One important step in the process of change and change management is figuring out what roadblocks you might experience along the way. Barriers are things that interrupt the goal of lasting change, and by identifying them ahead of time, disappointment and curve balls may be mitigated. In the 3-year research project that provided the operational process and evidence behind MUSIC CARE CERTIFY , the enablers and barriers within 27 long-term care homes implementing musical integration were collected and evaluated. We found 4 key factors that became predictors of success or readiness factors. We called them factors because in some cases, the indicator was a barrier and in other cases the exact same issue, handled differently was an enabler. We call these 4 factors, predictors of success: integration, core staff, processes, and delivery. Integration refers to what it takes to incorporate music into the care setting. Strong, decisive leadership, oversight, and advocacy for music care from the top and from the music care site team leader is critical. When music is perceived as holistic, integral, fun and pleasurable, then it is a huge enabler. When musical care is valued, then there is ongoing financial investment in training and programming. Care recipients need to be involved in making decisions about what happens around music so that music is not done ‘to’ them, rather ‘with’ them. Having a certified music therapist as the site team lead, or on the music care site team is advantageous for musical and clinical expertise. Musical care coaching and mentorship through training and ongoing support through organizations like Room 217 gives caregivers the confidence to use music effectively and responsibly. Core staff means that there is a group of staff members responsible for music care delivery, and they are all using music as care. Using a relational, person-centred approach, staff is aware of care recipient needs, and knows when music is most appropriate to meet those needs. The workplace culture is predominantly a growth mindset where staff are encouraged to learn, try new things, and think outside the box. There is a drive towards continuous improvement, where evaluation is a best practice, including professional reflective practice. Staff is adaptable and can easily flex and adapt to a changing environment and care recipient needs. Processes comprise the internal operational procedures that impact music care delivery. When recruiting care recipients for music care, residents are prioritized based on their needs. Music care planning has sequential steps and determined accountabilities with resources such as physical space, technology, and musical instruments available for music care. The plans and processes are well communicated and mobilized with the team. Music care tracking and training are well in place and are regularly reported on. Delivery of music care is reflected by flexibility. Is the music care program or strategy adaptable to language for example, or group size? Having the confidence to deliver music as care does not depend necessarily on your perceived musical talent. Being confident in the process of what you are delivering is most important. When musical care is delivered with social bonding in mind, then inclusivity, whether that is about ethnicity, or socioeconomics, becomes a necessity. Frequency of music care programming or strategy may be an important indicator for success. Delivering music care with a cohesive team approach is optimal. When music is used as an agent of change, particularly as a change management system like MUSIC CARE CERTIFY , the organization benefits in a number of ways. There are business wins such as differentiation from competitors, strengthening unique sector strategies, showcasing the achievement of your team, boosting morale. There are staff gains. Staff feels supported with new learning, access to music care tools, strategies, training and ongoing support. Staff may feel more resilient by building some personal musical self-care strategies. And we’ve shown some of the measurable changes that music can help to make: improved sleep, improved appetite, greater engagement, safer transitions for example. There really is nothing more person-centred than music care. It is completely customizable. Most of all, the care experience changes – for everyone in the circle of care. Better care. Improved quality of life. Moments of joy. Empowerment. Human connection; those are the changes we need and are looking for.

I undertook the MUSIC CARE Certification program when I had journeyed through caring for my mother with Alzheimer’s. It was during my training, I learned how music works in terms of timbre, melody and rhythm and beat, music care domains and music care strategies. It helped me to support mom as the disease progressed. I continued to certify through Music Care and then I had the joy of teaching others the level 1 program Fundamentals of Music Care Theory and Context . I have loved coming alongside others in Long Term Care and using music to support giving voice of what is within one’s life, preventing isolation and loneliness, creating community. I enjoyed all it all. Then, I found myself once again in the Emergency Room with Tim, (my family member) as we were helping him home in his palliative journey. My “outside life” took a back seat and my inside hospital life began. Tim’s was failing and he was no longer able to open his mouth and swallow to obtain nutrient’s due to Parkinson’s . We tried various types of foods, textures and flavours, however, opening his mouth and swallowing remained inaccessible. Tim loved Glen Campbell and Rhinestone Cowboy . When he was a young man, he would repeated play this song until the LP was worn through. He was given a new Glen Campbell CD at Christmas and the song was welcomed back into our lives. There I was ,in my new environment on the tenth floor of the hospital, playing Rhinestone Cowboy. Tim sang along. He actually sang along! He moved his mouth, swallowed and sang along. We were able to get pureed food into his body. Later, the disease continued to ravage his body and Rhinestone Cowboy helped us connected with other such as the speech language pathologist, doctors, cleaning staff and nurses. We sang and danced together with the music and Tim smiled. He knew he was part of a community who loved him. As we knew the end was coming, I played music with a simple melody, 60 beats per minute and soft timbre on my harp to support Tim as he fell into sleep. Near the end, I used tonal music in simple phrases to support calmness matching his breath. Tim passed peacefully and gentle. Today, at his funeral our last song “Rhinestone Cowboy”. After hearing the importance of this song, all the people present joined in singing to honour the village of Tim that so lovingly cared for him. Music Care training has become a natural rhythm in my life to use with aging and sick family members, supporting young children’s learning and providing self-care when I was tired after intense caregiving.

