Current Status of Neonatal Music Therapy Services Within the US

Abstract

Over the past 30 years, music therapy services in the neonatal intensive care units (NICUs) have expanded, yet there is still limited literature available that captures current practice trends in this setting. The purpose of this paper was to obtain descriptive data about current demographics, consultation, and clinical practice trends in NICU music therapy clinical practice in the US. A questionnaire was sent to 9,222 Board-Certified Music Therapists. Those providing music therapy services in the NICU and choosing to participate (N = 87) completed the questionnaire. Results showed that a majority of music therapists working in the NICU who responded to the questionnaire have completed additional training to provide specialized services. Most NICU music therapists reported spending less than 20 hr a week on the unit and providing a variety of family-centered interventions to infants starting at 28 weeks postmenstrual age (PMA). Common diagnoses for referral besides prematurity were Neonatal Opioid Withdrawal Syndrome and Chronic Lung Disease. Music therapists are well integrated within treatment teams with a majority reporting collaborating and/or co–treating with other therapies and/or clinical staff.

Every year an estimated 15 million babies are born preterm across 184 countries and this number continues to rise (World Health & Organization, 2023). Prematurity remains a global health problem and is the number one cause of death in the first month of life and the second leading cause of death in children under the age of 5 (Glass et al., 2015). In the US, about 1 in 10 or 380,000 babies are born prematurely (before 37 weeks of pregnancy) every year, a rate that is among the highest for high-income countries (March of Dimes, n.d.). Despite significant advances in treatment, preterm infants often face a lifetime of behavioral and neurodevelopmental abnormalities (Nopoulos et al., 2011).

In order to better support the overall development and outcomes of preterm infants, various developmental care models and interventions have been implemented within the neonatal intensive care unit (NICU) with specific regard to sensory development which impacts all areas of development during the first year of life (Hutchon et al., 2019). Preterm infants often have sensory experiences in the NICU that can have adverse neurosensory and neurobehavioral outcomes due to an immature neurological system, therefore, neuroprotection is a key strategy in protecting neurologic development (Sizun & Westrup, 2004). Due to rapid brain growth, neuroprotective strategies are pertinent to decrease the chances of neuronal death and aid in adaptation to stressful stimuli in the NICU environment (Soleimani et al., 2020). Developmentally supportive programs such as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) utilize strategies that support behavioral organization, alter the NICU environment to decrease stress, stabilize sleep rhythms, improve physiologic stability, and encourage neurodevelopment of the infant within a family-based care approach (Soleimani et al., 2020). Nonpharmacological, low-cost interventions that promote parent education and involvement such as kangaroo care, skin-to-skin care (SSC), swaddling, infant massage, and music therapy are often used within these developmental programs to decrease the risk and onset of health complications (Evereklian & Posmontier, 2017; Mangat et al., 2018).

Over the past 30 years, medical music therapy has been shown to be an effective, evidence-based treatment option for infants in the NICU to support a variety of needs such as neurodevelopment, parent engagement, and education (Standley, 2023). When implemented using evidence-based protocols, music therapy has yielded consistent, positive outcomes with few, if any, negative side effects (Standley, 2012). Common outcomes have included reduced length of stay, increased sleep time, stabilized heart rate and oxygen saturation levels, reduced stress-related behaviors, improved parent–bonding, increased weight gain, and improved feeding/sucking ability (Abromeit, 2003; Gooding, 2010; Keith et al., 2009; Standley, 2012).

There are presently a small number of training programs in the US for music therapists pursuing advanced skills to provide services in the NICU. Known as NICU-MT, the National Institute of Infant and Child Medical Music Therapy (Florida State University College of Music, n.d.) provides training on evidence-based NICU interventions at the national and international levels drawing from the medical and developmental models. First Sounds: Rhythm, Breathe, and Lullaby (Mount Sinai, n.d.) NICU music therapy training is also offered to music therapists at the national and international levels and utilizes music psychotherapeutic approaches with clinical improvisation (Loewy, 2000; Yakobson et al., 2020). Another program available to music therapists pursuing advanced clinical education is Time Together, a music therapy-based parent education program to promote parent–infant interaction in the NICU (Shoemark, 2018). All of these training programs emphasize a family-centered approach for all interventions.

