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

Talking to children after traumatic events: Six resources to share with families

Helping children cope through the aftermath of a traumatic event can be difficult.

Acts of mass violence bring up widespread worry, anxiety, uncertainty and trauma, and it can be overwhelming for parents to know where to start when talking to kids about it.

People often turn to healthcare providers for advice about the best ways to approach tough conversations with young people. The following is a list of helpful resources you can share with families about coping with the complicated feelings after a traumatic event.

Guidelines for helping youth after the recent shootings

This fact sheet by The National Child Traumatic Stress Network (NCTSN) offers guardians tips about helping children after an act of mass violence. It is presented in both English and Spanish versions.

For teens: coping after mass violence

Another NCTSN resource, this handout is tailored to parents of teens and includes information for adolescents on self-care after trauma.

American Psychological Association response to mass shootings in Texas, Ohio

American Psychological Association President Rosie Phillips Davis, PhD, offers an official statement, as well as a helpful list of resources, in the aftermath of mass gun violence.

How to help your child navigate the emotional aftermath of a traumatic event

This CHOC Children’s Blog post presents the five E’s, a clear series of steps parents and guardians can follow when talking to children, alongside a list of additional resources.

Talking to Children About Violence: Tips for Parents and Teachers

The National Association of School Psychologists offers points to emphasize when talking to kids of all ages about violence. Companion flyers are also offered in English, Spanish, Korean, Vietnamese, French, Amharic, Chinese, Portuguese, Somali, Arabic and Kurdish.

Should you talk to young children about tragic events?

This CHOC Children’s Blog post breaks down factors parents should consider before talking to their kid(s) about tragedy, including appropriate approaches by age group.

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.

CHOC Psychologist Encourages Mindfulness Through Flower Therapy

Long before Dr. Carlos Konishi was a seasoned pediatric psychologist at CHOC Children’s, he understood firsthand the healing effects of flower therapy.

As a psychology intern at CHOC more than a decade ago, he would create flower arrangements for the psychology department in his spare time, and quickly noticed the positive impact it had on the wellness of patients and his colleagues.

Dr. Carlos Konishi, pediatric psychologist at CHOC Children’s

Inspired largely by his Japanese heritage, known for its deep appreciation of nature, Dr. Konishi had always enjoyed working with flowers and plants as a pastime, and even used it as a therapy technique with patients in another facility.

As part of his dissertation, Dr. Konishi studied the possible impact of nature settings on people’s physical and emotional health.

“Our appreciation for nature is cross-cultural. At a very basic level, we are drawn to nature and how it makes us feel,” Dr. Konishi explains. “Think of a favorite vacation spot for instance; you often think of a place tied to nature. There’s something about nature that makes us feel reconnected and refreshed.”

In 2016, Dr. Konishi returned to CHOC to work as a full-time psychologist, and he continues to use the art of flower arranging today to encourage mindfulness and wellness among his colleagues. Every Monday, he sets up a flower therapy station in his department’s break room, including a variety of fresh flowers and colorful vases, which his fellow colleagues and students can use to create arrangements for their individual offices and therapy rooms where patients are seen.

Psychology department staff members creating flower arrangements at a recent retreat.

The physical act of arranging the flowers and concentrating on the soothing task stimulates mindfulness, Dr. Konishi explains. Like with other mindfulness activities, the task allows you to focus on the present moment and acknowledge your feelings, thoughts and sensations.

One of the many flower arrangements found throughout the hallways in the psychology department at CHOC.

He also enjoys creating flower arrangements for the hallways in the office like he once did as a student. He and his team often hear from patients and their families who comment on these beautiful touches of nature and how uplifting it makes them feel when they come in for an appointment.

“It’s part of your emotional health. When you see things that are aesthetically pleasing, you feel good,” Dr. Konishi says. “Flowers are a representation of the beauty of nature.”

