalition of Creative Arts Therapies Associations)
Biblio/poetry therapy- the intentional use of poetry and other literature for personal growth and healing (National Coalition of Creative Arts Therapy Associations)

6. Definitions
Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. It is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals (AMTA, 2011).
Active Music Therapy: Administered by a board-certified music therapist and requires physical action by the medical patient and/or patient’s family.
Passive Music Therapy: Administered by a board-certified music therapist and requires no or limited physical action by the medical patient and/or patient’s family.
Music Medicine: Passive listening to pre-recorded music offered by medical personnel (Dileo 1999).
Well-Being: Individual’s perceived health and quality of life based on satisfaction with emotional, social, and physical life experiences.

7. Overview of MT Methods
•Receptive Music Therapy: Live music listening, recorded music listening, song analysis, music guided-imagery for relaxation.
•Improvisational Music Therapy: Instrumental, vocal, storytelling and symbolic play.
•Re-creative Music therapy: Song singing
•Compositional Music therapy: Songwriting
-Lindenfelser, 2013

8. MT Goals
Pt/family will exhibit increased
•Comfort/relaxation
•Increased coping ability, esteem, well-being
•Decreased anxiety
•Decreased shortness of breath
•Report decreased pain/discomfort
•Express loss and grief
•Verbalize spiritual or cultural needs
•Plan music for memorial/funeral
-Lindenfelser, 2013

9. MT Interventions
•Provide music for relaxation/comfort
•Provide music for decreased pain/agitation/anxiety /discomfort
•Encourage emotional expression and response
•Provide music and guided imagery
•Assist Pt/family in songwriting or song analysis
•Encourage Pt/family participation in improvisation play
•Provide music to validate and support Pt/family spiritual beliefs
•Provide music to validate Pt/Family’s cultural heritage
-Lindenfelser, 2013

10. Why is the music meaningful
•It takes on deeper significance during times of loss and grief
•An art form that is universally valued
•Has cultural and spiritual significance
•Personal significance to specific events, rituals and traditions (Magill, 2009)
-AMJHPM vol 26 2009

11. The significance of the music for as perceived by surviving caregivers
Strategies used:
•Precomposed songs- reminiscence, life review, lyrics can guide thoughts
•Song composition – use of familiar melodies, life stories, enhances sense of personal value, attributes about the self, messages to significant others, opportunity for resolution
•Imagery in music for symptom relief, use of peaceful images
•Music listening-live music in sessions with caregivers, familiar music, connection to transformative events in life (Magill, 2009)

12. Clinical Aims
Reengage children with their environment using CAT to create three elements of contextual support:
•Structure: To provide Pt’s with opportunities for successful mastery over their environment.
•Autonomy Support: To afford Pt’s opportunities to make choices and direct activities
•Involvement: To express unconditional acceptance of Pt’s and reinforce their efforts and actions. (Robb, 2003)
-Bradt, 2013

13. 1. Listening to live, therapist-composed, improvised music
•I invite you to imagine you are sitting in a hospital room with a loved one. You are holding their hand and it is very quiet. Everyone present is thinking of the right things to say, but no one is saying anything. Gentle music is offered…

14. 2. Performing on an Instrument

15. Functional (Re)Creation!

16. 3. Improvising

17. Re-Creative & Compositional MT
•Song: Singing/playing familiar songs to normalize the experiece and to validate patient’s interests and identity.
•Songwriting: Can help facilitate communication of the patient’s experiences and feelings –often a treasured and tangible part for the family (Lindenfelser, 2013)

18. E.
•E. is a 13-year-old with spinal cord astrocytoma, secondary quadriplegia
•At approximately 5:30 3/9/10 respirations stopped and HR slowly decreased. Time of Death 5:48 AM.
•Legacy theme/intervention: Preserving E.’s voice by utilizing and celebrating her physical expression/Live music for comfort care post-mortem

19. E.
Continue living in the midst of letting go

20. E. was an artist and wanted to be a fashion designer

21. These sketches were designed before E. lost the use of her arms
These images were used to label the Cd’s of our recordings created for her family

22. Tell Me A Story

23. Family-Centered Synergy
•"On the day it became evident that Critter would lose his battle, Brian stayed with him and his family in the ICU, playing the songs that Critter loved, singing with the family and providing them with CD copies of the recordings. As we walked Critter back to A5 South in his bed, still on the ventilator, Brian was there, playing the music that meant so much to Critter. "When the family gathered around Critter's bedside to say a final goodbye, his father requested that Brian come and be close to the family. He was an essential part of Critter's care team, and his presence and music at the end of the journey provided such a comfort to the family. Critter's mother asked Brian to provide the music at his funeral, and Brian did a fantastic job.”
•She added, "Critter's best friend is a current patient, and at the funeral, he wanted to sing a song he had written. Brian assisted him in playing, and I believe that in the difficult months ahead for this child, Brian will also bring comfort through the love of music that all three share."

