Introduction

Prior to 2012, approximately 410,000 Australian people had been supported through "traditional block-funded service approaches" (Dowse, Wiese, Dew, Smith, Collings, & Didi, 2016, p. 81), where large organisations or institutions received a block funding to manage a large number of people with a range of different needs. In this previous welfare system, some stakeholders argued that understanding and supporting each individual's unique needs was difficult, and a major reform of disability funding mechanisms was considered necessary by what was then Rudd's Labour Party (Buckmaster, 2012). After an extensive investigation, the Productivity Commission (2011) concluded that the previous disability support system was "underfunded, unfair, fragmented, and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports" (p. 2). The Commission further emphasised the fundamental changes that the new National Funding system should provide to the people such as:

* entitlements to individually tailored supports based on the same assessment process,

* certainty of funding based on need,

* genuine choice over how needs are met (including choice of provider), and

* local area coordinators and disability support organisations to provide grass roots support and a long-term approach to care with a strong incentive to fund cost effective early interventions (Productivity Commission, 2011, p. 2).

Consequently, the government announced a funding plan called the National Disability Insurance Scheme (NDIS). Commonwealth, state and territory governments, who used to manage the disability funding system, were reestablished as a single agency called the National Disability Insurance Agency (NDIA) in 2012 (Buckmaster, 2012). In July 2013, the NDIA launched trials across a number of regional sites nationwide including the Barwon region in Victoria and the Australian Capital Territory, and since July 2016, the service has been instigated across Australia.

The NDIS places a strong emphasis on increased choice for people with disabilities, tailoring support packages to the individual needs identified by participants and allowing participants to prioritise the services they wish to access and to select their own providers. However, in the first two years of NDIS trials at various sites, some participants reported their choices to access certain services, such as music therapy, had been denied by authorities in the NDIA (McFerran, 2016; McFerran, Tamplin, Thompson, Lee, Murphy, & Teggelove, 2016). For example, several service users' requests to include music therapy in their NDIS plans were rejected in the trial region of New South Wales, and participants were advised to seek a speech therapist who is musical or told that music therapy is just like instrumental lessons (McFerran, 2016). Paradoxically, some music teachers who specialise in providing services for people with disabilities have been told that only music therapy services can be funded. To understand this phenomenon a group of researchers from the National Music Therapy Research Unit (NaMTRU) at the University of Melbourne conducted a qualitative study by collecting various reports of those involved, such as the NDIA, and the Australian Music Therapy Association (AMTA), as well as selected participants of the scheme or families of the participants. The study aimed to: (a) better understand the needs and capacity for contribution of each stakeholder involved, and (b) generate knowledge for each stakeholder regarding requirements and objectives of both the scheme and music therapy access options.

Literature Review

The practice of music therapy in the field of disability has a long and contested history that has been documented since the 1940s (Aigen, 2014). Literature exploring the therapeutic application of music for people with disability has typically been focused on person-centred goals that are identified by professionals to address perceived needs of the service recipients. Recent research in this area clearly supports the effectiveness of music therapy in school and institutional contexts and documents outcomes in social (Darrow, 2014; Pienaar, 2012), physical (Dieringer, Porretta, & Gumm, 2013; Klaphajone et al., 2013; Wang et al., 2013), communicative (Dunning, Martens, & Jungers, 2015; Krikeli, Michailidis, & Klavdianou, 2010; Pienaar, 2012; Stevenson, 2003), psychological (Krikeli et al., 2010) and wellbeing or quality of life domains (Curtis & Mercado, 2004; Shiloh & Lagasse, 2014). Whilst music therapy services have been used for decades to support and facilitate expert-determined goal attainment for people with disabilities, there is currently limited understanding of the ways in which music therapy can address the self-identified needs of people with disability in the community. This distinction is key to the ideology underpinning the NDIS which is built on the social, rather than medical model of disability.

