Collaborative Music Therapy and Speech-Language Pathology for Pediatric Acquired Communication Impairments: A Phenomenological International Perspective

Abstract

The partnership between music therapy and speech-language pathology is gaining recognition as an effective approach in the rehabilitation of young children with acquired communication impairments (ACIs). Yet, there remains a notable gap in understanding the distinctive contributions and challenges inherent in this collaborative practice. This study explored the perspectives of music therapists (MTs) and speech-language pathologists (SLPs) regarding the unique role of this collaborative effort, the elements of successful collaboration, and the methods implemented by clinicians to evaluate outcomes. Semi-structured interviews were conducted with nine pairs of MTs and SLPs in rehabilitation facilities across seven countries. These interviews were analyzed thematically using Van Manen’s approach to hermeneutic phenomenology. Three themes arose from the data: (a) the role of collaborative music therapy and speech-language pathology, (b) building blocks of successful collaboration, and (c) evaluating collaborative practices. This collaboration fosters a unified strategy aimed at achieving shared language and communication goals. By combining their distinct expertise, MTs and SLPs can address the complex and varied needs of children with ACIs more effectively. However, further research is essential to comprehensively understand the functional outcomes arising from such collaborative endeavors in pediatric ACIs. This is crucial for validating the efficacy and significance of this approach in bolstering language and communication skills and advocating for its wider integration within rehabilitation services.

Background

Acquired communication impairments (ACIs) refer to disruptions in speech and language functioning arising from neurological injury (Hécaen, 1976). These impairments stem from various etiologies of acquired brain injury (ABI) and present as conditions like aphasia, dysarthria, apraxia, and cognitive communication impairments (Burns et al., 2024b). Children with ACIs often require intensive neurorehabilitation, including speech-language pathology and music therapy, to relearn and redevelop abilities impacted by their injury (Burns et al., 2024b; Murdoch, 2011).

Collaboration

Collaborative care, where healthcare professionals share knowledge, expertise, and skills, is widely considered the most effective way to deliver quality care, with the client at the center (Reeves et al., 2010; Twyford, 2017; Twyford & Watson, 2008). Hobson (2006b) delineates three distinct modes of teamwork:

1. Multidisciplinary—Professionals approach the client’s needs from their specific disciplinary focus, implementing their own goals, interventions, and treatments autonomously. This ensures direct application of each discipline’s expertise but may result in fragmented care due to limited collaboration.

2. Interdisciplinary—The team collaborates on shared goals, with each discipline conducting individual assessments and treatments. Information is openly exchanged, and team members are well-informed about each other’s approaches. This enhances the depth of care by integrating multiple perspectives, though differing terminologies and frameworks can sometimes hinder full integration.

3. Transdisciplinary—Professionals transcend traditional disciplinary boundaries by integrating knowledge, methods, and perspectives from multiple disciplines into a unified approach. The potential for teamworking is realized and co-treating frequently occurs. This often leads to innovative, well-rounded solutions, although the blurring of roles and the complexity of synthesizing knowledge across disciplines can pose challenges.

An interdisciplinary approach is commonly found in specialist rehabilitation services (Behm & Gray, 2012). However, in many low- and middle-income settings, rehabilitation services are often limited to a single discipline, typically physiotherapy, resulting in significant service gaps (World Health Organization, 2017). Cartmill et al. (2011) recommend a transdisciplinary approach for populations with complex needs to provide comprehensive functional and psychosocial levels of care for optimal outcomes. While this approach is touted as the most efficient for early intervention, theoretical understanding of evidence-based practice does not always translate to the practical processes required to effectively establish and maintain high-functioning teams (Aubin & Mortenson, 2015; Bell et al., 2010). Ultimately, the choice of approach should be guided by the client’s needs, the rehabilitation goals, and the available resources and expertise within the team.