24. The Battlefield
“The Battlefield”
My Cancer’s like a battlefield
That I just keep on rockin’ through
Every day and night I fight
And I just keep on rockin’ through
Fartin’ and makin’ it right
Hoagies, fries and sprite
I just keep rockin’ through
My Cancer Is A Battlefield
Cancer is a battlefield
IV pumps and hospital beds
That I just keep on rockin’ through
Doctors and nurses all around
That I just keep on rockin’ through
Pepsi, steak, & corn
That I just keep on rockin’ through
Battlefield, battlefield
My cancer is a battlefield!”

25. Continuum Of Care/Legacy Work
The Battle Field

26. Movement 4: The Voice of home
•“Music From An 8 X 8 Room”
Inspiration from Diego Stocco’s “Music From A Tree”: http://www.youtube.com/watch?v=fY-ZoVMwGKM

27. 5. Music combined with other modalities (i.e., movement, imagery, art)

28. Search Strategy
•Keywords: music therapy, medical music therapy, pediatric music therapy, music therapy and: quality of life, pediatrics, hospitalized children, pain, inpatients
•Databases: MEDLINE/PubMed, CINAHL, PsychInfo, Cochrane Library, Alt Healthwatch, OhioLink, GoogleScholar, &
•National Association of Children’s Hospitals and Related Institutions (NACRHI) electronic mailing list

29. The Evidence Summary
•Peutz- meta-analysis CATs effect on psychological symptoms and QOL in patients with cancer during and after treatment, 27 RCTs
•During treatment, CAT significantly reduced anxiety (Δ = 0.28 [95% CI, 0.11-0.44]), depression (Δ = 0.23 [0.05-0.40]), and pain (Δ = 0.54 [0.33-0.75]) and increased QOL (Δ = 0.50 [0.25-0.74]). Pain was significantly reduced during follow-up (Δ = 0.59 [95% CI, 0.42-0.77]).
•Exposure to CAT can improve anxiety, depression, and pain symptoms and QOL among cancer patients
-Peutz, et al (2013)

30. Evidence Synthesis
Effect MT may have on Well-Being in Pediatric Patients
Emotional:
•Reduces trauma
•Lowers maternal anxiety
•Less crying in neonates
•Reduces distress before/during/after blood tests
•Increases positive affect
•Active MT reduces anxiety
•Music medicine reduces pain/fear for pediatrics undergoing lumbar punctures.

31. Evidence Synthesis continued
Social:
• Facilitates coping strategies
• Reduces maladaptive behaviors

32. Evidence Synthesis continued
Physical:
•Influences physiology
•Reduces migraine frequency
•Decreases pain during burn debridement
•Reduces the amount of pharmacological interventions in neonates: Increases feeding rates, increases quiet sleep states, reduces heart rate

33. Evidence Synthesis Continued Other Findings
•May enhance cognitive abilities
•Facilitate non-verbal/verbal communication
•State of science is underdeveloped
•Consistent outcome measures
•Consensus on research priorities
Other palliative care outcomes/functions
•Preloss grief
•Postloss grief
•Means for expression for decision-making and goals
•Dignity and identity
•Expression of emotions

34. Encouraging decision-making
No one is quite like you Or can be all you are So loving, so caring And always by my side When I see your face It makes me happy You make me strong You give me faith
With every song we sing You are in my heart You are my family We’ll never be apart
“No One is Quite Like You” Written for Mom
I’ll always be with you I’ll always be your friend I’ll always love you And be your baby girl

35. Focus on Family-Centered-Care

37. Case: 30 yr male w NF-1
Severe neuropathic pain unresponsive to :
Opioids
Anticonvulsants
Benzodiazepine
Tricyclic antidepressants
Topical Local Anesthetic patches
TENS

38. Culinary Arts: Finding Control

39. Leaving a legacy
•http://www.shutterfly.com/custompath/viewEdit.sfly?fid=55b8e05dd84b633626cd1d30d33b21f1

41. “If I don’t make fun of it, then who’s gonna?”

