On behalf of the Knowledge Transfer Network, I’m currently doing some research on around cross-innovation, asking: how does collaboration between different sectors and disciplines drive innovation? And more specifically, how can Creative Industry practice provide innovation in non-CI arenas? I’ve been talking to a range of practitioners in the field, and over the next few weeks will be showing how artists, creative strategists and digital technologists are working in fields as disparate as health, transport, policing… and on and on.
First up, the Jo White of Rhythmix in Brighton introduces the work of Wishing Well, bringing muic and sound design into hospitals across the region. What follows is a lightly-edited transcription of a long and in-depth conversation Jo and I had a couple of weeks back, touchin on her background, the formation of Rhythmix and then a detailed look at how Wishing Well came about.My thanks to Jo for giving us so much time.
I’m one of the project managers at Rhythmix, a music charity based in Brighton that works across the south east. We’ve been around for 15 years evolving from a consortium of music services who wanted to figure out how to engage young people who are not in the mainstream: children and young people who may be excluded from music education, who are not engaging with their school generally, or are in care, or are excluded because of disability.
Rhythmix’ job, then, is to engage children and young people whose circumstances make them vulnerable. Essentially we’re an arts organisation that’s interested in social and personal as well as musical outcomes: increasing self-expression, self-confidence, helping young people to engage with the support available to them. A lot of work I’ve done over the years has been supporting children who have never played an instrument before or had an opportunity to write songs. Personally I’m less concerned with performance, more with inclusion. But before we go into detail, a little on…
How I got here
My background is in folk music. I don’t have any formal qualifications – music or otherwise, beyond A Level, having dropped out of university to get involved in direct action, specifically the anti-road building movement. From that time I spent 10 years living with direct action teams and travelling communities in the west country and northern France. We lived communally, aspiring to very low impact lives.
Music was a really important to us – we earned our living as buskers. So one way and another, things of the fringes, music and community became came very important to my life. I spent time in France, where there’s still semblance of a folk tradition and became hugely interested in how folk music can bring communities together.
I knew I wanted to work with young people and music and over the course of the next few years ran into people describing themselves as “community musicians”. I moved to Brighton, enrolled in the legendary “Workshop Skills for Facilitators” course at Goldsmiths University and became a practitioner. I went on to eight years or so of leading workshops, keen to work especially in creative projects for primary age and in disability settings. Gradually I became more involved in project management with Rhythmix and at the same time becoming increasingly interested in middle ground between community music and music therapy – which are related but very different disciplines.
Enter Wishing Well
Around that time I met Kate Murdoch. Kate had been working in Paris with a group called Musique et Santé – Music and Health. They’ve pioneered a way of working in healthcare, taking musicians right to hospital; bedsides, not to perform one-to-one therapy with individuals for a set period of time, but to be just on the ward and interact with patients spontaneously.
They are interested in the sound ecology of a hospital. This can be especially harsh for children, surrounded by bleeping machines, ventilators, CBeebies in the background, anxious voices, unfamiliar language and loud footsteps. Moreover, research has suggested that children in critical care are über-vulnerable to the sonic environment and become hyper-vigilant, trying to decode what each sounds means. So softening this sound has become really important.
Kate had completed a “train the trainer” programme with Musique et Santé. We knew that she was the best person to bring the approach to our own team. We selected 10 practitioners who all had some background working in SEND (Special Education Needs and Disability), good vocal skills and a good range of music experience, and we put them on a five-day foundation course led by Kate and Nick Cutts, another M et S alumnus whose organisation Opus is based in Derbyshire. I have never seen a group of people so transformed! It’s the kind of training that really turns you inside out: three days of classroom-based and 2 days shadowing interactions in the children’s hospital.
We started Wishing Well, then, very much in the mould of Musique et Santé, although the Musicians are developing the methodology in their own ways and bringing their own ideas and expertise to the table. In particular, we wanted to look at how music technology might help. We use iPads at bedsides as they can be used by children with very light touch, really enable interaction and create incredible sound worlds. We’re interested in how music technology can support a better sonic environment for patients when live Musicians can’t be present; interactive sound installations in play areas and speakers placed in pillows, personalised play lists on iPods. (Brian Eno did similar work at the Chelsea & Westminster A&E)
We made a short film about our work at The Royal Alex, during the first years of Wishing Well, funded by Rockinghorse Children’s Charity through a successful Youth Music bid; you can watch the film here.
Our current work
We work with the Royal Alexander Children’s Hospital in Brighton, and with the children’s wards Hastings and Worthing. Additionally we work with Chailey Heritage Clinical Services, who provide respite and rehab services for children with profound disabilities and acquired head injury.
