The Communication-Relationship Outcomes Matrix (CROM): A tool for measuring communication outcomes in everyday music therapy practice

Abstract

Music therapy in the UK today operates within complex healthcare systems and a pressurised funding climate, where it is vital to evidence the benefit of services. However, effectively “measuring” the impact of therapeutic work can be challenging. Many outcomes measurement tools are too complex to be implemented consistently and can lack relevance to everyday therapy practice. This paper introduces the Communication-Relationship Outcomes Matrix (CROM), a clinician-reported observational outcomes measurement tool which was developed within a service evaluation protocol submitted by the author in 2015 for a top-up to Masters in Music Therapy qualification. The tool was developed to be used in a service for children with disabilities presenting with “severe communication difficulties” and “challenging behaviour” (criteria defined by the funder). It is commonly accepted in music therapy that the establishment, maintenance and development of the “therapist-client relationship” is one of the cornerstones underpinning practice and permeates all of the work that we do. In terms of specific therapeutic objectives, developing “communication skills” is a common area of focus for many service users, but it is a wide umbrella term, which can include numerous behavioural elements and mechanisms such as self-awareness, engagement, attention, facial expression, gesture, verbal and non-verbal interaction, and emotional selfexpression, all of which are difficult to define and measure. This outcomes tool has been designed to address some of the key constructs of developing communication within the context of a relationship-based approach. It also aims to be sufficiently practical to be applicable in everyday practice while still capturing the nuances of our work.