42. •My goal is to approach living with cancer with humor, optimism, and yes indeed sarcasm (that is a part of who I am.) I look forward to many, many more years of accidental distaste, but I hope to fail miserably in that department and continue to teach optimism, patience, how to laugh in despair, and to never give up.

43. Eight weeks have gone and passed; I wasn't sure if I would last. But the time has come to raise the mast, Sail along and continue this blast Of a ride my life has been. I believe that news will be great, . But a few months I have to wait, And during that time I appreciate The value of patience and an optimistic state Of mind. I cannot fall behind I remind Myself to find All the beauty in this seemingly cruel world Into which we've all been hurled.
Like a flag coming unfurled,
My heart becomes twirled
With thankfulness and gratitude
That I have a positive attitude
And that I'll travel to any latitude
To keep on being that dude.
This radiation treatment is coming to an end,
It made my body contort and bend.
A painful round each day would send,
But I was greeted each day with a smile from a friend.
The people I met who have taken care of me,
Who have always seemed to want to be
There doing their best to make us tumor free ...
I will leave here optimistically.
optimistic 02.02.11

44. Legacy
•“Brian, there are no words to express what the time you spent with Q meant to him and to me. We received this email (of the recording) from you before we even got home and the cd immediately thereafter. I am so grateful to you and to whomever summoned you to our room.”

45. TAB

46. StoryCorps
Our Principles StoryCorps is built on an uncompromising commitment to excellence across all aspects of the project, from collecting, sharing, and preserving people’s stories; to organizational management; to maintaining an extraordinary work environment where respect and dignity are paramount. The interview session is at the heart of StoryCorps. We treat participants with the utmost respect, care, and dignity.

47. •Metastatic desmoplastic round cell tumor, diagnosed in 2/07. DOD: 1/3/09
•27 years of age, two children at home
•Lullabies for two children
•Legacy theme/intervention: Creating consistent night rituals for coping & comfort
M.

48. M.

49. HEARTBEAT MUSIC THERAPY

50. Re-Creative & Compositional MT
•Song: Singing/playing familiar songs to normalize the experiece and to validate patient’s interests and identity.
•Songwriting: Can help facilitate communication of the patient’s experiences and feelings –often a treasured and tangible part for the family (Lindenfelse 2012, Bradt 2013)

51. doppler
infant
toddler
Infant
Rock School aged Pt.
12 mo + parents
Rock with Sibling
Hip hop
Infant + parents
First Birthday

52. http://cincinnatichildrensblog.org/patient-family- experience/and-the-beat-goes-on/ http://abcnews.go.com/blogs/health/2014/05/26/therapist- turns-heartbeats-of-dying-patients-into-music/ http://www.huffingtonpost.com/2014/07/02/recorded- heartbeats-brian-schreck_n_5552019.html http://wvxu.org/post/using-dying-heartbeats-make-music

54. Future Challenges
•Can a deceased person’s legacy intensify loss associated with a complicated relationship?
•How to assess the potential impact of a legacy work on the recipient? Will they be comforted?
•How to assess the emotional consequences of the work in progress?

55. “This is the voice of home.” -Clive Robbins
“One of the last things that Paul Nordoff said to a colleague when he was dying in hospital was, ‘You know, the greatest mystery of all is that we’re made of music.’”
Ansdell, G. (1995). Music For Life. P.8 ISBN 1-85302-299-3