Within a medical model of disability, having a disability is considered to be an individual's problem that requires medical attention by an expert. Within a social model of disability, having a physical, intellectual, or mental disability is understood as being part of the diversity of human experiences and a responsibility of the society to allow for the active participation of all citizens (Carson, 2009). The social model that originated from Scandinavian countries in the late 1970's initiated a deinstitutionalisation movement across the world, and people with disabilities whose lives had been managed in large institutions and organisations were moved back into the community, often in sheltered housing. Values such as community participation and social inclusion were critical in this movement. This paradigm shift visibly influenced the field of music therapy in the 21st century (Ansdell, 2002), with the emergence of contemporary music therapy models such as community music therapy (Stige & Aaro, 2011) and resource oriented music therapy (Rolvsjord, 2010) also emanating from Scandinavia. Other equity oriented approaches such as feminist music therapy (Hadley, 2006) and anti-oppressive music therapy (Baines, 2013) have shaped contemporary music therapy practices and research worldwide (Aigen, 2014; Kenny & Stige, 2002).

Community music therapy research and theory has been most clearly aligned with the disability rights movement worldwide (Stige & Aaro, 2011; Stige, Ansdell, Elefant, & Pavlicevic, 2010), endorsing a focus on empowerment and community participation that is aligned with the rhetoric of the NDIS on choice and control. Congruently, action research projects in this field have shown how people with the most profound disabilities can make choices within and about music therapy (Warner, 2005), participate in community music therapy groups, such as choirs (Elefant, 2010), as well as music festivals (Stige, 2010). More critical approaches have also been emerging around the globe, with a focus on ableism, neurodiversity and broad questioning of assumptions about what people with disabilities want from music therapists as captured in the journal VOICES special edition on music therapy and disability studies (Hadley, 2014). Local scholars in the Asia Pacific region have been prominent in this discourse, including Daphne Rickson (2014), Hiroko Miyake (2014) and Melissa Murphy (2018), whose recent PhD presented a critical analysis of young people's access to music as they transitioned from child to adult disability services. While promoting these consumer-driven forms of practice, the NDIA appears to apply principles from the medical model when funding therapeutic services, which demands a focus on measurable, evidence-based practices rather than participants' rights and choice to access music in many forms (Cameron, 2017; McFerran, 2016). This inconsistency has caused confusion for people with disabilities, their families, and service providers, as well as those involved in the planning process, including the NDIA staff (McFerran, 2016).

Music therapy practices in Australia have also been changing slowly to embrace the social model of disability. Although Registered Music Therapists (RMTs) often embrace humanistic approaches in the field, medical model practices such as neurologic music therapy (NMT) (1) have also become popular in a range of fields including the disability sector. This treatment model emphasis may serve as a point of distinction between the work of RMTs and community musicians in the same sector and is surprisingly well matched to the demands of the NDIS, who often seek evidence whilst also promoting choice.

To better understand the relationship between different service providers, McFerran (2008) conducted a mixed methods research project to compare the practices of RMTs and community musicians in one adult disability service. Some distinctions between the programs were apparent, with the community music program being described as "being about energy and expression" and seemed more targeted towards those with mild and moderate disabilities, while the music therapist was seen as facilitating "meaningful interactions and self-expression at a personalised level" (p.22) better suited to people with severe and profound intellectual disability. Despite differences between the programs that were readily identified to the researchers, many of the carers felt that both programs offered participants an opportunity to transcend their disability and connect with others joyously, socially and musically. This matches closely with Stige's (2009) description of practice in the disability field when visiting Australia, when he said "music as a social phenomenon is both a very common thing and a very special thing." The role of music therapy can therefore be understood as the provision of professional and qualified services that address agreed psycho-social-emotional goals, whilst it is important to note that this occurs within a landscape of other music services that serve musical outcomes.

One recommendation arising from the comparative study (McFerran, 2008) was to consider more bridging options into community. However, a decade later, Murphy and McFerran's (2016) critical analysis of 27 articles describing music programs in the disability sector showed that the majority of programs were still conducted in closed groups for people with disabilities. Once again, the emphasis was on social encounters and music therapists focused on building connections between group members within expert driven models. For example, Lee's research (Lee & McFerran, 2012) revealed a similar emphasis on expert models, with findings of improvements in communication being fostered through the provision of consistent song-choice opportunities for individuals with Profound Intellectual and Multiple Disabilities (PIMD). However, Lee's (2014) subsequent research, involving interviews with five RMTs who worked with individuals with PIMD on a long-term basis, moved towards the social model by acknowledging that the improvements were not just in the skills of the RMTs, but also in the increasing depth of the relationship between therapist and client, which also allowed the therapist to better understand the client's communication.