Music therapy interventions are provided at almost every stage and level of care in the NICU. Passive music listening/infant-directed singing/live music listening has been found to be effective for stress reduction, parent bonding, weight gain, and stabilization of vital signs for infants born at 28 weeks postmenstrual age (PMA) and later (Caine, 1992; Cassidy & Standley, 1995; Cevasco-Trotter et al., 2022; Standley, 1991). Interventions such as multimodal neurologic enhancement have been found to significantly decrease length of stay while supporting neurodevelopment (Detmer et al., 2020; Walworth et al., 2012). The use of contingent music through the Pacifier Activated Lullaby (PAL) device has provided significant outcomes for infants with feeding issues such as quicker transitions and independence to oral feedings and decreased hospital stay (Chorna et al., 2014; Hamm et al., 2015; Standley et al., 2010), while the use of entrained live rhythm and breath sounds with familiar lullabies has been found to improve non-nutritive sucking (Loewy et al., 2013). The use of the PAL has also been found effective in providing pain relief after painful medical procedures as well as live lullaby singing (Ullsten et al., 2016; Whipple, 2008).

A variety of music therapy interventions have shown to be effective in increasing parent bonding, engagement, and education for preterm infants before and after discharge as well as reducing parental stress and providing support for end-of-life needs (Detmer, 2016; Gooding & Trainor, 2018; Hamm et al., 2017; Loewy et al., 2013; Robertson & Detmer, 2019; Walworth, 2009; Whipple, 2000). For infants ≥37 weeks PMA (term equivalent), developmental music therapy interventions have yielded significant outcomes for improvement in motor, cognitive, and communication skills (Emery et al., 2018). Given the growing body of evidence supporting the use of music therapy in the neonatal intensive care unit, many NICUs across the US are now hiring music therapists to provide services for a variety of needs.

As music therapists seek to begin programs and as units seek to add music therapy services, questions around structure, organization, referrals, treatment, and funding often arise with curiosity about how music therapy is already implemented in other units. To date, there are no studies that include a practice analysis of descriptive data related to all aspects of music therapy practice in the NICU. Standley & Riley, (2016) surveyed board-certified music therapists (N = 106) working in the medical setting with children and 51% reported providing services in the NICU but did not provide further descriptive data related to the implementation of music therapy clinical practice in this setting. The purpose of this survey was to obtain pertinent evidence related to prevalence, organization, consults, and treatment to provide a better understanding of how music therapy services are being utilized within NICU’s across the country. Specifically, the following questions related to clinical practice were asked: (1) where are music therapy services in NICU being offered and how often; (2) what is the leadership structure and organization of the music therapy positions that serve the NICU; (3) how are music therapists receiving requests for services in the NICU; (4) do music therapists receive the consults in relation to common diagnoses of infants that receive music therapy services; (5) what are the most frequently used music therapy interventions and ages of related infants; and (6) which therapeutic services music therapists are co-treating within the NICU.

Methodology

Participants

Participants for this study (N = 87) were board-certified music therapists (MT-BC) through the Certification Board for Music Therapists (CBMT). The researchers received approval through CBMT and were sent a list of 9,222 board-certified music therapists with related email addresses. CBMT and other organizations do not have the ability to send a list of board-certified music therapists based on the population they serve or the type of facility of employment. Inclusion criteria for this study were that board certified music therapists had to be currently providing services in neonatal intensive care units. The researchers received approval from CBMT as well as approval from the respective institutional review boards which approved the survey questionnaire and study design.

Survey

A survey tool was created by the researchers for this study (see Supplemental Material). Prior to study implementation, a draft of the survey was administered to four music therapists providing services in the NICU and two music therapy faculty members working at separate universities to determine the clearest survey configuration, estimate of time needed to complete the survey, and most appropriate questions related to music therapy practice in the NICU. Due to the inability to send the survey to only music therapists practicing in the NICU, the first question on the survey asked participants if they were currently practicing in the NICU with a “yes” or “no” option for response. If the participant chose “no,” then they did not meet the inclusion criteria for this study.

The survey included a demographics section to better understand where music therapists are working and the structure of their position to provide further insight into how music therapist services are offered in NICUs. This information is paired with data collected related to interventions provided and the acuity of infants receiving music therapy to give a more comprehensive analysis of current practice. This section contained questions regarding the region in which the participant was located, the number of years providing services in their current NICU as well as the total number of years as a NICU music therapist, and type of training received. In addition, participants were asked which type of facility (general hospital or pediatric hospital) and level of NICU where they provided services which included level I (newborn nursery) Level II (special care nursery providing care to infants ≥32 weeks PMA), level III (provides care for infants born ≤32 weeks PMA), and level IV (provides highest level of medical care for premature and newborn infants with availability of pediatric subspecialists and the ability to care for infants on extracorporeal membrane oxygenation). Participants were also asked about the level of employment, department/service line/program in which music therapy services are employed, position/title of participant, and hours per week of providing services in the NICU.

