Music as a prescription for healing: Uplifting sick kids, one song at a time

Music therapy sessions led by Cassi Crouse uplift kids like Tyson (18 mo.) who are undergoing treatment at Packard Children’s.

Cassi Crouse, MM, MT-BC, uprooted her life in the South to follow her dream to work as a music therapist at a children’s hospital. After graduating from Florida State University with a masters in music therapy, she packed her bags and headed to the West Coast to join Lucile Packard Children’s Hospital Stanford. As a Board-Certified Music Therapist, Cassi manages music interventions to help premature infants in the neonatal intensive care unit (NICU). But her work extends beyond the walls of the hospital’s nurseries, and includes care for infants and children in the pediatric and cardiovascular intensive care units (ICUs) as well. We sat down with Cassi to learn more about her role, and how music therapy helps to support critically ill children on their road to recovery.

Tell us about your path to Packard Children’s

For me, working at a children’s hospital as a music therapist was always my dream job. Stanford is such a well-known name for a lot of reasons: the quality of care, the innovation and the passion. Susan Kinnebrew, director of Child Life and Creative Arts, extended an offer, which I was thrilled to accept. I ended up saying yes, and moved from Florida to California about eight months ago. It’s been one of the best things to happen to me.

How do you use music therapy to help babies in the NICU?

It can be incredibly intimidating having a baby in the NICU. There are a lot of machines, tubes and wires that are required to help the infants. I find a lot of times parents are not sure how to interact with their baby. Music is a fantastic way to foster and promote bonding. One of my patients was an infant, around eleven months. She was intubated and very sick, and mom and dad were not sure how to interact with her. I talked to the mom about using music to bond with her baby. Overstimulation was a concern for this patient, so the music was soft, steady and slow.

And how do you tailor the music to meet the needs of the child? 

Research has shown that the most effective music is patient-preferred music. I worked with a 13-year-old girl who needed to have a PICC line placed, and she was really nervous, so we made a plan and she shared some of her favorite songs and artists. I became someone she could trust and feel comfortable with. We made a plan and she chose four different songs from four artists she liked. She was able to choose what order the songs would come in, and we were able to use music to provide some structure and predictability for her during the procedure. She knew that, ‘after Taylor Swift, she’s going to sing the Katie Perry song, and after Katy Perry, she’s going to sing a Justin Timberlake song.’ It was something for her to anticipate and rely on, providing something else to focus on during her procedure.

You mention playing preferred music for patients. What kind of instruments do you use?

I am primarily a singer and typically have a guitar with me. I also have a great music therapy cart through the generosity of donors. The cart is stocked with instruments for all different age groups. Sometimes when kids are in the hospital, there are a lot of no’s and things that they cannot do, so my instruments are all success oriented. For babies, I’ve got shakers and rattles that are easy to hold and grasp with their hands. For younger kids I have lollipop drums that are engaging. I’ve got maracas, little tambourines–so many different things that are colorful, bright and inviting. For older kids I’ve got tubes called boom whackers, and these awesome drums called the hapi drums.

Do you hold group sessions? Or is music therapy held privately, bedside?

The majority of my sessions are held at the bedside. Kids in the ICU require levels of medical care which makes it difficult to leave their rooms. Many of the ICU rooms were joint rooms before we moved into the new hospital expansion, and I had to be sensitive to the volume of our music therapy sessions. As you might imagine, a five year old just whacks on the drum really loud, which is great. I want them to be able to do that, but in the past I had to be conscious of who was in the room next to us. In the new main building, all the patient rooms are private. I’m able to bring my instruments and let the kid be as loud as they want, which can be therapeutic for them–to bang a drum really loud and get some anger out.

You mention some of the feelings surfaced during music therapy. Can you tell us more about that process?

As a music therapist I use music to provide opportunities for emotional expression and exploration. A way I do that is through instrumental play, so asking, ‘Can you play what it feels like to be happy? Can you play what it feels like to be sad?’ This is a process of walking them through emotions, and that way I am not putting them on the spot saying, ‘How do you feel today?’ I use music to get them to a more comfortable place where they can identify how they are feeling in that moment. With older patients, I use song writing and lyric analysis to talk about feelings and what their hospitalizations have been like.

Any new projects on the horizon at Packard Children’s?

There’s a beautiful intervention referred to as heartbeat recording that was created by a music therapist named Brian Schreck. With heartbeat recording you’re capturing the patient’s heartbeat. There’s a little microphone that plugs into the stethoscope, and then that plugs into an iPad or a computer and the patient’s heartbeat is recorded. From there, whoever I am working with would identify a song that is meaningful to them. The heartbeat serves as the rhythm for the music, and it is the beat that drives the song. Then we record the music on top of it to create something that is original and memorable for the patient and family.

The creative arts therapy program is just getting started at Packard Children’s. Stay tuned for exciting new updates and developments from Cassi and our Child Life and Creative Arts Therapy team.