This emphasis on building relationships within long-term therapy was also reported by Cameron (2017), who described an array of benefits for four adults she had worked with over many years in areas such as: communication and self-expression, choice and control, social contact and ameliorating deterioration, and development of skills. She explained how these benefits were achieved through careful and sophisticated therapeutic facilitation at critical moments, and explored the importance of qualified professionals providing music therapy services under the NDIS scheme.

In summary, it is evident that service provision in the disability field is changing ideologically, although this change is inconsistent and diversely understood, both around the globe and locally. A bio-psychosocial model is adopted by the World Health Organisation's International Classification of Functioning, Disability and Health (ICF) (2001) to encompass elements of biological, social and individual perspectives of health and to integrate both the medical and social models of disability. This model may be relevant for RMTs who flexibly adjust their practices to suit the perceived resources and needs of participants in distinct contexts. Whilst funding and services continue to change under the NDIS, we determined that it would be useful to attempt to better understand music therapy access from multiple perspectives by interviewing stakeholders whose involvements with the NDIS were different during the first two years in the trial sites. Ethical approval was granted by the University of Melbourne (Ethics ID: 1545407.1) and data for this study was collected in October and November, 2015.

Method

Study Design

A qualitative approach was employed to address the research aim which sought perspectives of parties involved with the roll out of the NDIS. Rather than undertaking a large-scale survey to collect relevant data, in-depth interviews with a smaller number of key stakeholders were used to produce rich descriptions of their lived experiences, leading to subjective insights into how each person constructed that particular view from their position. Specifically, Interpretative Phenomenological Analysis (IPA) (Smith & Eatough, 2007; Smith, Flowers, & Larkin, 2009) was utilised since it was developed to interpret how participants make sense of experiences in their personal and social world (Smith & Eatough, 2007). IPA also allows the researcher to take an active role in contributing to meaning making using the techniques such as epoche, which is different to descriptive phenomenology with strict limitations on the researcher's personal involvement with the data (Giorgi, 2009). By using IPA, the researchers aimed to understand the phenomenon from the multiple perspectives by incorporating and making connections between the descriptions.

Recruitment

This study was conducted in partnership with the research office of the NDIA and the AMTA, and funded by the University of Melbourne. Purposive sampling (Creswell & Plano Clark, 2011) was used to recruit people who had experiences with the NDIS through the study's partnering organisations. The AMTA Board invited RMTs already working in NDIS trial sites through their membership base. The NDIA's research office manager invited some NDIS planners and other staff to participate in the study. Once RMTs and NDIA workers were invited, we used a snowball recruitment method in which the RMTs and the NDIA workers identified others, including persons with a disability and/or their families who have used the scheme to fund music therapy services. All the participants were required to be competent to provide informed written consent, and we sought a balance of NDIA staff, RMTs, and persons with a disability and/or family in the scheme, although this was not achieved.

Study Participants

A total of nine people, consisting of three NDIA staff, five RMTs, and one mother of an eight-year-old boy with a functional disability, agreed to participate in the study. Most of the participants had been involved with the NDIS since the beginning of the trials in July 2013 and represented trial sites in three states: New South Wales (NSW), Victoria (VIC), and Australia Capital Territory (ACT). Information about each participant is presented in Table 1, including the names of the participants (pseudonyms) and the number of clients who accessed music therapy under the NDIS scheme, since these were further analysed.

Data Collection

The same researcher conducted all nine interviews. Due to issues with distance to these regional trial sites, the three NDIA staff and parent participated in phone interviews, and all five RMTs were interviewed via Skype. All participants were offered the option of either medium. The participants all agreed to their interviews being audio-recorded, and each interview lasted no more than an hour. Open-ended questions were asked as follow:

1) In your own words, please explain the NDIS.

a. Who does it support?

b. What are its primary objectives?

