Music therapy in a mental health setting

Music therapy has been part of CHOC Children’s specialized therapeutic programming for more than 10 years. The program has grown recently, due to increased awareness of its effectiveness and a rising need among CHOC patients. We sat down with Kevin Budd, a board-certified music therapist in CHOC’s Mental Health Inpatient Center, to discuss the benefits of music therapy in an inpatient psychiatric setting.

Q: What comprises music therapy as a practice?


A: Music therapy is the clinical, evidence-based use of musical interventions to accomplish individualized goals. This occurs within a therapeutic relationship between a credentialed professional who has completed an approved music therapy program and a patient. During music therapy, we address physical, psychological, cognitive and/or social functioning challenges for patients of all ages. Essentially, music is the tool that helps support a patient’s non-musical need.

Q: How does music therapy support clinical goals?

A: A patient’s clinical goal is the starting point for determining which musical intervention will be most effective. In the Center, these goals could include: mood regulation, self-expression, self-esteem, anxiety, interpersonal effectiveness, treatment motivation, positive coping skills and others. There’s no one-size-fits-all treatment when it comes to music therapy and mental health. We might work towards a patient’s goals several different ways, such as through focused music listening, songwriting, song discussion, group instrument playing, music and relaxation, singing and more.

Music therapists rely on assessment, treatment planning and evaluation to determine whether a patient’s current music therapy methods are meeting their needs. Without treatment goals, there could be no effective music therapy.

Q: What is an example of using music therapy to address a clinical goal?


A: If a patient’s clinical goal is to increase identification of positive coping skills, we might work on lyric analysis within the patient’s preferred style of song. We could discuss triggers, resilience and negative life situations in the song. After this discussion, we could rewrite the chorus of the song, including identification of a negative situation and a positive coping skill to help address it. The patients can then be encouraged to share what they created—by singing, spoken word or other creative means.

Within this exercise, not only has the patient used a creative medium to identify a negative situation and how to cope with it; they have also built confidence after completing and sharing their creation, felt more connected with others in the group by being vulnerable and feeling validated, improved their mood and increased their treatment motivation.

Q: What kind of impact have you seen in mental health patients who have participated in music therapy?


A: Sometimes it’s hard for patients to verbalize past trauma or express their struggles. But with music therapy, they can discuss a song that relates to their current situation—whether it is bullying, family problems, hopelessness, anxiety or another stressor. During this process, patients may be able to process and verbalize more, since the lyrics are an easier gateway for expression.

During group ukulele playing, patients who have difficulty with interpersonal relationships can cohesively and successfully play music together in a positive, supportive space without the need to talk. They can work on distress tolerance and problem-solving skills while persevering through a challenging task—and by the end, they have improved self-esteem.

In any setting, music instantly affects our bodies—mentally, physically and behaviorally. It’s amazing how one musical intervention can address multiple goals.

Q: What is unique about music therapy in an inpatient psychiatric facility?


A: Music therapy can look different in the inpatient psychiatric setting than in other areas of the hospital. Within the Center, goals for music therapy are focused on combatting the reasons why a patient is admitted—these could include suicidal ideation, depression, anxiety or other factors keeping a patient from participating in a healthy way in daily life. The goal of the MHIC is to stabilize these patients and provide them with as many resources as possible to cope with their mental health challenges.

Music therapy does just that and provides opportunities for patients to learn, process, practice and discover new skills through tailored music interventions. The MHIC offers opportunities for a diverse group of kids and teens to express themselves in a supportive, safe and validating environment. Individual music therapy sessions are available to patients in the Center who need additional one-on-one support to complement their other treatment.

Q: Why did you want to become a music therapist? Why a mental health setting specifically?


A: I’ve gone through my own mental health challenges throughout my life, and I always found that music validated my journey. Music helped me distract myself and process my feelings. Music met me where I was in the moment and gave me hope. It also gave me a platform to express myself in ways I didn’t know how to otherwise.