Collaborative Music Therapy and Speech-Language Pathology

Music and language are deeply intertwined, both utilizing elements such as pitch, rhythm, and tempo to convey and express emotive meaning (Besson & Schön, 2001). Music functions at both pre-verbal and verbal levels, acting as a potent form of communication accessible long before the acquisition of expressive language (Bunt & Stige, 2014). Though music and language differ in semantics, they share some neural mechanisms involved in processing pitch and rhythm (Jentschke, 2016; Peretz et al., 2015). However, it remains largely elusive as to how music elicits neural changes that help to facilitate speech and language processes in the brain (Lee et al., 2019). Nonetheless, music plays a therapeutic role in language rehabilitation, particularly within ABI. Singing has been shown to improve several speech-related parameters, including phonation time, intensity, speech rate, prosody, vocal range, and overall intelligibility (Baker et al., 2005; Cohen, 1992; Kim & Jo, 2013).

Music therapists (MTs) and speech-language pathologists (SLPs) bring distinct yet complementary contributions to the treatment of individuals with ACIs. Their shared skillset in assessment, goal setting, social skills development, and play facilitation suggests a natural potential for collaboration in practice (Ryckaert & Kenworthy, 2016). Twyford and Watson (2008) propose that collaborative efforts between music therapy and speech-language pathology can enhance motivation and attention, thereby bolstering communication and social interaction skills. Kennelly et al. (2001) emphasize that music, being both stimulating and enjoyable, enhances motivation in repetitive speech exercises. Co-treatment involving music therapy and speech-language pathology has been employed to support various client groups, including adults with apraxia of speech and aphasia (Hurkmans et al., 2015), children with developmental apraxia of speech (van Tellingen et al., 2023), and children with developmental communication impairments (Geist et al., 2008). Hobson, (2006a, b) asserts that active collaboration between MTs and SLPs is essential for delivering optimal service provision, especially for individuals with neurologic deficits or ACIs.

The Pediatric ACI Landscape

Despite the recognized benefits of interprofessional approaches, the intersection of music therapy, speech-language pathology, and pediatric ACIs remains underexplored. In a review of music therapy and pediatric ABI, Burns et al. (2024a) identified no empirical studies examining collaborative efforts between MTs and SLPs. Existing research relies heavily on anecdotal reports and case studies (Bower & Shoemark, 2009; Kennelly & Brien-Elliott, 2001; Kennelly et al., 2001), limiting generalizability. Although dated, their relevance and applicability remain significant. Researchers have demonstrated the importance of collaboration in addressing articulation, speech rate, pitch range, intonation, and volume control in dysarthria rehabilitation (Kennelly & Brien-Elliott, 2001; Kennelly et al., 2001), and word-finding capabilities and expressive language in aphasia rehabilitation (Bower & Shoemark, 2009; Kennelly et al., 2001). However, they offer limited insights into clinician experience and role delineation between MTs and SLPs. Factors influencing successful collaboration and knowledge around measures of success are lacking, and further research is necessary to fully elucidate the impact and broader applicability of these interventions. Burns and O’Connor’s (2023) interviews with MTs and SLPs provide foundational insights into clinicians’ experiences in pediatric ABI. Clinicians positively reported that, despite being resource-heavy, shared knowledge and collaborative intervention enhanced client care. However, the small sample from a single rehabilitation setting in Ireland may not fully represent global practices. Burns et al.’s (2024b) survey of music therapy clinical practices in pediatric ACIs revealed that collaborative endeavors with SLPs were viewed as the most impactful approach to intervention. While the study did not delve into the specific reasons behind the perceived effectiveness of collaboration, further investigation is essential to understand the underlying factors contributing to successful interprofessional practices in this context.

Study Aims

The purpose of this study was to explore the experiences of MTs and SLPs collaborating in the treatment of children with ACIs. By collecting first-hand accounts from clinicians working in a field with limited research, the objective was to gain insights that could facilitate reflection on the complexities of collaborative practices, enhance service provision, and guide further research in pediatric ACI. The study sought to address the following research questions:

• What is the role of collaborative music therapy and speech-language pathology in the rehabilitation of children with ACIs?

• What are the elements of successful collaboration between music therapy and speech-language pathology in this context?

• How are MTs and SLPs evaluating the impact of their collaborative practices within pediatric ACIs?

