Pediatric music therapy in the United States: A subsequent inquiry

Pediatric music therapists (PMTs) were required to meet the following inclusion criteria to participate in this survey: 1) currently employed and providing music therapy services for children in a pediatric hospital in the United States as a part-time, full-time, or contracted employee, and 2) hold current credentialing from the Certification Board for Music Therapists (i.e., board-certified music therapist; MT-BC). Two strategies were used to identify potential survey participants. First, researchers used their professional networks to identify AMTA and non-AMTA members working in pediatric hospital settings. Second, social media platforms (e.g., Facebook, Instagram) frequented by PMTs were utilized to share informative flyers and interactive quick response (QR) codes with access to the online REDCap survey. These combined methods resulted in survey responses from 84 unique participants.

Informed by the prior survey study and current clinical practice, the research team constructed a 51-item online questionnaire with four areas of inquiry: 1) therapist demographics, 2) organizational structure, 3) clinical practice, and 4) additional responsibilities. Survey questions included discrete, ordinal, nominal, rank-order, and open-ended response options. Respondents were able to skip questions, and some questions allowed multiple responses. Members of the workgroup tested the online platform for clarity of presentation, ease of use, and to estimate the time required to complete the survey (10–15 minutes). These survey elements were selected and implemented to increase user ease, enhance response rate, and prevent survey fatigue.^[7] Of the 51 questions, there were 13 sub-questions prompting respondents to provide additional descriptions and/or specific information to capture supplemental data.

The survey was administered using the Research Electronic Data Capture (REDCap) application, which provides secure, web-based data collection and management.^[8] Potential participants accessed the survey via a QR code, which linked the participant to a secure REDCap web page with information about the survey. The webpage detailed the purpose of the study, provided consent information, and granted participants access to survey questions. All data exported from REDCap was de-identified and shared with each research team member. The study remained open and accessible from January 2023 through March 2023.

REDCap was utilized to aggregate responses, provide summary statistics, and enable the export of all data in multiple file formats for further analysis. Descriptive statistical measures were used to summarize data for questions with discrete and ordinal response types. Statistical analyses and visualizations were performed using R (Version 2024.12.1+563)^[9] within the RStudio environment. The packages utilized included ggplot2, dplyr, and tidyr for data management, statistical analysis, and visualizations. Data were further analyzed using boxplots, heatmaps, stacked bar charts, and scatterplots to better understand relationships among variables. A pearson correlation analysis was conducted between burnout and staff-to-bed ratio. Then, a multiple regression analysis was conducted to examine the relationship between burnout and key predictor variables, including staff-to-bed ratio, staffing levels, hospital operating budget support, and the presence of a clinical ladder. Qualitative data was analyzed using inductive coding to identify themes and commonalities among the responses. Qualitative and quantitative data components were then compared with corresponding data from the 2020 survey.

A weighted average was calculated for questions related to the prioritization of referrals and the most frequently served clinical need areas. This calculation assigned weight according to the level at which each area of need was ranked, providing a more accurate reflection of the aggregated ranked order data.

Thirteen open-ended questions were presented, asking respondents to provide text responses. Responses were analyzed using inductive coding methods. Inductive coding occurs when themes are developed directly from the harvested data without predetermined categories. This allows insights and theories to emerge organically from the examined data.^[10] Responses to each open-ended question were assigned to all three study team members. The group members analyzed each text response question individually, reviewed aggregated responses, and organized the material by emerging themes similar to procedures described by Creswell.^[11] Group members then worked collaboratively to compare individual analyses, achieve consensus, and identify themes.