When considering career paths, I wanted to find a way to harness the role music had played in my life in a therapeutic way. After receiving my undergraduate degree in music, I developed a special interest where psychology and music intersect—the space where music therapy truly breathes. I pursued my graduate degree in music therapy and then became a board-certified music therapist.

I feel humbled and fulfilled to be able to support kids and teens at CHOC with the tool of music. By creating an authentic therapeutic alliance, I can support them through a harsh and challenging time in their lives. I am thrilled to be on the front lines of the music therapy program at CHOC Children’s, and I look forward to supporting its growth and success in treating pediatric patients.

Learn about Specialized Therapeutic Programs at CHOC

A day in the life of a mental health nurse

The CHOC Children’s Mental Health Inpatient Center is an inpatient psychiatric center exclusively dedicated to the treatment of children ages 3-17 with mental illness who are in immediate risk of hurting themselves or others. It is the only inpatient facility in Orange County that can treat patients younger than 12. Our doctors and care team are all specially trained to treat children and provide the very best patient- and family-centered care 24 hours a day, seven days a week.

During a child’s stay, he or she engages in daily multidisciplinary therapeutic groups and receives individual therapy, family therapy, brief psychological testing and psychiatric care.

In observance of Mental Health Month, follow along for a day in the life of Madeline, a clinical nurse in CHOC’s Mental Health Inpatient Center.

5:15 a.m. – After fighting my snooze button, I wake up, shower, and drink some much-needed coffee.

6:30 a.m. – My cat yells his goodbyes to me as I give him a treat and leave for work. On the way, I vibe out to music to get pumped up for the day. I’ve worked at CHOC for over a year now. Last year, I was accepted into CHOC’s Registered Nurse Residency program. As a new nurse, I felt called to work in a mental health setting. I am beyond proud to stand alongside the brilliant CHOC team on the frontlines of mental healthcare.  

7:00 a.m. – I join my team in our conference room for a daily briefing report. Together, we review any newly admitted patients, our current population of patients, and any safety concerns. One of the ways we keep kids safe is through trauma-informed care. Upon admission, we work with patients and their families to determine any triggering situations or actions the patients may have, and then learn how strong emotions may manifest outwardly; such as pacing, shaking, or becoming very quiet. This information helps us to rapidly identify when patients are struggling and may need extra support or encouragement to utilize their coping skills. One of my favorite environmental adaptations we can provide for patients is our sensory room. It helps stimulate a few of our five senses to help kids cope and be more present in the moment. Sometimes, just hearing the rhythmic movements of the bubbles can be soothing and have a great calming effect.

7:30 a.m. – Once I have an understanding of our environment, I walk the unit to check on the patients. Most are still asleep, so I then look up my patient’s medications, while verifying medication consents. All pediatric psychiatric medications need parental consent obtained by the patient’s psychiatrist.

8:15 a.m. — Our medication room has a barn door, so I can efficiently and safely administer patients’ morning medications, preform a quick mental status check-in, and obtain vitals.

9:30 a.m. — One of my patients is currently taking a new medication. In order to better understand her body’s acceptance and tolerance of the drug, we need to run labs. Before drawing her blood, I numb a small area of her skin using a J-Tip®. During the blood draw, a child life specialist and I help the patient cope by offering her modeling clay and a hide-and-seek activity book.

10:00 a.m. — Throughout the day, our patients are divided into groups based on age to attend group sessions. This creates a structured environment that promotes the development of coping and social skills they can utilize when they go home. The sessions focus on our various themes of the day that can range from problem solving or emotional regulation to nutrition and wellness. These sessions are led by our team of nurses, social workers, child life specialists, plus art and music therapists. This morning’s group session is focused on gross motor skills. Our group leaders soak up some sunshine in our beautiful outdoor area while supervising patients socializing and joining in on a game of handball.

11:00 a.m. — I sit down with one of my patients to discuss their day so far and check in on any thoughts of self-harm that we can work through together. Afterwards, as part of the patient care team, I meet with that patient’s psychiatrist Dr. Lavanya Wusirika, and social worker Gaby, to discuss the patient’s care plan.