Ethical approval was sought and obtained through the Research Ethics Committee at the University of Limerick (2023-10-20-AHSS).

Methodology

Author’s Lens and Biases

In phenomenological research, researchers must acknowledge and set aside their preexisting beliefs and assumptions about the phenomenon under study (Hiller, 2016). The research team brings diverse perspectives shaped by their roles and experiences. Authors 1 and 4 are music therapy clinicians-researchers with extensive pediatric neurorehabilitation experience. Their previous collaborations with SLPs have fostered a deep appreciation for such practice. Authors 2 and 3, music therapy students, have formed similar perspectives through clinical training and contemporary literature. Author 5, a music therapy researcher and educator with experience in adult settings, provides a broader understanding of collaboration, though with expectations that may differ from pediatric contexts. The research team acknowledged their diverse professional backgrounds and made a concerted effort to remain aware of any preconceptions throughout data collection and analysis.

Research Design

The researchers employed an interpretivist design to gain an in-depth, context-specific understanding of clinicians’ experiences. A hermeneutic phenomenological design was adopted to explore the lived experiences of collaborating MTs and SLPs working with children with ACIs. Phenomenology, defined as the study of that which can be directly experienced (Williams, 2021), and hermeneutics, a method of revealing the unseen world of lived experience (Oerther, 2020), guided the approach to understanding the subjective realities of collaborative clinical practice. This design emphasized the autobiographical and contextualized nature of each clinician’s experiences (Miles et al., 2013). Capturing such encounters from the viewpoint of both clinicians simultaneously aimed to bring the experience of collaborative practices with children with ACIs to life by recognizing the contextual dimensions of their narratives.

Participant Recruitment

A purposive sampling method was employed to identify clinicians possessing specific target characteristics, ensuring that the sample reflects relevant insights and experience within the research context (Bowling, 2014). The inclusion criteria required that participants be (a) fully qualified MTs or SLPs with at least five years of clinical experience working with children with ACIs, (b) regularly engaging in collaborative music therapy and speech-language pathology practices with children with ACIs, and (c) be proficient in either English or Spanish. Clinicians working outside the specific remit of pediatric ACIs in areas, such as autism, were excluded.

The recruitment process involved identifying collaborating pairs of MTs and SLPs meeting these criteria. Invitations and information leaflets were extended to clinicians in pediatric rehabilitation hospitals, and music therapy associations were also contacted to distribute study information to their members. In addition, a snowball sampling method emerged, where initial participants facilitated the recruitment of additional subjects from within their professional networks (Naderifar et al., 2017). Clinicians from 37 countries were invited, with 9 teams from 7 countries agreeing to participate.

Data Collection

Semi-structured interviews were selected as the most appropriate means of data collection, allowing for a comprehensive exploration of participants’ experiences while ensuring alignment with the research questions (Morse, 2012). A topic guide was developed to systematically cover key issues while allowing flexibility to delve into aspects critical to the participating dyads (Arthur & Nazroo, 2003). See Supplementary Material. This approach supported a wide-ranging discussion of both anticipated and emergent topics (Bowling, 2014). When interviewees diverged in interesting and relevant directions, follow-up questions were posed to clarify or expand on their points. The focus was on understanding the essence of participants’ experiences, prioritizing depth and richness over precise terminology (Willig, 2008).

Geographical dispersion necessitated online interviews via Zoom. Conducted from January to April 2024, interviews ranged from 45 to 60 minutes in length. All interviews were video recorded and transcribed verbatim. In the singular instance where an interview was conducted in Spanish, author 3, a native speaker, translated and verified the accuracy of the English manuscript for subsequent analysis. Interview transcripts were not returned to participants for review.

Data saturation was not fully achieved, as the heterogeneity of the participants’ experiences continued to provide new information and perspectives (Guest et al., 2006). Although common themes were emerging, the distinct healthcare systems and cultural influences introduced nuances that made it difficult to reach a point where no new information was generated. While saturation is often an indicator of data adequacy, it is not always a strict requirement when dealing with diverse populations (Guest et al., 2020). However, the absence of saturation might indicate the need for caution in generalizing findings across all contexts.