2) In your experience, how does the development of support plans for participants of the scheme (people with disability) take place?

3) How is eligibility for service provision determined?

4) What kinds of music-based services do you know about that are available through the scheme?

5) What is your understanding of the purpose and use of music-based services for people with disability?

6) What has been your experience of working with the NDIS?

Data Analysis

Having gathered the data from nine participants, four stages of analysis were undertaken, following key principles of IPA suggested by Lakin and Thompson (2012).

Stage 1: Immersing in the data and extracting key statements from the interview transcripts.

The interviews were transcribed into text line by line. After becoming familiar with each participant's perspective, key statements relevant to the research questions were identified and extracted in an Excel-spread sheet for further analysis. Each statement was coded with labels such as 'Alice_3,' which means it was Alicia's 3rd statement.

Stage 2: Conducting an idiographic level of analysis, concerning the person-in-context.

Attending to each participant's data, a researcher then performed double hermeneutics which enabled her to attend to each statement and try to make sense of what the person was making sense of his/her own experience (Smith, 2007). More specifically, with each statement, the researcher first asked "What matters to the interviewee?" from the person's perspective, and then interpreted this perspective from the researcher' point of view by trying to interpret "What that means to the interviewee?" The researcher interpreted the participant's inner thoughts and feelings based on the description of the experiences (Larkin & Thompson, 2012). An example of this idiographic process is presented in the Appendix 1, with all the other analyses recorded in an Excel form.

Stage 3: Developing Emergent Themes by gathering similar perspectives across the nine participants.

As the current study interviewed people representing three groups in relation to the topic, it was apparent that similar perspectives were observed within the same group of people. For example, in the following two statements, the two NDIA staff explained how all their decisions to fund music therapy should have been justified:

* I've only funded it (music therapy) 2 or 3 times and all sort of different reasons. So, I've funded it for one 15-year-old with a lot of behavioural problems. He had autism, was nonverbal and found it very difficult to self-regulate. Mum was a single parent finding it very challenging. And there'd been some music therapy at school that had been, well they anecdotally said that it had been successful. So, we put that in the plan to look at that sort of self-regulation: breathing and calming. (Alicia_3)

* Goals always need to be linked back to the disability and justified from that perspective. (Bryce_6)

Based on these two statements, an Emergent Theme was developed, "it's important for me to justify my decision to fund music therapy," and a code N1 was given to this theme as well. N refers to NDIA staff, indicating that this theme was dominantly reported by the NDIA staff. In this way, R represented RMTs and P represented Parents. By looking across the similar interpretations of nine participants' perspectives in this way, a total of 14 Emergent Themes were identified. Table 2 shows how each Emergent Theme was developed, typically based on at least two interviewee's statements. Two themes (e.g. N5 and P1, see Table 2) comprised only one person's opinion but were included because those nuanced statements were critical in forming the Final Themes. Moreover, in phenomenological analysis, not only the agreed perspectives across the participants are valued, but also critical individual perspectives are valued (McFerran & Grocke, 2007). Hence, including these two themes was appropriate.

Stage 4: Searching for connections across Emergent Themes by abstracting and integrating themes and revealing Final Themes.

By further examining the various perspectives captured in the Emergent Themes, three Final Themes were developed. For example, of the 14 Emergent Themes, the following four themes appeared closely related:

* N1: It's important for me to justify my decision to fund music therapy

* N2: I have personal belief about the certain benefits of music therapy

* N5: I should be careful in supporting music therapy because not everyone is convinced about the effectiveness of music therapy

* R7: It is not about only the choice of services but also how to make a good argument for that choice. NDIA planners should understand music therapy more but RMTs also need to use the right language for effective communication.

While the first three themes reflect the NDIA staff's inner thoughts while making decisions about whether to fund music therapy services, the last theme is based on two RMTs' experiences and these further explained that the choice to access music therapy did need to be argued on the basis of a solid justification and using accepted language. Accordingly, this Final Theme was named "The decision-making process of the NDIA planners revealed." Two more Final Themes were developed in this way and are presented in the result section. To ensure the credibility of the analysis, each stage of analysis was recorded transparently and traceable by other researchers in the university team, and each outcome was reviewed by co-researchers.