12:30 p.m. – It’s time for the patients to have lunch. Our patients eat together, so I assist with passing out lunch trays and pouring drinks. One of our licensed vocational nurses, Brenda, has become our unofficial DJ, and she plays music during lunch to help create a fun, therapeutic environment.

1:00 p.m. – I receive a call from a patient’s parent. After addressing their questions, I update them on their child’s plan of care, medications and current temperament.

2:00 p.m. – I use my own lunch break to catch up with my coworkers. We spend a lot of time together, and I’m lucky to have such an amazing work family.

3:00 p.m. – It’s time for one of our patients to head home. Upon admission to the unit, our team begins organizing outside resources and planning ways to increase safety and support at home. This information is built upon throughout their stay and is incorporated into an individualized safety and coping plan. After our social workers discuss the plan for home with the patient and their parent, I review current medication information and additional discharge instructions. Staff members and fellow patients send off their peer with warm wishes and words of encouragement.

4:30 p.m. –As a nurse, it’s my turn to lead one of our nursing groups. After the patients participate in a discussion about favorite coping skills and we do a check-in of their current emotions, we follow a painting tutorial to practice our theme of the day, mindfulness.

6:00 p.m. – I spend time updating my patients’ charts, including their mental status assessments and treatment plans. This way our whole team can see the patient’s progress and any concerns.

6:45 p.m. – During daily community meetings, all of our patients join together, and our staff leads a check-in to summarize what has been learned from our theme of the day. Patients take turns sharing their high and low of the day and how we can build on these experiences for tomorrow.

7:00 p.m. – As our night shift nurses arrive, we take turns giving a report of their patient’s day and mental status. We share new triggers that we have learned from the patients as well as new coping skills that were helpful. Knowing how we can best care for patients before, during and after a crisis or stressful situation is fundamental for trauma-informed care. By caring for every patient as a whole, not as a diagnosis or as someone defined by their trauma or maladaptive behaviors, we are able to better understand and care for them.

8:00 p.m. ― Get home and share a delicious meal with my husband. A long hug and many kisses are bestowed unto my cat Boots. The three of us will cuddle up and watch a show before we head to sleep and start again.

Veteran Nurse to Help Lead CHOC Mental Health Inpatient Center

After spending time with a relative with a mental illness, Dani Milliken knew as early as age 6 that she wanted to help people who struggle with mental illness when she grew up.

“From that point on, I dreamed of working as a psychiatric nurse,” Dani says. “I am so fortunate that I get to come to work every day and love what I do. My passion in life is psychiatric nursing; it always has been and it always will be.”

Dani will put that passion – as well as a wealth of experience in establishing a pediatric inpatient mental health unit – to good use as clinical director of the CHOC Children’s Mental Health Inpatient Center, set to open next spring.

“The community is in need, and CHOC is stepping up to the plate in a big way,” she says. “I have been impressed with everyone’s commitment to developing a safe environment that patients, families and staff feel proud of.”

Before joining CHOC in June, Dani helped design and operationalize a pediatric inpatient mental health unit at Nationwide Children’s Hospital in Columbus, Ohio. Previously, she spent four years at Twin Valley Behavioral Healthcare, a state-owned and -operated inpatient psychiatric hospital in Ohio. There for four years, she served in a variety of roles, most recently as assistant director of nursing.

Dani hopes her work at CHOC will set the standard of care for psychiatric nursing across the country, as well as help remove a stigma that persists around patients with mental illness and the clinicians who treat them.

“Unfortunately, there can be incredible amounts of stigma surrounding not only the patients on an inpatient psychiatric unit, but also the staff that works there,” she says. “I look forward to teaching everyone about quality psychiatric treatment, and what it means to be a real psychiatric nurse.”

Dani earned her bachelor’s degree in nursing from Mount Carmel College of Nursing, and went on to receive her master’s degree in nursing administration. She is currently working toward a doctorate in health care administration.