Data Analysis

Hermeneutic phenomenological analysis is an iterative process of reading transcripts and developing themes, continually enhancing the researchers’ understanding (Oerther, 2020). Van Manen’s (1990) hermeneutic phenomenological approach was employed, which involved the following activities:

1. Turning to the nature of lived experience: Formulating a phenomenological question and developing a deep interest in a particular lived experience.

2. Investigating experience as we live it: Capturing the phenomenon through methods of investigation that provide rich descriptions of the lived experience.

3. Reflecting on the essential themes: Conducting thematic analysis to identify and reflect on essential themes that characterize the phenomenon. This involves open coding, creating initial themes, and highlighting core aspects of the experience.

4. The art of writing and rewriting: Articulating participants’ feelings, thoughts, and attitudes to vividly and accurately capture the essence of their experiences.

5. Maintaining a strong and oriented relation: Remaining engaged with the research questions to ensure focus on the lived experience being explored.

6. Balancing the research context by considering parts and whole: Integrating individual themes into a comprehensive understanding of the phenomenon by examining the relationship between the parts (individual themes) and the whole (overall experience) to achieve a balanced and nuanced interpretation.

The authors’ initial perspectives were noted and set aside before analysis. The first three authors independently reviewed the interviews, coding and thematically analyzing the data following Van Manen’s (1990) approach. Each transcript was read multiple times, with the text coded line by line to generate initial codes. These codes were then clustered into broader themes, focusing on units of relevant meaning that illuminated the research questions. Finally, these groupings were refined into core themes representing participants’ experiences. The research team then discussed their analyses to reach a consensus on the final themes, enhancing the credibility of the analysis by ensuring a comprehensive exploration of the data (Bernard et al., 2016).

To further validate the study and mitigate potential biases, two randomly selected teams of collaborating pairs examined the emerging themes. This external validation process aimed to confirm the fidelity of the analysis and explore any additional perspectives. While member checking with each pair was not feasible due to time and resource constraints, the feedback received led to revisions in theme and sub-theme names, ensuring a more accurate representation of participants’ descriptions and minimizing the influence of personal assumptions and biases on the analysis.

Results

Nine pairs of MTs and SLPs from seven countries outlined their experiences of collaboration within pediatric ACIs. A summary of participants’ demographic information is detailed in Table 1.

Using Van Manen’s (1990) hermeneutic phenomenological approach, three overarching themes arose: (a) the role of collaborative music therapy and speech-language pathology, (b) building blocks of successful collaboration, and (c) evaluating collaborative practices. See Table 2.

Theme 1: The Role of Collaborative Music Therapy and Speech-Language Pathology

Throughout the interviews, the synergy between music therapy and speech-language pathology was a central focus, and their collaborative role in supporting children with ACIs was addressed. Three key subthemes were identified: (a) complexity demands teamwork, (b) collaboration is innate, and (c) cross-fertilization nurtures knowledge and expertise.

Complexity Demands Teamwork

Participants underscored the unique challenges of pediatric ACIs, emphasizing its distinction from adult ACIs due to the added layer of child development. This complexity frequently challenged seasoned clinicians. Aus-SLP1 expressed, “even as a speech pathologist, that is supposed to know everything about those presentations, it is always something new. Every patient is different and presents with different issues.” “Trickier” (Ire-SLP2) or “complex” (USA-MT) presentations were prioritized for joint sessions. As noted by Ire-SLP1: “we are coming together because we need to.”

Collaboration was viewed as essential for gaining crucial insights into clients’ communicative presentations and effectively addressing identified needs. Participants described its role in early diagnosis as “vital for unraveling complexities” (UK-SLP), with each clinician seeking assistance, advice, or guidance from others as needed.

I’m just waiting for [Aus-MT1] to come so I can see whether it is dyspraxia or aphasia or whatever—it’s the only way I can do it. I rely on music therapy in helping me work these kids out—it’s invaluable (Aus-SLP1).