Findings

Final Theme 1: The decision-making process of the NDIA planners revealed (Emergent Themes N1, N2, N5, & R7).

Initially, most RMTs and the parent expected that music therapy would be easily funded upon request during the planning process, as it was included on the NDIS providers' list. However, in the interviews, all the NDIA staff explained how complicated it could be for them to make a decision on whether to fund music therapy or not, and if they decided to fund, justifying their decisions to fund music therapy became crucial (N1). The planners we interviewed held a range of beliefs about the potential benefits of music therapy and they were more able to agree to funding if the request aligned with those beliefs (N2). For example, one planner strongly believed that music therapy would be beneficial for a child who had difficulties with speech, indicating that she would fund music therapy only for the speech goals. This revealed that most of the NDIA staff we interviewed had limited knowledge of the breadth and scope of music therapy.

It was also understood that there were many other elements to consider when planners made decisions for a participant, and they had to justify their decisions to a higher authority or colleagues in the NDIA. As not everyone in the NDIA was convinced about the effectiveness of music therapy and s/he felt impelled to care about other planners' opinions on music therapy, at least one planner felt that she should be careful or cautious in supporting music therapy (N5). With regard to this issue, two RMTs with years of experiences with the NDIA suggested that the NDIA planners needed to better understand music therapy, and that RMTs need to use the right language for effective communication. One of the RMTs explained that being on the NDIS providers' list did not mean that all the requests would be accepted, and each request needed to be submitted with an accepted justification which linked back to the client's disability and goals (R7).

In order to understand who made the decision to provide access to music therapy and how it was justified, ten cases of participants who were able to access music therapy through the NDIS funding were further analysed. The details of each case are presented in Appendix 2 and Table 3 to show the result of the analysis.

Out of these ten examples, five were child clients who were under 10 years of age (case example no. 3, 4, 5, 8, 9) and receiving Transdisciplinary Early Intervention Packages (TEIP). Surprisingly, one client (example 8) was given access to music therapy even though the parents did not request it and did not know what music therapy was. The main goals for these children in early intervention were improving their functional abilities and skills in relation to their developmental needs such as improving speech, communication, physical skills, self-expression and articulation of emotions.

Among the other five examples, four school aged children were aged between 14 and 15 years and attending school (case example no. 1, 2, 6, 10), and two could be described as noteworthy in their uniqueness. Example 2 was reported by the NDIS Planner Alicia, and she explained that the 14-year-old boy who was born without eyes needed extra support in accessing adapted print music in order to participate in a community band. Therefore, the planner supported the boy to have practical support from a RMT. She further explained that his parents were paying for the trumpet lessons, which is an expense expected to be paid by any parent, regardless of whether their child has a disability. However, the extra cost for the adapted printed music was a special need resulting from this boy's disability, so the planner supported this cost.

Similarly, Example 6 appeared to be quite a special case where a teenage boy with autism was participating in ongoing music sessions with a community musician prior to entering the NDIS. Although the main focus of their sessions was expanding song-repertoire and singing together, the NDIS considered it as fulfilling Occupational Therapy (OT) needs and funded this musician as if he was an OT assistant. Under NDIS arrangements, an RMT was funded to twice observe their sessions and provide an assessment. The rationale for funding the other two teenagers was behavioural problems (Example 1) and mental health issues (Example 10), and in both cases, the families were finding it challenging to manage their child's behaviours and therefore ongoing music therapy was supported.

Only one adult client was funded to participate in on-going music therapy (case example no. 7). This 30-year-old woman had been working with a music therapist for many years before entering into the NDIS. Her family argued that music therapy played an important role in supporting their daughter to share her life experiences with family and relatives living overseas because she would write songs to share with them.

Final Theme 2: The impact of the NDIA's decisions on both participants and RMTs' practices was revealed, and RMTs expressed desires to better understand the NDIS approval process (P1, RP6, NPR4, R3, R5, & R1).