56. Let’s Dance

57. References
•Ansdell, G. (2000). Music For Life: Aspects of Creative Music Therapy with Adult Clients (p.8). 325 Chestnut Street, Philadelphia, PA 19106: Jessica Kingsley Publishers Ltd.
•Armstrong, L. (N.D.). Quotation #27042 from Laura Moncur’s Motivational Quotations.Retrieved April 27th, 2006 from http://www.quotations.com
•Cincinnati Children’s StarShine Program: http://www.cincinnatichildrens.org/service/s/starshine/default/
• Cincinnati Children’s Hospital Medical Center (2010): “Tell Me A Story” http://www.youtube.com/watch?v=JEXxVG550bs
• Dorak, M.T. Retrieved December 5th, 2005, from http://dorakmt.tripod.com/music/symphony.html
•Keys, A. (2004). “If I Ain’t Got You” from her album The Diary of Alicia Keys.
•Krout, R.E. (2004). A Synerdisciplinary Music Therapy Treatment Team Approach
•for Hospice and Palliative Care. Australian Journal of Music Therapy, 15, 36.
• Lowey, J.V. (2005). Music Therapy at the End of Life (p.xvi). 538 Covered Bridge Road, Cherry Hill, NJ, 08034: Jeffrey Books.
•O’Callaghan, C. (2013). Music therapy preloss care though legacy creation. Progress in Palliative Care 2013 VOL. 21 NO. 2
•Robbins, C. (2004). Class lecture. Nordoff-Robbins Institute. New York, NY: NYU
• Robbins, C. (2005). Personal Interview. Nordoff-Robbins Institute. New York, NY: NYU
• Stocco, D. (2009). Music From A Tree: http://www.youtube.com/watch?v=fY-
•ZoVMwGKM

58. References
•Bradt, J (edited 2013). Guidelines for Music Therapy Practice in Pediatric Care. ISBN: 978-1-937440-48-0. Barcelona Pub.
• Lindenfelser, K. J., Hense, C., & McFerran, K. (2012). Music therapy in pediatric palliative care: Family-centered care to enhance quality of life.
•Nelson, A. 2011. Medical Illustration (Heart) http://antondesigner.blogspot.com
•Dobi, R. 2014. Symphony. http://society6.com/robdobi/symphony- kpf_print#1=45
•Pickett, D. (2014) A Passage from Mahler's score of Beethoven's Ninth Symphony: http://www.fugato.com/pickett/nso2000.shtml

59. MT in the Seacrest Studio
•http://cincinnatichildrensblog.org/rare-and- complex-conditions/heart- conditions/seacrest-studios-performance- was-my-victory-lap/#.Uqn5ERZyHww

60. References From Presentation
American Music Therapy Association (AMTA), (2011). Habilitation: Music Therapy Research and Evidence-Based Practice Support. From http://www.musictherapy.org/ assets/1/7/bib_habilitation.pdf
American Art Therapy Association (AATA), (2014). http://www.arttherapy.org
Klassen, J.A., Liang, L., Tjosvold, L., et al., (2008). “Music for Pain and Anxiety in Children Undergoing Medical Procedures: A Systematic Review of Randomized Controlled Trials.” Ambulatory Pediatrics 2008; 8: 117- 128, [1a].
Mrazova, M., & Celec, P., (2010). “A Systematic Review of Randomized Controlled Trials Using Music for Children.” The Journal of Alternative and Complimentary Medicine, Vol. 16, Number 10, 2010, pp. 1089-1095,[1b].
Naylor, K.T., Kingsnorth, S., Lamont, A., et al., (2011). “The Effectiveness of Music in Pediatric Healthcare: A Systematic Review of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine. Vol., 2011, Article ID 464759, 18 pages, [1a].
Ngyuen, T.N., Nilsson, S., Hellstrom, AL., et al., (2010). “Music Therapy to Reduce Pain and Anxiety in Children with Cancer Undergoing Lumbar Puncture: A Randomized Clinical Trial.” Journal of Pediatric Oncology Nursing 27(3) pp. 146-155, [2a].

61. References
•Duda, L.J. (2013). Integrating music therapy into pediatric palliative care. Progress in Palliative Care 2013 VOL. 21 NO. 2 65
•Zebrack, B., Bleyer, A. et al. (2006). Assessing the Health Care Needs of Adolescents and Young Adult Cancer Patients and Survivors. Cancer. December 15, 2006 / Volume 107 / Number 12
•Lindensfelser, K.J., Grocke, D. et al. (2008). Bereaved Parents' Experiences of Music Therapy with their Terminally III Child. Journal of Music Therapy, XLV (3), 2008, 330-348.
•Freyer, D.R. (2013). Care of the Dying Adolescent: Special Considerations. PEDIATRICS Vol. 113 No. 2 February 2004
•Oeffinger, K.C., Kawashima, T., et al. (2006). Chronic Health Conditions in Adult Survivors of Childhood Cancer. N ENGL J MED 335;15 October 12, 2006.
•Wiener, L., Ballard, E. et al. (2008). How I Wish to be Remembered: The Use of an Advance Care Planning Document in Adolescent and Young Adult Populations. JOURNAL OF PALLIATIVE MEDICINE Volume 11, Number 10, 2008