The value of differing perspectives was emphasized by Sp-SLP: “sometimes we will see the same things but sometimes we will notice different things.” Joint intervention was deemed effective in supporting early pre-verbal skills, facilitating subsequent language acquisition, and alleviating symptoms of ACIs.

Collaboration is Innate

Participants struggled to articulate a concise role to succinctly justify the presence of two clinicians in a single session, despite their commitment to collaboration in pediatric ACI. They instinctively gravitated toward each other when assistance was needed with a specific child: “we just do it, don’t we?” (Aus-SLP1).

Participants recognized the commonalities between the two disciplines, acknowledging that both work toward enhancing speech, language, and communication with this population. Aus-MT2 described how the roles seamlessly integrated when combined:

It is fluid. It moves in and out and back and forth all the time—constant modification—all of that working out what it is that we are doing and what the intervention is going to look like—is a different role.

Despite shared goals, participants expressed conflicting attitudes on whether their roles as clinicians changed when working individually versus collaboratively. Some felt that their core responsibilities remained constant, viewing both individual and collaborative efforts as “different pieces of the same puzzle” (Aus-SLP2). Others believed their roles adapted significantly when working in a collaborative context, noting that the presence of another clinician brought new dynamics and opportunities for intervention: “When we work together, it’s like we’re adding layers to the same task. My role shifts slightly to complement [Ire-SLP1]’s strengths” (Ire-MT1).

Cross-Fertilization Nurtures Knowledge and Expertise

Participants praised the informal, “collegial learning” (Can-SLP) occurring through collaborative processes, valuing the acquisition of new techniques, confidence, and experiences resulting from collaboration. UK-SLP shared insights gained from UK-MT, describing a shift in approach toward “being” with the child rather than setting rigid expectations. Arg-MT echoed this, noting how collaboration “enriqueció mi formación y desarrollo” [enriched my training and development].

While participants found collaboration personally enriching, their focus remained on maximizing the outcomes for children. Aus-SLP2 emphasized the transformative potential of working with MTs: “everybody should get to work with a music therapist—then you can get more out of the child.” Sp-MT underscored that “every child that comes has different goals linked to speech or conversation, or social abilities, we help each other to make the children do their best.”

Theme 2: Building Blocks of Successful Collaboration

Participants provided insights into the factors that contribute to successful collaboration. Three subthemes emerged from the data, namely (a) personality, (b) practicalities, and (c) understanding roles.

Personality

Teams universally highlighted the significance of personality in fostering successful collaboration. As one participant articulated, “it is the people first, then the two disciplines, and then you have to follow the child” (Ire-SLP1). Participants stressed the importance of interpersonal dynamics, highlighting the need for an environment of equality and mutual respect, where individuals can “gently share things that are relevant along the way” (Aus-MT1). The value of rapport was underscored, with one participant noting their collaborating pair “is also a good friend—I love her. That also helps” (Can-MT).

Participants reported that personal compatibility enhanced collaboration, making the partnership more effective. “Getting to know each other” (Ire-MT2) was deemed an essential prerequisite. Building upon this, UK-MT stated, “we took time to really build a way of working together … achieving that level of congruence can take time—together we operate very fluidly as a team.”

Participants acknowledged that not all partnerships succeed. Personal connection between collaborators can impact the effectiveness of their partnership, with one participant commenting, “llevarse bein con el companero, eso me parce muy bien super importante por que a veces tu puedes tener mucha formacion y por ahi no fluye” [getting along with your partner, that seems very important to me because sometimes you can have a lot of training and it doesn’t flow] (Arg-MT).

Practicalities

Several participants underscored the significance of securing stable funding for music therapy positions, highlighting that “structural and institutional barriers are what frequently inhibit collaboration” (USA-SLP). They noted a prevailing sentiment that MTs must continually “prove” (UK-MT) themselves. Participants reported that the lack of funding for MTs limits opportunities for collaboration. “Unfortunately, we only have [Can-MT] two days per week” (Can-SLP).