The next section contained questions related to the participant’s music therapy practice in the NICU including how music therapy consults are generated and if automatic consults are utilized, services that are being reimbursed, earliest postmenstrual age (PMA) that services are being consulted/provided, as well as interventions provided and those most commonly utilized/requested. In addition, questions regarding common subdiagnoses (besides prematurity) services are consulted for, specific diagnoses in which music therapy services are not allowed or cannot provide treatment, and co–treatment and related interventions used when working with other disciplines. The majority of questions utilized a “check one” or “check all that apply” response format. Response options provided by the researchers were compiled from existing literature on this topic.

In the case of questions regarding goals or interventions for music therapy (MT), there is currently no literature containing a thorough list of all goals or interventions from all approaches. Goals and interventions that were published in multiple literature sources including books or research articles were provided (Knight et al., 2018; Loewy, 2000; Loewy et al., 2013; Shoemark, 2018; Standley, 2023). All questions with “checkbox” responses had the addition of an “other” response that allowed participants to write-in their own response due to the authors inability to ensure all goals or interventions were listed. These write-in responses were then coded or added to the list of responses for analysis.

An online version of the questionnaire was created using Qualtrics, a secure online survey software used for creating, collecting, and managing survey data. Board-certified music therapists received an email that contained a brief description of the study as well as survey instructions and an internet link to the survey. There was also a brief statement that assured confidentiality and that no identifiable information would be used. It was estimated that the survey took about 15 min to complete. A reminder email was sent a week before the survey closed to contacts who had not responded. The survey was available to all contacts for one month to obtain all necessary data, from sending initial and reminder emails to receiving completed surveys.

Results

Participants

At the time of this study, all 9,222 music therapists certified through CBMT were eligible to participate and sent the questionnaire. As a result, 189 music therapists responded to the survey and 87 stated they currently provide services in the NICU. An accurate response rate was not calculated due to the inability to know how many MT-BCs are currently practicing in NICU in the US.

Most participants (65%) reported working full-time within a children’s hospital setting. Over half (69%) reported providing services in their current NICU for ≤5 years, with an average of 5.12 years (SD = 5.25) of overall NICU experience reported. Regarding the number of hours spent providing services per week, a larger number of respondents (25%) reported spending 6–10 hr per week in the NICU (Figure 1). In addition, most respondents reported working as a staff music therapist (73%) as opposed to holding a supervisor or manager position.

Responses were received from all regions of the US. The region with the highest response rate was the Southeastern region which reported 19 (22%) music therapists providing services in the neonatal intensive care unit while the New England region had the fewest responses with four respondents (5%). Regarding training, a majority (85%) reported they completed additional music therapy training to provide services in the NICU. Over half reported completing the National Institute for Infant and Child Medical Music Therapy NICU training (69%), followed by Rhythm, Breath, Lullaby training (26%), and Time Together (2%), and other training such as those offered for continuing education for neonatal nurses (2%). Regarding the four levels of NICU care, the majority of respondents reported providing services in a level IV (59%) or III (35%) NICU. When asked to state which department or service line they worked in, more than half of respondents reported child life, family, or women’s and children’s support services (59%; Figure 2).

Music Therapy Practice

Many music therapists (25, 31%) reported receiving consults for music therapy service through a formal order system from physicians, nurse practitioners, and physician assistants. A larger number of respondents (35%) stated receiving their consults through a referral system from physicians and nurses. Some music therapists reported using a less formal referral system receiving referrals from all medical or clinical staff and family (30%), child life specialists (2%), or members of a neuroprotective team (1%). In regards to the process of alerting staff of viable infants for music therapy services, 21 (19.81%) reported referrals being elicited from speaking with various NICU staff (PT, OT, ST, RN, Neonatologist, Social Worker, Child Life), 17 (16.03%) through electronic medical records/chart review, 14 (13.20%) attended medical rounds, and 12 (11.32%) attended interdisciplinary team meetings.