Though much of her free time is spent getting settled in Orange County after a cross-country move, Dani looks forward to hiking and biking with her husband and dog, as well as quilting and sewing.

In her short time at CHOC, Dani already has been impressed with the culture of collaboration, accountability and respect.

“I am inspired at the amount of teamwork, collaboration and respect that I have encountered during meetings with various disciplines,” she says. “All of these things speak loudly about the level of quality care being delivered to patients here at CHOC. I am thrilled to be a part of this amazing team!”

Upon its opening, CHOC Children’s Mental Health Inpatient Center will be the first pediatric inpatient mental health center in Orange County to accommodate children younger than 12.

With 18 private rooms in a secure and healing environment, the center will provide a safe, nurturing place for children ages 3 to 18, and specialty programming for children younger than 12.

The center is the cornerstone of CHOC’s efforts to create a pediatric system of care for children, teens and young adults in Orange County with mental illness. One in five children – about 150,000 in Orange County – will experience a diagnosable mental health problem.

Learn more about CHOC’s efforts to help children with mental illness.

CHOC Children’s Announces Plans to Address Pediatric Mental Health Crisis

Community leaders and executives from CHOC Children’s recently announced a transformative initiative to ensure children and adolescents with mental illness receive the health care services and support they currently lack in Orange County’s fragmented system of care.

CHOC Children's Mental Health CenterOne in five children experience a diagnosable mental health condition during childhood — about 150,000 children in Orange County alone; yet there are no psychiatric inpatient beds for patients under 12 years in Orange County . Due to the absence of designated space to treat young patients, sometimes children with serious mental health episodes remain in the emergency department for days at a time. In addition, there aren’t enough inpatient psychiatric beds for adolescents either, with many needing to be hospitalized outside of Orange County.

“We recognize that pediatric mental illness has become a nationwide epidemic, and are committed to ending it,” Kimberly Chavalas Cripe, CHOC president and chief executive officer, said. “CHOC and our partners are excited by the opportunity to create a scalable model for pediatric mental health care that other communities nationwide can replicate.”

Establishing a Caring, Healing Home for Children in O.C.

Children’s advocate Sandy Segerstrom Daniels, managing partner, C.J. Segerstrom & Sons, donated a $5 million lead gift to help establish CHOC Children’s Mental Health Inpatient Center. The new center will provide a safe, nurturing place for children ages 3 to 18 to receive care for mental health conditions. It will also provide specialty programming for children ages 11 and younger.

Located on the third floor of CHOC’s Research Building, the Center will feature:
•18 beds in a secure, healing environment
•Outdoor area for recreation
•Specially trained pediatric staff

Construction is expected to begin by fall 2015 and finish in late 2017.CHOC Children's Mental Health Center

CHOC has launched a fundraising campaign to raise $11 million for inpatient capital and startup costs, and $16 million to endow the program. CHOC is raising additional funds for outpatient mental health services.

Recognizing the urgency to help meet the community’s need, last fall CHOC and Rick and Kay Warren, co-founders of Saddleback Church formed a taskforce — led by Dr. Maria Minon, CHOC chief medical officer, and Dr. Heather Huszti, CHOC chief psychologist, and comprised of community leaders, educators and faith-based advisors — to begin discussing a comprehensive pediatric system of care for patients with mental illness.

CHOC’s support of the pediatric system of care includes:
•expanding mental health services this year for CHOC patients being treated for serious/chronic illnesses (these children are more likely to have mental health problems, such as depression and severe anxiety, than their healthier peers);
•opening an intensive outpatient program in 2016 to keep struggling children out of the hospital and assist those who have been released;
•expanding CHOC’s outpatient eating disorders program by 2016;
•and continuing to facilitate and work on multiple county-wide projects with the task force.

“We know our plans are ambitious, but they are critical and life-saving. The vision begins with establishing a caring home at CHOC for our children and families to turn to for help,” said Cripe.

To learn how to support CHOC’s mental health campaign, please visit www.choc.org/mentalhealthgiving.