Furthermore, MTs noted their varied roles and responsibilities. With “limited funding comes limited resources” (IreMT1), necessitating the “triaging of music therapy services” (USA-MT) to prioritize and allocate time and efforts effectively. “We only have limited opportunities to see a child, so we need to determine, does the child need procedural support, psychosocial support, or do I need to collaborate with physiotherapy instead?” (USA-MT).

Participants unanimously stressed the importance of time allocation and scheduling for effective joint planning, goal setting, and documentation. As stated by Arg-MT, “creo que se benefician todos cuando realmente ahí objetivos específicos para ese paciente o cuando realmente ahí un trabajo coordinado, anticipado, planificado” [everyone benefits when there are specific objectives for the patient or when there is really coordinated, anticipated, planned work].

Understanding Roles

Participants stressed the importance of having “shared knowledge of what each brings to the table” (UK-MT). One participant articulated, “if I did not understand your role, what music therapy entails, I wouldn’t know how to ask you to do something to help the communication goal” (Ire-SLP1), succinctly summarizing the difference between genuine collaboration and merely working “side by side” (Ire-SLP2).

A prevailing theme was that collaboration faltered when roles were not equally understood and valued. MTs described instances where they felt relegated to a supporting role, where “someone else is the leader, and I’m the follower” (Aus-MT1). While acknowledging that a leader/follower dynamic could be appropriate in certain contexts, the absence of a “true collaborative approach” (Aus-MT1) was keenly felt.

Theme 3: Evaluating Collaborative Practices

Participants shared their experiences of evaluating collaborative endeavors in pediatric ACIs. Two subthemes were established, namely (a) reliance on qualitative note writing and (b) sensitivity of video recording.

Reliance on Qualitative Note Writing

Participants found session evaluation challenging, with several noting that “there are very few standardized measures that are normed to this population” (USA-SLP). Goal Attainment Scaling was cited as beneficial due to the “need for quantitative data, rather than qualitative data” (Can-MT), though concerns about “subjectivity and consistency” (Ire-MT2) across practitioners were raised. During interviews, the predominant evaluation method mentioned was joint qualitative note writing. Reflecting this sentiment, Ire-SLP2 stated:

In terms of marking changes. I would be using my notes for that. If you went back over the notes, you would be able to see there was “only needed a prompting to make a choice today” and six weeks later maybe that’s changed.

There were reservations about formal evaluations, particularly in acute care settings where conditions fluctuate significantly. Aus-SLP1 emphasized: “I’ve been taught that until our patient stabilizes in terms of their cognitive state- between that sort of zero and three-month stage- not to do too much formal evaluation.”

Aus-MT2 emphasized the importance of assessing the relevance and impact of assessments on the client. They questioned the necessity of “time-consuming assessments” (Aus-MT2) and reports, advocating for meaningful use of resources. The consensus was that active support during sessions, documented through qualitative notes, was more beneficial for the child’s progress.

Sensitivity of Video Recording

Many participants viewed video recording as a visually compelling method for tracking outcomes. While video recording can provide clear, objective evidence of progress, Aus-SLP1 expressed concern as securing consent can be complicated and “emotionally taxing for parents.” Managing technology during sessions was viewed as “burdensome” (Ire-MT1) unless properly equipped facilities were available. However, participants were inspired to consider videoing, arising from hearing their collaborative partner endorse it. “The idea of taking a little snippet of video at each point would be quite amazing” (Aus-MT1).

The Essence of the Phenomenon

To encapsulate the essence of the collaborative work between MTs and SLPs within pediatric ACIs, the following descriptive piece is written from the perspective of the participants. Guided by Van Manen’s (1990) hermeneutic phenomenological approach, the essence is presented in a narrative form that reflects the lived experiences of those involved in this collaborative practice.

In our work with children with ACIs, the synergy between music therapy and speech-language pathology has become an indispensable part of our approach. The challenges presented by pediatric ACI demand a level of teamwork that transcends traditional boundaries. In these moments, collaboration becomes not just helpful but essential, allowing us to navigate the complexities of each child’s case with greater insight and effectiveness.