Out of 79 respondents, 19 (24%) reported receiving automatic consults on all viable infants and from these responses, 5 (26%) reported receiving automatic consults from neonatologists, 4 (21%) from nurses, 4 (21%) from any medical staff, 2 (11%) from nurse practitioners, and 1 (5%) from physician assistants. When asked what the earliest postmenstrual age (PMA) of infants for which music therapy services are being consulted, almost half (49%) reported receiving consults for infants with PMA of 28–31 (Table 1) and the most common subdiagnosis besides prematurity music therapy services are consulted for is Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome (Table 2). Most respondents stated that there were no diagnoses for which music therapy could not receive a referral. A few respondents (n = 15, 20%) reported some diagnoses/clinical scenarios they were not able to seek a referral for treatment including Extracorporeal Membrane Oxygenation (ECMO), sensory stimulation precautions, extremely preterm (prior to 28 weeks PMA), high flow oscillatory ventilation (HFOV), infants younger than 37 weeks of age (term equivalent), neurologic conditions (seizures, intraventricular hemorrhage, cooling), full contact isolation, acute medical instability, Necrotizing Enterocolitis (NEC), and use of paralytics.

When asked what interventions were provided, most respondents reported providing parent bonding services in the NICU (84%) while few reported providing vocal holding/toning (6%) or music as controlled motion (5%). In regard to interventions consulted, a majority of respondents (77%) reported developmental music therapy being the most common intervention consulted. When asked about billing, only 12 (15%) out of 79, reported billing but all 12 reported billing for parent/family support and counseling including trauma informed care. See Table 3 for a full list of interventions provided, consulted, and billed for by music therapists.

Co-treatment and Collaboration

The majority of respondents (87%) reported that they co-treat or collaborate with other professionals when providing services in the NICU. For the sake of clarity, co-treatment in this setting is commonly defined as a music therapist and other discipline (e.g., physical therapist, speech therapist) treating the infant simultaneously for the same goal. Rehabilitation therapies were the most cited disciplines for co-treatment with music therapy in the NICU with physical therapy and occupational therapy both being cited by 53 of the 65 music therapists who reported co-treating, and speech therapy being cited by 40 music therapists. Other disciplines that were reported by music therapists as co-treating or collaborating in NICU were child life (18), social work (9), nursing (9), chaplain/spiritual care (8), massage therapy (5), physician (4), lactation (2), psychology (2), developmental specialist (1), respiratory therapist (1), and integrative medicine (1). Music therapists reported mostly co-treating during sessions with developmental goals utilizing developmental music therapy (42%) with many reporting that they co-treat by providing auditory stimulation during infant massage, stretching, range of motion, and movement interventions (25%), live music for procedural support (23%), and PAL or music to support non-nutritive sucking (22%).

Discussion

The use of music therapy services in the neonatal intensive care unit has grown over the past 20 years due in part to evidence-based research that has yielded consistent, clinically significant outcomes such as shortened length of stay and stabilization of physiologic parameters (Cevasco-Trotter et al., 2022;  Standley & Gutierrez, 2020). To the best of the authors’ knowledge, this descriptive study is one of the first of its kind to capture data reflecting a variety of variables related to contemporary music therapy practice (e.g., demographic information related to the music therapists’ position, how requests for services are obtained, common interventions being provided as well as ages and diagnoses of infants receiving services) specifically in the NICU. This information is pertinent to better clarify how music therapy is being implemented in NICUs across the US and to examine how this has been a growing area of practice, especially in the past 10–15 years.

In the study by Standley & Riley, (2016) that surveyed music therapists identified by the U.S. Certification Board for Music Therapy as working in medical settings with children, 86 of 100 participants who responded to NICU practice-specific questions reported being trained in the advanced training for the NICU-MT certificate through the National Institute for Infant and Child Medical Music Therapy. In the same survey, 54 reported providing services in the NICU which is less than the finding in the current survey of 87 music therapists. In addition, over half of the respondents in the current survey have been working in their NICU for ≤5 years with an average of 6 years of overall NICU experience. These data reflect an increase in the number of respondents reporting providing services in this setting as well as the average duration of years currently working in this environment compared to the Standley & Riley, (2016) study which had reported an average of 2 years.

The increased years of experience in the NICU could be due to the growing number of continuing education opportunities and approaches available to music therapists to obtain the skills needed to provide highly detailed and effective interventions in the NICU. Due to the specialized care required for preterm infants, many professionals such as rehabilitation therapists, nurse practitioners, medical doctors, and social workers require or highly recommend additional and advanced training to practice in this setting (AOTA, 2006; ASHA, 2004; Bachman & Lind, 1997; Sweeney et al., 2009; Torpy et al., 2009). To provide advanced training for music therapists, programs such as those through the National Institute for Infant and Child Medical Music Therapy and Rhythm, Breath, and Lullaby, have been created over the past 20 years and provide lecture content and hands-on clinical training at a variety of national and international training sites. While not currently required to work in the NICU, a large percentage (72%) of participants stated completing advanced training suggesting that the music therapy profession as well as healthcare professionals are recognizing the level of competence not provided at the undergraduate level that is necessary and pertinent to better align with other NICU professionals.