The parent participant in this study reported that the outcomes of her music therapy funding requests across several planning processes depended on the planner's knowledge of music therapy. This resulted in inconsistent outcomes (P1) and these inconsistent outcomes negatively impacted on her son. This mother's experience was also confirmed by other RMTs who described how planners limited the amount and frequency of music therapy which sometimes caused issues related to therapeutic closure (R6).

While most people believed that the RMTs' reports were crucial in the planning processes (NPR4), two RMTs found that the NDIA did not approve the recommendations made in their reports. In particular, one RMT described how the NDIA did not follow through on her six monthly progress reports and never responded to her suggestions for a client to access community music programs (R5). Some RMTs described that communicating with the NDIA was often a very slow and complicated process and RMTs felt out of their control at times (R3). Accordingly, most RMTs hoped to be better informed about how the NDIA is structured and actually works (R1).

Final Theme 3: This is an important time to raise awareness of music therapy and RMTs can be active in this process to advocate for music therapy as a necessary service (N3, PR2, R2, & R4).

The three NDIA staff hoped that other planners might get more information about music therapy and RMTs in general, and expected RMTs to actively communicate with the planners to provide knowledge and information about music therapy (N3). They explained that the NDIA planners have mandatory trainings every fortnight and that this might be a useful place for RMTs to start the promotion of music therapy and education of the NDIA planners. Likewise, the parent participant and one RMT thought RMTs should have more active roles in educating and promoting music therapy as a reasonable and necessary service to both planners and parents/families of persons with disabilities. It was also understood that being acknowledged by other allied health professionals was helpful and having these professionals write recommendation letters for music therapy might be extremely important in relation to the NDIS (P2).

Most RMTs agreed that awareness of the benefits of music therapy needed to be increased and some believed it was now an important time to raise awareness in collaboration with the NDIS, since some planners had actively recommended music therapy to families (R4). Since the request for music therapy should come from participants of the scheme and/or their parents' voices, RMTs believed they might need to prompt and inform participants to do so in the future (R2). Some RMTs expected AMTA to take an active role in more formal aspects of advocacy, and to provide publicly available information and tools, which has since occurred. Formal advocacy from AMTA has included animated videos for social media as part of a broader public relations campaign, an online training course on the NDIS, the establishment of an NDIS sub-committee who has had several meetings with the NDIA, and an active Facebook page that is monitored by that committee. Together with the RMT community, many parents and other professionals have been active in contributing to greater understandings about the benefits of music therapy during this time of transition.

Discussion and Conclusion

Since the inception of the NDIS in July 2013, there have been many ongoing changes. These interviews were conducted in October and November 2015 and the focus on individual stories means that there is no basis for generalisation. Therefore, results and findings of the current study should be understood and interpreted appropriately. Following up the participants in music therapy at the time of data collection and investigating their journey in a longitudinal study could provide additional insights in the future.

Music therapy is recognised by the NDIS as a reasonable and necessary therapeutic service. As the scheme unfolds, there have been cases where families, clients and the NDIA staff have not clearly or consistently understood what it is or how it could be funded under the scheme. Similarly, other allied health and creative arts therapies, have anecdotally reported similar experiences of misunderstanding. The results of this study also suggest that RMTs have found it difficult to understand the scheme at times, showing that the confusion can flow in both directions. This study revealed that the inclusion of music therapy on the NDIS list did not secure families' rights to access music therapy services and there is no guarantee that people's choices to receive music therapy will always be enabled by the scheme.

As the roll out of the NDIS continues in the coming decade, RMTs will be required to demonstrate their professional skills and draw on their ethical obligations to advocate for participants' rights to access music therapy services. This study shows that individual RMTs may have different experiences and face diverse demands as individual planners learn about the kinds of services that participants in their scheme want and desire. During this time, it will be essential to continue to respond to current information about the NDIA and its decision-making processes and it may be useful to engage in research that better explains what music therapists do. Ongoing connection to the Australian music therapy community may serve as one conduit for RMTs in facilitating this ongoing communication, as well as a sensitivity to the desires of people accessing the NDIS and a careful distinction between our own desires to serve and an openness to what people are truly requesting. This kind of ongoing reflexivity will benefit Australian society as we embrace the social model of disability, and all the bio-psycho-social models that come next, ensuring that our actions are in keeping with the famous dictum that heralded the beginning of the critical disability movement: Nothing about us, without us.