Our collaboration goes beyond merely combining our skills; it involves a seamless integration where our roles merge and adapt in response to the needs of the child. There is a fluidity in our sessions, a constant back-and -forth as we modify our approaches, sometimes leading, sometimes supporting, but always working towards a shared goal.

Through this process, we also find ourselves growing as professionals. The exchange of knowledge and expertise enriches our practice, leading to better outcomes for the children. However, the success of our collaboration is not solely due to our shared skills; it is deeply rooted in the relationships we build with each other. Mutual respect, understanding, and a strong personal connection are the foundation of our effective teamwork. When we truly appreciate each other’s roles, our sessions become more fluid, and the children benefit from a more integrated and supportive approach.

As we continue to work together, we remain committed to refining and expanding our collaborative practice. We see the need for more systematic methods to evaluate therapeutic outcomes and gain deeper insights into our collaborative impact. By communicating the benefits of this approach, we aim to advocate for its broader adoption, ensuring that more children can access and benefit from this form of care to support their language and communicative needs.

Discussion

This study explored the perspectives of MTs and SLPs regarding collaborative work with children who have ACIs. By bringing together data from a highly specialized sample, this research seeks to illuminate the experiences and insights related to collaboration in this field.

Navigating Collaborative Practice

Based on the findings, the intrinsic complexity of pediatric ACIs exists, often necessitating a collaborative music therapy and speech-language pathology approach. Participants’ experiences revealed that collaboration is often indispensable in addressing the diverse communication challenges presented by children with ACIs. This reflects the sentiment of existing literature that underscores the essential role of collaboration in optimizing outcomes for individuals with complex healthcare needs (Reeves et al., 2010; Twyford, 2017). Although participants did not explicitly reference teamwork models, their descriptions suggested the use of interdisciplinary and transdisciplinary approaches. Their collaborative methods were flexible, adapting to the child’s needs, and showcasing cooperation that was highly responsive to the dynamic requirements of patient care.

A notable finding from this study is the struggle participants experienced in defining the collaborative role clearly. This ambiguity may stem from the relatively new and under-researched nature of this collaborative approach. In traditional settings, the roles of MTs and SLPs are well-defined and distinct (Hobson, 2006a, 2006b; Kennelly & Brien-Elliott, 2001). However, when these professionals work together, their roles can become fluid and intertwined, leading to a dynamic but sometimes unclear collaborative practice. Despite this lack of precise role definition, the impact of collaboration on improving speech, language, and communication skills in children with ACIs is evident (Bower & Shoemark, 2009; Kennelly & Brien-Elliott, 2001; Kennelly et al., 2001). Participants instinctively gravitated toward collaborative practices, driven by the complexity of their cases. While the exact mechanisms and best practices for such work are still emerging, this evolving understanding highlights the necessity for further research to explore and solidify the roles within these collaborative efforts.

Triaging of Services

The limited availability of MTs significantly restricts collaboration with SLPs. This limitation is compounded by the broad scope of music therapy practice, which addresses a wide range of needs beyond communication, necessitating a strategic prioritization of services. In contrast, SLPs, with a typically larger workforce, have more frequent opportunities for collaboration. Participants consistently noted that the scarcity of music therapy resources impedes the potential for sustained and effective collaboration. This intermittent availability can lead to fragmented care, where collaborative efforts are confined to sporadic joint sessions rather than a continuous, integrated approach. Such constraints hinder the ability to establish a cohesive treatment plan and reduce opportunities for clinicians to develop the deep, intuitive understanding necessary for effective teamwork.

Music therapy in pediatric ACIs extends beyond communication to encompass a variety of therapeutic needs, including psychosocial support, cognitive rehabilitation, and motor skill development. This broad scope necessitates a triage system to prioritize the most pressing needs of each child as identified by USA-MT. Assessing each child’s unique needs involves considering multiple factors, including the severity of communication impairment, the child’s emotional and psychological state, and the presence of co-occurring impairments resulting from their ABI. Given the diverse needs addressed by music therapy, establishing clear criteria for prioritization is essential. Stable funding and institutional support are essential to facilitate ongoing, effective collaboration, ultimately improving therapeutic outcomes for this vulnerable population. While the specific constraints described may be particularly pronounced in the context of music therapy within pediatric ACIs, it is reasonable to speculate that similar challenges are likely faced by other allied health professionals working with limited resources in various settings.