Program Development

Even though a majority of respondents reported working full-time at their medical facility, only 14% reported providing services full-time in the NICU compared to the majority who reported providing 20 hr or less of music therapy services in either a level III or IV NICU. This is the first time data have reported specific hours spent in the NICU per week by music therapists. Even though information in the literature is sparse, many reasons have been reported for fewer hours allocated to time spent in the NICU other than a small number of NICU beds. In Robertson (2023), it was stated that a lower number of consults to generate a full-time position, misinformation, lack of knowledge and exposure to MT services by clinical staff, as well as limited funding were common reasons why many music therapists do not work in the NICU more than 20 hr a week. These findings are crucial to understanding how to better implement and expand services in the NICU. More research that examines variables related to program development is warranted to aid music therapists in becoming a vital part of the NICU care team.

Advocacy and education related to music therapy services in the NICU is often cumbersome due to scheduling and frequent staff turnover which can have a negative effect on the number of referrals made and acuity of infants receiving services. Funding, including the source or provider, for music therapy services at the hospital could also impact services provided in the NICU as well as the ability to seek reimbursement for services. Unlike service lines such as nursing or neurorehabilitation, child life/family support services often include an umbrella of programs and resources provided to patients that are typically not billed for. Additional variables affecting reimbursement could be the type of managed care contracts the facility has or the type of service line that manages music therapy. Facilities that are billing for music therapy services contract with Health Maintenance Organizations (HMOs) which often provide a percentage of charges back to the facility creating additional revenue. Many other facilities have contracts that provide a fixed amount of coverage per day or for the length of the hospital stay and do not generate additional revenue for services like music therapy. A NICU-based service line like nursing or rehabilitation therapies may be more advantageous for units and music therapists seeking to provide more services and obtain reimbursement.

Many music therapists reported using a referral system in the NICU while a small percentage of respondents reported using an order system for consults for services. Within an order system, orders for music therapy services can only be placed by medical providers such as neonatologists, nurse practitioners, and physician assistants. This limits the number of qualified staff who can place the order for services and requires more education among the attending clinical staff. These issues as well as the issues mentioned previously related to staff education could be the cause for a higher number of respondents using a referral system. The higher reported use of a referral system could also be an additional reason why few respondents reported receiving reimbursement for music therapy services in the NICU as an order is often needed to seek reimbursement.

Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) was reported as being the most common subdiagnosis for referral besides prematurity. This finding could likely be a reflection of the current opioid epidemic in the US and the need for more nonpharmacological treatments to address the severe side effects of withdrawal. These infants also require a substantial amount of care from healthcare staff so new care models like Eat, Sleep, Console (ESC), which prioritize nonpharmacologic approaches to the care of these infants (swaddling, skin-to-skin contact, minimizing overstimulation, and breastfeeding) while increasing parent/caregiver involvement, are being implemented (Grisham et al., 2019). While there is a need for more literature regarding the effectiveness of music therapy with this diagnosis, the findings thus far have yielded positive outcomes. Detmer et al. (2017), found that infants diagnosed with NAS/NOWS cried less, slept for longer periods, and demonstrated better paced sucking response during feeding than infants that did not receive music therapy. More research in this area is needed to identify specific music therapy interventions/protocols that may be an effective treatment option within models of care like ESC.

Interventions

Multiple interventions were reported being provided in the NICU with parent bonding and education among the highest frequency of responses. Significant findings in the literature have yielded positive outcomes when parents have been involved in the developmental care of their infant such as decreased parental stress and increased parent attachment and coping (Caine, 1992; Cevasco, 2008; Gooding & Trainor, 2018; Shoemaker et al., 2015) as well as reduced overstimulation of infant, increased visitations by parents (Detmer, 2016; Whipple, 2000), and enhanced achievement of developmental milestones (Hamm et al., 2017; Robertson & Detmer, 2019; Standley et al., 2009; Walworth, 2009). Many respondents reported providing developmental music therapy interventions targeting early motor, communication, and cognitive skills. These interventions have been found to significantly impact developmental skill acquisition in term-equivalent infants (37 weeks PMA) and post-term infants in the NICU (Emery et al., 2018). The use of developmental music therapy interventions was also reported as the most utilized during co-treatment with rehabilitative therapists such as physical, occupational, and speech therapy.