The survey contained seven demographic questions. In the 2023 survey, 76.1% of respondents reported having ten years of experience or less, compared to 65.2% in the 2020 survey. A significant discovery from the 2023 survey was that 40% of music therapists in the PMT field have five years of experience or less. This aligns with the 2020 publication, which reported that 46.6% of PMTs were new to the field and had worked for five years or less. In 2020, 57.5% of respondents reported being at their current work setting for three years or less, and similarly, in 2023, 55.2% reported being in their current work setting for three years or less. This affirms that retention remains an issue for music therapy in the pediatric medical setting. Results from this survey also demonstrated a younger workforce, with 78.2% of respondents in 2020 being under 40 years of age compared to 89.4% of respondents who reported being under 40 years old in 2023. The change in age reflects a 12.9% decrease in age diversity from 2020 to 2023. There has been an 11.8% decrease in the number of master’s-prepared clinicians within the field of PMT. In 2020, 57.1% of PMTs were master’s-prepared clinicians; in 2023, 50% of the workforce were bachelor’s-prepared clinicians. PMTs can gain additional advanced music therapy training, although fewer hold specialized training in 2023 than in 2020. This is evident due to 58.9% of respondents holding Neonatal Intensive Care Unit Music Therapy (NICU-MT) certification in 2020,^{[12, 13]} compared to 41.4% in 2023. Neurologic Music Therapy (NMT) was the second-highest additional training area,^[14] with 54.4% of the workforce holding an NMT certification in 2020 compared to 41.4% in 2023. Other training(s) reported by respondents included guided imagery and music, hospice palliative care, Nordoff-Robbins, and other(s). Free text responses captured under “other” included the following: Music Therapy Assessment Tool for Awareness in Disorders of Consciousness, abbreviated as MATADOC;^[15] Time Together;^[16] Rhythm, Breath, Lullaby; Creative Arts and Trauma Treatment through the Kint Institute; and Eye Movement Desensitization and Reprocessing (EMDR). 2023 saw a decrease in PMT’s membership in the American Music Therapy Association (AMTA). In 2020, 82.9% of respondents were members of the AMTA compared to just 49.3% in 2023, a significant decrease of 33.6%. Trends in the data show that PMT clinicians are younger, less experienced, less educated, and have less advanced training(s) when compared to data captured in the 2020 publication. Over half of respondents indicated they were 30 or younger (n = 36, 54.7%), and almost 40.3% reported having practiced five years or less (n = 27). Half of the respondents reported having earned a bachelor’s degree (n = 32, 50%), and the most frequently reported specialized training(s) (n = 48) were NICU-MT (n = 24, 41.4%) and NMT (n = 24, 41.4%). A summary of all demographic data is shown in Table 1.

Half of the PMT workforce is consistently employed in free-standing children’s hospitals. The organizational structure of departments remained consistent; in 2020, 56.9% of PMTs were housed within the Child Life department, and 56.8% of PMTs were under the Child Life department in 2023. Funding for programs saw minor changes from 2020 to 2023. In 2023, position funding was split evenly, with half of PMT positions funded through philanthropy and half through hospital operations. In 2020, 56.2% of respondents identified that their position was funded through philanthropy, followed by 43.8% of positions falling under hospital operating budgets. This indicates a 6.2% increase in music therapy positions being funded through hospital operations. Survey results also indicate growth in the number of full-time music therapy positions. In 2020, 35.6% of respondents reported being the sole music therapist in their facility. However, in 2023, most respondents reported having at least three music therapists in their setting. The majority of respondents (83.8%) reported full-time employment, and 39.2% of respondents reported they have flexibility within their work schedule.

Overall, data suggests pediatric medical music therapists are experiencing stagnation concerning organizational structure. Examples include similar percentages for work setting types and music therapy positions continuing to be primarily funded through philanthropic support. An area where positive change is noted consists of the number of full-time music therapists employed in pediatric hospitals. Organization and work setting data are detailed in Table 1.

3.3.1Clinical practice

Individual respondents were asked for how many hospital beds they provide music therapy coverage. In the 2020 results, PMTs covered an average of approximately 94 beds. In 2023, survey results depicted an 8.37% decrease in bed coverage, with PMTs singularly providing services for a mean of roughly 86 beds per therapist. Data regarding clinical load is included in Table 2. In addition to bed ratios, data was collected on which units PMTs provide services. Notably, the top five units receiving music therapy services remain the same across both surveys: Pediatric Intensive Care (PICU), Neonatal Intensive Care (NICU), Hematology and Oncology, Medical, and Surgical units.

Table 2.Clinical load and music therapy service structure

Question	2020					2023
	n	Min	Max	Mean	SD	n	Min	Max	Mean	SD
Clinical Load
# of beds you cover	103	10	400	93.89	85.11	71	0	360	85.52	70.69
# of total beds in facility	107	10	651	225	178.8	71	30	973	309.4	230.2
	# Responses		Sum	%		# Responses		Sum	%
Music Therapy Service Structure
Hours worked per week	118					74
0-8			3	2.5				2	2.7
9-16			12	10.2				2	2.7
17-24			11	9.3				4	5.4
25-32			14	11.9				7	9.5
33-40			78	66.1				59	79.7
# of individual sessions per day	115					74
0			2	1.7				1	1.4
1-3			8	7				14	18.9
4-6			75	65.2				53	71.6
7-9			22	19.1				4	5.4
10-12			4	3.5				2	2.7
13 or more			4	3.5				0	0
What is your service delivery model*						72
Service lines								14	19.4
Unit-based								43	59.7
Floor-based								14	19.4
Referral based								48	66.7
Other								1	1.4

Note. * Indicates a question added in the 2023 survey

Figure 1.

Units served by pediatric medical music therapists

Though the units remained unchanged, the populations served on each unit varied slightly in the most recent survey. The results displayed in Figure 2 suggest that mechanically ventilated, medically complex/multiple disabilities, hematology/oncology, chronic conditions, and brain injuries are the five most prominent clinical populations served by music therapists in the pediatric healthcare setting.