Assessing the Effectiveness of Collaborative Interventions

From the data, a predominant reliance on qualitative note writing exists for evaluating the outcomes of collaborative sessions. The potential of video recording as a tool for tracking progress was also recognized, though concerns about consent and practicality were raised. While these methods provide detailed, contextualized insights, the lack of standardized measures poses a challenge for objectively assessing the impact of interventions. This issue is exacerbated by the fluctuating conditions of children with ACIs, which complicates formal evaluations, a concern also noted by Burns and O’Connor (2023).

There is a notable lack of standardized assessment tools in both music therapy and speech-language pathology for this population, with existing tools often failing to capture the subtle changes in these children. Developing robust and feasible evaluation methods is crucial to accurately capture the effectiveness of interprofessional interventions. MTs have a professional responsibility to design and implement such tools (American Music Therapy Association, 2013), as limited opportunities to evaluate outcomes will inevitably impact service provision, underscoring the urgency of addressing these gaps.

Limitations and Recommendations

The study encountered several limitations that warrant consideration in interpreting its findings. While the sample size was appropriate given the chosen methodology, the study would have benefitted from greater diversity among participants. Despite efforts to include clinicians from Asian and African countries, the final sample predominantly consisted of individuals from Western, English-speaking backgrounds. This was partly due to the study invitations not being issued in native languages, and the research team’s capacity to conduct interviews only in English and Spanish. The ability to participate in interviews in one’s native language is crucial for accurately expressing experiences and reflections, and this limitation likely affected the diversity of the sample. For instance, a German-speaking team initially expressed interest but ultimately decided not to partake, citing concerns about their proficiency in English. Another limitation was the absence of member checking. This omission is particularly relevant to the interview conducted in Spanish. Despite translation efforts, the lack of member checking means that the translation’s accuracy in reflecting the participant’s intended meaning could not be confirmed. This highlights the importance of incorporating validation methods, especially when working across languages.

Furthermore, the voluntary nature of participation may have introduced a positive bias in the sample. Clinicians who opted to participate may have already held favorable views toward collaborative approaches, possibly skewing the findings toward more positive experiences. This bias could lead to an underestimation of the challenges associated with collaborative care delivery in pediatric ACIs. In addition, while the research team aimed to set aside preexisting beliefs regarding collaboration, it is important to acknowledge that the authors’ professional background and experiences may have influenced the study’s design, analysis, and interpretation.

Future researchers should aim to include more diverse samples and consider quantitative and mixed-methods methodologies to capture a wider range of experiences and perspectives. This will provide complementary insights into the nuances involved in collaborative practices between MTs and SLPs. Alternatively, a more focused examination of a specific region could yield details into the specific challenges and opportunities within that context. In addition, longitudinal studies could offer valuable insights into how these collaborative relationships evolve over time. A critical next step for advancing the field is to conduct empirical research that translates insights from existing literature into actionable studies, specifically evaluating the effectiveness of collaborative therapy. Bridging the gap between theoretical knowledge and practical application will enhance the quality and impact of collaborative music therapy and speech-language pathology intervention.

Conclusion

The purpose of this study was to explore the experiences of MTs and SLPs in collaborative practices for children with ACIs. The findings illuminated the synergy between these professions, especially in handling intricate cases where their combined efforts led to more robust intervention. While defining collaborative roles posed challenges, participants emphasized collaboration as a pathway to enriching skills and expertise, ultimately enhancing the quality of care provided. In addition, the study underscores the difficulties in evaluating outcomes of collaborative efforts effectively. Moving forward, it is crucial to advocate for the resources and support needed to nurture effective collaboration, ultimately improving outcomes for this population.

Supplementary Material

Supplementary material is available online at Music Therapy Perspectives

Conflicts of interest

None declared.

This work was supported by the Irish Research Council under award number [GOIPG/2024/4046].

References