62. References
•Magill, L. (2009). The meaning of the music: The role of music in palliative care music therapy as perceived by bereaved caregivers of advanced cancer patients. American Journal of Hospice and Palliative Medicine
•Peutz, T.W., Morley, C.A., et al. (2013). Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients With Cancer. AMA Intern Med. 2013;173(11):960-969.
•Malchiodi, C. (2013) Art Therapy and Healthcare. The Guilford Press.
• Georgia O’Keefe quote: http://thinkexist.com/quotation/i_found_i_could_say_things_with_color_and_shapes/206654.html

63. References
•Holliday, E.L., McLeod, S. (2009). listening to children with communication impairment talking through their drawings. journal of early childhood research 7(3)
•Knapp, C., Madden, V., et al. (2009). Music Therapy in an Integrated Pediatric Palliative Care Program. American Journal of Hospice & Palliative Medicine1 / Vol. 26, No. 6, December 2009
•Hilliard, R.E. (2006). Music Therapy in Pediatric Oncology: A Review of the Literature. J Soc Integr Oncol 2006;4(2): 75-78
•Hilliard, R.E. (2003). Music Therapy in Pediatric Palliative Care: Complementing the Interdisciplinary Approach. Journal of Palliative Care 19:2/2003; 127-132
•Lindenfelser, K.J., Hense, C. (2012). Music Therapy in Pediatric Palliative Care: Family-Centered Care to Enhance Quality of Life. American Journal of Hospice & Palliative Medicine® 29(3) 219-226
•Robb, S.L. (2003). Coping and chronic illness: MT for children with cancer. In S.L. Robb (Ed.), Music Therapy in Pediatric Health-
care: Research and evidence-based practice (pp.101-136). AMTA

64. References
•O’Callaghan, C. (2013). Music therapy preloss care though legacy creation. Progress in Palliative Care 2013 VOL. 21 NO. 2
•Horowitz, S. (2013). The Healing Power of Music and Dance. ALTERNATIVE AND COMPLEMENTARY THERAPIES. VOL. 19 NO. 5
• Trauger-Querry, B. (2014). Who Says It’s a Sunset? What a Patient’s Artwork Can Tell Us. Publication of the National Hospice and Palliative Care Organization February 2014.
• Aasgaard, T. (1999). Music therapy as milieu in the hospice and paediatric oncology ward. In D. Aldridge (Ed.),
•Music therapy in palliative care: New voices (pp. 29–42). Philadelphia, PA: Jessica Kingsley Publishers.
•Bradt, J (edited 2013). Guidelines for Music Therapy Practice in Pediatric Care. ISBN: 978-1-937440-48-0. Barcelona Pub.

65. References from Guidelines For MT Practice in Pediatric Care: Bradt 2013
•Aasgard, T. (2001). An ecology of love: Aspects of music therapy in the pediatric oncology environment. •Journal of Palliative Care, 17(3), 177–181 •Aasgaard, T. (2003, August 1). Musical acts of love in the care of severely ill and dying children and their families. Retrieved from http://www.musictherapyworld.de/modules/archive/papers/show_abstract.php?id=51Amadoru, S., & McFerran, K. (2007). The role of music therapy in children’s hospices. •European Journal of Palliative Care, 14(3), 124–127.American Academy of Pediatrics, Committee on Bioethics & Committee on Hospital Care. (2000). Palliative Care for Children. •Pediatrics, 106(2), 351–357. •Armstrong-Dailey, A., & Zarbock, S. (2009). Hospice care for children. New York: Oxford University Press.
• •