There are real differences between the various hospitals, so we adapt our approach to each setting. For instance, the children’s ward at Conquest Hospital in Hastings, there is a high turnover rate and we rarely see the same child twice. By contrast, at the Royal Alex in Brighton, we target children in the High Dependency Unit who are in hospital for long and frequent stays throughout their lives. These children are at risk of developmental delay and missing out on all the normal things that childhood should bring. So that’s what we try to provide – normal things in an extraordinary environment.
Let me give you some examples of our work…
Our Musicians do a certain amount of one to one work with young people with very little movement. We use technology to create an environment where they can express themselves through music so that there “disability” is no longer an issue. We’ve worked with some incredible people who are taking the concept of triggering sounds to new levels; building bespoke digital instruments which can be played with the same level of expression as a more conventional instrument
On the other hand, an intervention can be far simpler. We had a situation recently involving a girl who had had a tracheotomy. The staff needed to insert a valve in so that she could talk, but the girl was finding it extremely uncomfortable and difficult to use. The nurses suggested getting her to sing songs she knew in order to distract from the discomfort and to learn how to articulate verbally using the valve. Simple but very effective.
Or again, just think about the environment on a hospital ward: it’s almost an entirely alien one. The beds don’t look like beds, the tables don’t look like tables; the children have no frame of reference as nothing looks like it does at home. One way we can help maintain wellbeing, then, is to bring something familiar to the hospital environments: a song that they have heard, their mum singing at home, or songs from the children’s TV they know well. We bring the outside world in.
On a different tack, we’re also working with people with advanced dementia who are being looked after on specialist wards. These patients are in the assessment ward for three to four months at a time with the hope that the Nursing and Occupational Therapist teams will be able to help them so that they can then go back home or into a specialised residential home.
Our practitioners work alongside with the OTs and move between “reminiscence repertoire”, identifying music that was meaningful to people in their twenties and creative improvisation, helping people be present and define themselves in the moment. We want to offer a new experience too; why not have new experiences later on in life? Digital technology has been a real enabler here. We had one lady using Thumbjam on the iPad who was delighted to be “playing the violin” after so many years. By taking people back into their youth we are able to bring them a great deal of comfort and help the OTs improve wellbeing.
The importance of advocacy, and getting to the right people
Everything we do is publically funded, so of course a big part of my job is writing funding applications. Beyond that, a lot of my role is about creating partnerships and about advocacy. I put a lot of time into finding the right people to speak to at a hospital, then into explaining what we do, how we do it and why it is so important. The joy of working somewhere like the Alex is that we have music champions who not only understand the work but shape and guide it. They understand completely how the soundscape of the hospital can effect children and their recovery.
We’ve has put a lot of thinking into how to capture outcomes: we are, after all, an outcomes-based organisation. But while this is a vital field of work, the Musician in Healthcare is a new role so we’re working hard to build up our evidence base. People can interpret “wellbeing” in very different ways for example. Clinical research like Randomised Control Trials are hugely expensive and time consuming.
Much of what we capture is necessarily qualitative – and bear in mind that with a lot of our children the indicators work with are non-verbal. So we’re observing things like calm but alert states, eye contact, interactions with staff and family members and ease of going to sleep. Again, difficult to capture, but we can describe these outcomes, especially when working with a person who knows that child very well. And it’s important to record the anecdotal stuff too, things from parents and staff like “It’s the first time I’ve seen this child light up and since we have been in Hospital”.
Possible future directions
We work across seven trusts with multiple funders so it’s a bit like spinning plates. I’m trying to secure long term funding, of course, allowing us develop more sustainable programmes, with rigorous evaluation and more widespread advocacy. Building up a language and an identity around this work has been a huge process for us and is ongoing. It takes time – and therefore money – to make this work understood. In the meantime there are several initiatives either in planning or in early stages.
With the best will in the world, our musicians are only going to be at the Alex, say, twice a week. That’s six hours in total. Try telling families who’ve just had a really good interaction that you’ll be back, next Wednesday! That’s a long time to wait for the next bit of fun. I would love to work with people whose expertise is digital technology to address this. Can we have musical or sonic “play areas” at the end of each ward? Can we have speakers in pillows for children who are profoundly sick who can be comforted by immersive sound? Interestingly, we haven’t yet gone to a local external creative media company, although this is of course a town renowned for them; clearly there must be local possibilities for the co-creation of this kind of project, where technology and creativity meet healthcare?
We’re delighted to be delivering a Music in Healthcare course for 3rd year medical students at Brighton and Sussex Medical school. They choose between various optional modules at certain times of year (called student selected components). Our first module was full and it was heartening to see how the students understood the role of music in building trust with the children that they might look after.
We’re currently working with a team of creative dance practitioners and colleagues at Surrey Arts to create a Music and Movement pilot for people with dementia. I find it personally frustrating that we separate out music and movement in our work. We want to enable people to express themselves in any way they can. It’s fantastic working with creative dancers – like us they are participant led and our methodologies seem to blend seamlessly.