Dr. Konishi’s commitment to his mental and emotional health and that of his colleagues does not stop with flower therapy, however. He and a few colleagues have formed a wellness committee in their department. Throughout the year, they organize activities such as Smoothie Day, pet therapy, yoga and flower arranging with the goal to help staff reset and be more present for their patients’ care. The committee has also organized Tea for the Soul through CHOC Spiritual Care as well as Healing Touch therapy and Reiki sessions for the department staff.

“Wellness and mindfulness programs can be beneficial for everyone and can play a very important role in decreasing burnout and increasing engagement,” Dr. Konishi says. “I strongly recommend creating a small team of individuals who share an interest in wellness to ensure sustainability and allow for a variety of activities. These activities don’t have to be very long and can provide a reprieve from the daily stressors people face and can help them recharge and refocus throughout the week.”

Mental Health Nurse Manager Shares How Nursing is the Art of Caring for People

CHOC Children’s wants its community providers to get to know its staff. In recognition of National Mental Health Awareness Month, meet Lisa Schneider, nurse manager in CHOC’s new Mental Health Inpatient Center.

Q: What is your education and training?
A: I have a degree in nursing from The Ohio State University, and I am in the last semester of completing my master’s degree with a focus on Nursing Administration. In addition, I am a board-certified psychiatric-mental health registered nurse.

Q: What are your special clinical interests?
A: I am very passionate about pediatric mental health. I have a strong interest in trauma-related diagnoses and crisis prevention, as well as serving as an advocate to de-stigmatize mental health.

Q: How long have you been on staff at CHOC?
A: I am new to the organization and so excited to be here! I have been with CHOC since January 2018.

Q: What diagnoses are most common among the patients you care for?
A: As the community is beginning to recognize mental health disorders sooner, children and adolescents can present with a wide range of diagnoses such as depression, anxiety, eating disorders, psychosis, autism, PTSD, and ADHD, among others.

Q: What myths about mental health would you like to dispel?

A: Many people believe that talking to kids about suicide can put the idea into their heads. However extensive research has shown that this is not the case. Suicide is currently the second leading cause of death in children and young adults ages 10-24. Start the conversation now and talk to your kids about suicide – it could save their life.

Q: What excites you most about the Mental Health Inpatient Center?

A: The opening of the Mental Health Inpatient Center is so exciting because we will be providing innovative care and services to children and their families. The unit will consist of private rooms, group activity rooms, an expansive outdoor play area, along with daily programming such as music therapy, art therapy, pet therapy, and classroom education. The Center is designed around aspects of nature to promote a holistic and healing environment.

In addition, every child will receive a comprehensive treatment plan which will include individual and family therapy sessions while inpatient, and care continuation at discharge. I am so excited for the positive impact this Center will have on the kids in our community, especially since we will be the first to offer inpatient mental health services to children under the age of 12 in Orange County.

Q: What inspires you most about the care being delivered here at CHOC?
A: I am inspired by the tremendous amount of dedication that CHOC has shown in our mission to provide quality healthcare to children. Specifically, we are taking a leadership role and setting a high standard through our commitment to de-stigmatizing mental health and expanding services. It is important to remember health does not solely rely on physical health, but strongly depends on mental health as well. In order to achieve overall health and well-being, mental health must be cared for with the same emphasis that is placed on physical health.

Q: Why did you decide to become a nurse?
A: I chose to become a nurse based on the philosophy of nursing. Nursing is known not only as a science, but also as an art in caring for people. I have a passion for creating strong nurse-patient relationships, which can promote the healing process. I chose pediatrics because I’m inspired by the resiliency I see in children, and mental health specifically because I strongly believe in the concepts of prevention and early intervention.

Q: If you weren’t a nurse, what would you be and why?
A: If I wasn’t a nurse, I think I would probably be a police officer. I enjoy serving others and building strong relationships within the community.

Q: What are your hobbies/interests outside of work?
A: Outside of work, I love spending time with my husband and 4-year-old son. We are new to California so we have been spending a lot of time exploring this beautiful state!

Learn more about CHOC’s mental health services at www.choc.org/mentalhealth.