66. References
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• •

67. References
•Daveson, B., & Kennelly, J. (2000). Music therapy in palliative care for hospitalized children and adolescents. Journal of Palliative Care, 16(1), 35–38.
•Davies, B., Brenner, P., Orloff, S., Sumner, L., & Worden, W. (2002). Addressing spirituality in pediatric hospice and palliative care. Journal of Palliative Care, 18(1), 59–67. •Doka, K. J. (1995). Talking to children about illness. In K. J. Doka (Ed.), Children mourning, mourning children (pp. 31–39). Washington, DC: Hospice Foundation of America. •Fagen, T. S. (1982). Music therapy in the treatment of anxiety and fear in terminal pediatric patients. •Music Therapy, 2(1), 13–23.Faulkner, K. (2001). Children’s understanding of death. In A. Armstrong-Dailey & S. Zarbock (Eds.), Hospice care for children (2nd ed., pp. 9–22). New York: Oxford University Press, Inc. •Flower, C. (2008). Living with dying: Reflections on family music therapy with children near the end of life. In A. Oldfield & C. Flower (Eds.), Music therapy with children and their families (pp. 177– 190). Philadelphia, PA Jessica Kingsley.

68. References
•Friebert, S. (2009, December 8). National Hospice Palliative Care Organization Facts & Figures: Pediatric Palliative and Hospice Care in America. Retrieved from http://www.nhpco.org/files/public/quality/Pediatric-Facts-Figures.pdf •Froehlich, M. (1996). Music therapy with the terminally ill child. In M. Froehlich (Ed.), •Music therapy with hospitalized children: A creative arts approach (pp. 209–217). Cherry Hill, NJ: Jeffrey Books. •Gilmer, M. (2002). Pediatric palliative care: A family-centered model for critical care. Critical Care Nursing Clinics of North America, 14, 207–214. •Goldfarb, F. D., Devine, K., Yingling, J. T., Hill, A., Moss, J., Ogburn, E. S., & Roberts, R. J. (2010). Partnering with professionals: Family-centered care from the parent perspective. •Journal of Family Social Work, 13, 91–99. •Goldman, A. (1998). ABC of palliative care: Special problems of children. •British Medical Journal, 316, 49–52. •Grocke, E., & Wigram, T. (2007). Receptive methods in music therapy: Techniques and clinical applications for music therapy clinicians, educators and students. Philadelphia, PA: Jessica Kingsley.Hilliard, R. E. (2003). Music therapy in pediatric palliative care: Complementing the interdisciplinary approach.
• •

69. References
•Journal of Palliative Care, 19(2), 127–132.Hinds, P. S., Schum, L., Baker, J. N., & Wolfe, J. (2005). Key factors affecting dying children and their families. Journal of Palliative Medicine, 8(1), 70–78. •Huang, I., Shenkman, E. A., Madden, V. L., Vadaparampil, S., Quinn, G., & Knapp, C. A. (2010). Measuring quality of life in pediatric palliative care: Challenges and potential solutions. •Palliative Medicine, 24(2), 175–182. •Hynson, J., & Sawyer, S. (2001). Paediatric palliative care: Distinctive needs and emerging issues. •Journal of Paediatric Child Health, 37, 323–325.Ibberson, C. (1996). A natural end: One story about Catherine. British Journal of Music Therapy, 10(1), 24–31. •Klass, D., Nickman, L. L., & Silverman, P. R. (1996). Continuing bonds: New understandings of grief. Bristol, PA: Taylor and Francis Publishers. •Knapp, C. A., & Contro, N. (2009). Family support services in pediatric palliative care. •American Journal of Hospice and Palliative Medicine, 26(6), 476–482.
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•

70. References
•Goldfarb, F. D., Devine, K., Yingling, J. T., Hill, A., Moss, J., Ogburn, E. S., & Roberts, R. J. (2010). Partnering with professionals: Family-centered care from the parent perspective. •Journal of Family Social Work, 13, 91–99.Goldman, A. (1998). ABC of palliative care: Special problems of children. British Medical Journal, 316, 49–52. •Grocke, E., & Wigram, T. (2007). Receptive methods in music therapy: Techniques and clinical applications for music therapy clinicians, educators and students. Philadelphia, PA: Jessica Kingsley. •Hilliard, R. E. (2003). Music therapy in pediatric palliative care: Complementing the interdisciplinary approach. Journal of Palliative Care, 19(2), 127–132. •Hinds, P. S., Schum, L., Baker, J. N., & Wolfe, J. (2005). Key factors affecting dying children and their families. Journal of Palliative Medicine, 8(1), 70–78. •Huang, I., Shenkman, E. A., Madden, V. L., Vadaparampil, S., Quinn, G., & Knapp, C. A. (2010). Measuring quality of life in pediatric palliative care: Challenges and potential solutions.
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