Innovative leaders in health and social care are always looking for evidence-based, scalable solutions that can meaningfully improve care. Music care is a transformative approach that’s making measurable, sustainable change in care settings. Several years ago, the Room 217 Foundation developed a Theory of Change (ToC), a framework designed to document how a program works, why it works, and the impact it creates. ToC is a concept rooted in program evaluation from the 1990s. The value of ToC lies in its structured approach to making complex change programs clearer, more accountable, and more effective. Room 217 had already created logic models for our various programs. ToC took us deeper—helping us think through not just the program’s activities, but the underlying assumptions, the necessary conditions for success, and the long-term benefits for all involved. Our basic assumption was simple: Music can be a powerful agent of change within a caring community. Through our research in 82 long-term care homes and 84 hospices in Canada, we saw firsthand the effects of music. Music improved people’s moods, changed the atmosphere, fostered hope, and built a sense of community among caregivers and patients alike. The ToC process allowed us to ask: How can we measure and sustain these effects on a broader scale? This question led to the creation of MUSIC CARE CERTIFY (MCC)—a quality improvement program that integrates music into the culture of care organizations, turning music into a core, measurable component of care. There have been clear advantages to developing a ToC. Leveraging a comprehensive program rationale has clarified our assumptions, assessed the merits of our standardized quality improvement program, and explained the activities and processes that contribute to change. We have established a shareable vision of the program and identified enablers and barriers to success we can explain to others. We discovered that ToC design methodologies vary. Yet each method typically addresses several key areas which include: Identifying a problem or opportunity that requires a program response, the root causes and effects of the problem and who is affected Scoping the objectives of a program solution and the foreseen impact Naming stakeholders who would likely be a part of the solution Enumerating measures of success Listing assumptions about why, in our case, we think MUSIC CARE CERTIFY will work. The visual metaphor we used to guide our ToC was a tree. We placed the causes of the problem at the roots, the effects as branches, and then focused on the leaves and fruit as the solutions. The imagery helped us map out how music could grow within a care environment, eventually becoming a deeply embedded part of the care culture, a visible and lasting solution. Through this process, we became even more convinced of music’s role in solving the quality of life issues that so often affect caring communities. By integrating music care systematically and sustainably—through the components of MCC—we provide a realistic, scalable solution that’s both affordable and replicable. Imagine care settings where music is integrated into the culture, where quality of life improvements are not just hoped for, but proven. This is the future we’re building—one where music becomes a key player in revolutionizing care.

Jazz Walia is a third-year undergraduate student in the Bachelor of Health Sciences (BHSc) program at McMaster University. During the 2023 winter academic semester, she participated in the Room 217 Research Practicum course generously funded by FAVDTR and wrote this blog post as part of her coursework. When I was in my first year of university, just before my first undergraduate assessment, our professor’s only piece of advice was: “Just put on some Mozart 30 minutes before and you’ll be grand.” I initially thought the advice was completely random, but I was convinced it was a hint for a question or even bonus points. Not so shockingly, there were no Mozart questions on the test, but I did end up typing “Mozart” on Spotify 30 minutes before our test and listening to the first classical music playlist I saw. Two years later, my Spotify and YouTube recommendations are filled with playlists called “Calming Music for 12 Hours” or “Classical Test Music.” Music has always provided me with great comfort; however, it is the soft melodic tones of classical music that have transformed my "pre-test ritual." For me, this type of music has always had a calming effect on me whenever I feel stressed, but especially when it comes to mitigating performance anxiety. A quick search on the internet will yield you thousands of results of people searching for the same thing—"calming music"—on various streaming services. Millions of people listen to the likes of Mozart , Bach , Chopin , etc., on platforms such as YouTube and Spotify, begging the question: why exactly does it work? Over the past couple of decades, research into music listening has inspired further exploration into the use of music as an intervention for reducing anxiety. In a recent survey by the Centre for Addiction and Mental Health (CAMH), 25.1% of survey participants expressed feeling moderate to severe anxiety. In addition, 24.0% of Canadians indicated needing some sort of mental health services but were unable to access them, highlighting the need for accessible services and systems. It’s estimated that only 20% of people experiencing anxiety receive formal interventions , illustrating the need for evidence-based resources. Previous research suggests that music can have a significant effect on endocrine function and autonomic activity, enhancing parasympathetic activities—your body’s "rest and relaxation" state—and reducing respiratory rate and