Regardless of part-time or full-time employment status, the aforementioned interventions were also reported as the most commonly consulted interventions. This finding indicates an overall consistent need for this intervention as a majority of music therapists are practicing in Level III and IV NICUs where infants with chronic needs are treated and often experience long stays in the NICU past the infant reaching term equivalency (≥37 weeks PMA). This outcome could also point to the need for more education and advocacy among staff regarding the benefits of music therapy services for infants prior to reaching 37 weeks PMA. While it appears many music therapists are being consulted to primarily work with older infants in the NICU (≥37 weeks PMA), evaluations of clinical practice have found that earlier intervention for younger and more critical infants yields better clinical outcomes (Hamm, 2020; Yinger & Standley, 2011) The staff may not be aware of these findings and may be hesitant due to a lack of understanding of interventions that can be utilized at an earlier age. Continued investigation and advocacy regarding the effects of music therapy on the development of extremely preterm (born ≤28 weeks PMA) and very preterm infants (28–32 weeks PMA) is warranted to enhance the ability for music therapists to provide earlier intervention.

Music for soothing purposes was also indicated as being highly utilized in the NICU. This corresponds with the data reflecting NAS/NOWS as being the most common subdiagnosis for which music therapy is consulted. As mentioned previously, there is a growing need for continued investigation into evidence-based practice when providing services to these infants to better clarify protocols for effective interventions for symptom management.

Limitations

One of the biggest limitations of this study is that currently there is not a list that specifically identifies music therapists who are providing services in the NICU. At the time this survey was distributed, all 9,222 board certified music therapists were sent the survey with only 189 self-selecting to take the survey with 87 of those meeting the inclusion criteria to complete it. If there was a location/website/list that identified all NICU music therapists, the survey may have yielded a larger response rate.

While most respondents stated they completed advanced training, the implementation of music therapy services in the NICU varies greatly in the level of evidence-based practice and continuity of services based on results from questions regarding goals and interventions. In addition to developmental music therapy practice and parent bonding and education, there were an additional 16 interventions reported being used in the NICU. This variety in treatment made analyzing the implementation of music therapy in the NICU more difficult due to the wide variety of services being provided and is another limitation of this study.

With so many interventions being provided, there appeared to be some confusion between various interventions within participant responses. For example, multi-sensory stimulation with live singing and multimodal neurologic enhancement seemed to be used interchangeably as well as reflective instrumental support and “music with use of ocean disc and gato box.” The response rate for the interventions listed may not be correct due to the aforementioned discrepancies and is a limitation of this study.

Researchers pulled intervention and goal responses on the survey from multiple sources as there is no publication with all goals and interventions from all approaches. Additionally, the literature varied in amount and level of evidence supporting each goal area or intervention with some being described in different manners or with varying to no protocols. Clear definitions and evidence-based protocols for each intervention are needed to increase clarity and understanding of the application of each.

Conclusion

This survey provides a review of descriptive data examining current music therapy practice related to service implementation and integration within the NICU. There were many outcomes that have not been reported previously in the literature such as the type and frequency of interventions being used in the NICU, common subdiagnoses of infants receiving services, hours spent providing services per week, method of requesting music therapy services by clinical staff, as well as the earliest postmenstrual age in which services are being consulted. This new data not only provides information related to current clinical practice, but also may aid music therapists in developing and implementing NICU services.

While these findings are encouraging, the data indicate there is still room for growth and expansion of music therapy services provided across the US. Responses showed that interventions and services being provided in the NICU vary greatly in the level of evidence-based practice and continuity of services, highlighting the need for streamlined research and clarification of intervention protocols to solidify music therapy services in the NICU as a standard of care beginning at 28 weeks PMA. In addition, little is known of the effectiveness of music therapy services for infants ≤28 weeks PMA, therefore, more research is needed in this area of practice seeing that respondents reported receiving referrals and providing services for extremely premature infants.

Even though it appears that music therapists are receiving appropriate referrals for services, further advocacy and education are needed among medical staff in the NICU to better fund and continue expanding music therapy services. Further research examining barriers as well as effective strategies including funding for the expansion of services in the NICU is warranted. In addition, obtaining data related to services provided away from the bedside (e.g., sibling/parent support groups, etc.), telehealth services, clinical supervision, and cultural practice is needed to provide further insight into contemporary music therapy practice in the NICU.

References

Author notes