Figure 2.

Populations served by pediatric medical music therapists

3.3.2Music therapy service delivery

3.4.1Administrative

3.4.2Supervision

3.5.1Background

During the initial descriptive analysis, burnout emerged as a significant trend among respondents (see Figure 3). The themes identified during the qualitative analysis were utilized as variables throughout the quantitative analysis. To begin looking for connections among the variables, burnout was identified as an independent variable.

Figure 3.

Distribution of burnout frequency

3.5.2Method and Results

A Pearson correlation analysis^[17] was conducted using RStudio to examine the relationship between burnout and the staff-to-bed ratio. The analysis revealed a moderate positive relationship between burnout and the staff-to-bed ratio (r = 0.358). The correlation was statistically significant (p = .001), indicating that as the staff-to-bed ratio increases, burnout levels tend to rise. A multiple regression analysis was also conducted to examine any relationships between burnout and other key predictor variables, including staff-to-bed ratio, staffing levels, hospital operating budget support, and the presence of a clinical ladder. The regression model produced an R-squared value of 0.1375, indicating that approximately 13.7% of the variance in burnout could be explained by the independent variables included in the model. These intersecting relationships are demonstrated on the heatmap in Figure 4. The heatmap provides a visual representation of the correlations among the key variables identified, allowing for insights into how different factors interact. The color gradient shows the strength and direction of relationships.

Figure 4.

Heatmap of burnout by funding, clinical, and coverage variables

There are two main limitations to this study that should be considered. First, the unit of analysis in the current survey was based on individual responses of PMTs, not their PMT teams. Due to the open-access nature of survey distribution methods, it is difficult to estimate the representativeness of our sample. Researchers aimed to mitigate over-reporting by stating questions related to each participant (e.g., “For how many hospital beds do you alone provide coverage?”). A second limitation was the lack of study recruitment resources at professional organization levels to find PMTs, resulting in a smaller sample size (84). Researchers recruited PMTs through professional networks and known social media platforms utilized by clinicians. Although the sample size was small and without additional incentive, 84 respondents out of a potential pool of 285 demonstrates a typical response rate for follow-up research.^[20]

Additionally, the small sample size also reduces the generalizability of the findings. A limited number of respondents can impact the statistical power of the analyses, and with a smaller dataset, outliers or variations in responses may disproportionately influence correlation and regression results, making it more challenging to establish definitive relationships between variables. Although relationships between burnout, staffing ratios, and institutional support were explored, the directionality of these associations remains unclear. Future research utilizing longitudinal designs could provide deeper insights into how these factors evolve over time and influence therapist retention and service delivery.

A strength of the current study is the continuity between the survey structure and questions. Utilizing the same REDCap build from the 2020 Knott et al. publication allowed for similarity in construction and continuity with question development, resulting in precise data for trend comparisons.^[5] The study highlights meaningful trends and areas for intervention, emphasizing the need for further research with larger, more diverse samples and longitudinal tracking to strengthen the understanding of workforce sustainability in pediatric music therapy. There is potential to continue to build upon the survey and build a longitudinal data set.

Given the ratio of music therapists to patient beds (1:86) reported in this study, we recommend that those employing PMTs consider the following:

1. Hire an adequate number of music therapists (minimum one music therapist per 85 beds) for your institution as operationalized positions. This growth trend in therapist-to-patient ratios has emerged over several years of survey data collection and evaluation.

2. Support PMTs in developing best practice recommendations for music therapy service structures, such as a policy statement specific to PMT services, to help align PMTs with other ratio-protected professionals in healthcare settings.

3. Increase opportunities for professional development through funding continuing education opportunities, implementing a clinical ladder, and creating leadership opportunities for music therapists.

By strategically allocating music therapy services based on clinical demand and therapist capacity, institutions can maximize the impact of music therapy while mitigating burnout-related attrition. A more data-driven approach to staffing and resource distribution could help ensure that therapists are deployed where they are most needed, allowing for more efficient use of available personnel and services. Additionally, refining operational structures, such as interdisciplinary collaboration and funding models, could enhance institutional integration and reduce unnecessary workload burdens on therapists.

Proactively addressing these systemic challenges not only improves therapist well-being and retention but also strengthens the overall efficacy of music therapy services in pediatric healthcare settings. Organizations can better utilize music therapy as a high-value intervention by prioritizing sustainable staffing models, resource optimization, and professional growth opportunities.

Should this survey be replicated in the future, the following adjustments are recommended:

1. Collect additional demographic information, such as gender.

2. Specify the source of referrals.

3. Add mental health and behavioral health into the populations and units covered.

4. Specify the data collected by PMTs about patient care, productivity, etc. Further, an in-depth qualitative study of well-established PMT programs could provide insight into how the success of those programs has been sustained.