heart rate. In a study by Ubmrello et al ., featuring about 960 critically ill patients, 15 to 60 minutes of music therapy were shown to have a significant effect on reducing anxiety and stress. In a recent review of 21 studies conducted by Harney et al., it was discovered that listening to music had an overall large effect on reducing anxiety. This study was the first of its kind and highlights that while we can see a link between music listening and anxiety, more research needs to be done into important aspects such as music selection, length, setting, and dosage when looking into this relationship. Even if you’re not a fan of the classics, both "fast" and "slow" music have been shown to improve mood. In a study by Darki et al. , 98% of fast music listeners and 99% of slow music listeners reported that music helped manage stress. The study also showed that listening to slow music decreased heart rate and both systolic and diastolic blood pressure . Fast music, on the other hand, increases heart rate and both systolic and diastolic blood pressure. Fast music was seen as "uplifting," while slow music was seen as "calming." These feelings of calmness when listening to slow music help showcase why it might be helpful to listen to music in an anxious state. Of course, "slow" music isn’t restricted to just the classics, which arguably can be "fast" at times, but rather music that often features a relaxed pace, a slower tempo, and a simple, repetitive rhythm and melody. Our relationship with music is extremely subjective and unique to our own experiences. It has been shown that music has profound effects on both our physical and mental health; it can serve as a significant non-pharmacological resource to help mitigate anxiety and stress. The internet—most notably YouTube, Spotify, and Apple Music—is filled with playlists specifically for mood. Music and video streaming websites are a great place to start when selecting music that works for you and exploring different genres and playlists! Author’s note: Spotify , YouTube , and Apple Music are audio streaming services that can be accessed through the internet or through cellular devices. Creating an account is free and on YouTube, an account is not needed to listen to music.

Parkinson’s disease is a progressive disorder that is caused by degeneration of nerve cells in a part of the brain called the substantia nigra, which is responsible for controlling movement. It’s the most common movement-related brain disease, affecting approximately 1% of people 60 years and over worldwide (AANS, 2023). When you hear Parkinson’s disease, what comes to mind? Most people will think of slowed movements (bradykinesia), tremors and rigidity, a stooped posture and shuffling (or festinating) walking pattern. But did you know that Parkinson’s disease heavily impacts the voice? Approximately 90% of people with Parkinson’s disease experience something called dysarthria (Moya-Galé, 2019). Dysarthria refers to a group of motor speech disorders characterized by weakness, slowness or poor coordination of the speech muscles. It is referred to as an execution disorder because the weakened speech muscles result in consistent speech errors. Signs of dysarthria might include an inability to speak loudly, abnormal speech rhythm, a strained, raspy or nasal sound voice, monotonous speech, difficulty moving the tongue and facial muscles, slow and/or slurred speech and rapid speech that is difficult to understand. While there are seven types of dysarthria, hypokinetic and hyperkinetic dysarthria are most commonly associated with Parkinson’s Disease. Hypokinetic dysarthria is marked by difficulty initiating speech, rigidity, short rushes of speech, a harsh of breathy sound, monopitch and monoloudness. In contrast, hyperkinetic dysarthria is marked by difficulty inhibiting speech, irregular articulation, emotions and facial expressions, as well as tremor, dystonia (involuntary muscle contraction) and tics. With all dysarthrias, the main concern is intelligibility of speech. Did you know that music therapy can be used to treat symptoms of dysarthria? In Neurologic Music Therapy, there are two main techniques I have used when working with client’s with Parkinson’s Disease. The first technique is Rhythmic Speech Cueing (RSC). In RSC, the rate of speech is controlled via auditory rhythm (Thaut & Hoemberg, 2016, p. 151). By practicing speech to a metronome the temporal characteristics of speech, such as fluency, rate of speech and intelligibility improve. The beat of the metronome is determined by assessing the client’s fluency and rate of speech. From here, functional sentences can be practiced. For example, if working on metric cueing, each syllable would be matched to one beat of the metronome (“I – want – a – glass – of – wa – ter”). The second technique is Vocal Intonation Therapy (VIT). In VIT, vocal exercises are used to maintain and rehabilitate aspects of voice control such as inflection, pitch, breath control, timbre and dynamics (Thaut & Hoemberg, 2016, p. 179). These exercises are similar to those used in vocal warm up. Another concern among those with Parkinson’s disease is monoloudness and reduced loudness because it can be difficult to communicate with others if they cannot hear you. A music therapist might use an exercise that has the client crescendo their voice to practice singing more loudly, and then transfer this skill to speaking. With the prevalence of Parkinson’s disease it is important to think about all aspects of the disorder – especially the voice – because it allows us to communicate with one another. In persons with Parkinson’s disease, singing can then be used as an effective tool for maintaining vocal function in an engaging and motivating way.