Acknowledgements

This research was conducted with a grant from The University of Melbourne Engagement Grant and support of the

Australian Music Therapy Association and the National Disability Insurance Agency.

References

Aigen, K. (2014). The study of music therapy: Issues and concepts. New York: Routledge.

Ansdell, G. (2002). Community music therapy & the winds of change. Voices: A World Forum for Music Therapy, 2(2).

Baines, S. (2013). Music therapy as an anti-oppressive practice. The Arts in Psychotherapy, 40(1), 1-5. doi:http://dx.doi.org/10.1016/j.aip.2012.09.003.

Buckmaster, L. (2012). Budget Review 2012-2013: National Disability Insurance Scheme. Retrieved from:https://www.aph.gov.au/About_Parliament/ParliamentaryDepartments/Parliamentary_Library/pubs/rp/BudgetReview201213/NDIS#_ftn2.

Cameron, H. (2017). Long term music therapy for people with intellectual disabilities and the NDIS. Australian Journal of Music Therapy. Advance online publication. Retrieved from http:www.austmta.org.au/journal/article/long-term-music-therapy-people-intellectual-disabilities-NDIS, 28.

Carson, G. (2009). The social model of disability. Glasgow, Scotland: Scottish Accessible Information Forum.

Creswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed methods research (2 ed.). California and London: SAGE Publications, Inc.

Curtis, S. L., & Mercado, C. S. (2004). Community music therapy for citizens with developmental disabilities. Voices: A World Forum for Music Therapy, 4(3), doi: 10.15845/voices.v4i3.185.

Darrow, A.-A. (2014). Promoting social and emotional growth of students with disabilities. General Music Today, 25(1), 29-32. doi: https://doi.org/10.1177/1048371314541955.

Dieringer, S. T., Porretta, D., & Gumm, E. (2013). Using music therapy principles to enhance physical activity participation In children and adolescents with disabilities. Palaestra, 27(3), 42-46.

Dowse, L., Wiese, M., Dew, A., Smith, L., Collings, S., & Didi, A. (2016). More, better, or different? NDIS workforce planning for people with intellectual disability and complex support needs. Journal of Intellectual & Developmental Disability, 41(1), 81-84. doi:10.3109/13668250.2015.1125868.

Dunning, B. A., Martens, M. A., & Jungers, M. K. (2015). Music lessons are associated with increased verbal memory in individuals with Williams syndrome. Research in Developmental Disabilities, 36, 565-578. doi:10.1016/j.ridd.2014.10.032.

Elefant, C. (2010). Giving voice: Participatory action research with a marginalized group. In B. Stige, G. Ansdell, C. Elefant, & M. Pavlicevic (Eds.), Where music helps: Community music therapy in action and reflection (pp. 199-215). Burlington, Vt.: Ashgate Publishing Ltd.

Giorgi, A. (2009). The descriptive phenomenological method in psychology: A modified Husserlian approach. Pittsburgh, PA: Duquesne University Press.

Hadley, S. (2014). Shifting frames: Are we really embracing human diversity. Voices: A World Forum for Music Therapy, 14(3).

Hadley, S. (Ed.) (2006). Feminist perspectives in music therapy. Gilsum, NH: Barcelona Publishers.

Kenny, C., & Stige, B. (Eds.). (2002). Contemporary voices in music therapy: Communication, culture, and community. Oslo, No: Unipub forlag.

Klaphajone, J., Thaikruea, L., Boontrakulpoontawee, M., Vivatwongwana, P., Kanongnuch, S., & Tantong, A. (2013). Assessment of music therapy for rehabilitation among physically disabled people in Chiang Mai province: A pilot study. Music & Medicine, 5(1), 23-30. doi:10.1177/1943862112470462.

Krikeli, V., Michailidis, A., & Klavdianou, N.-D. (2010). Communication improvement through music: The case of children with developmental disabilities. International Journal of Special Education, 25(1), 1-9.

Larkin, M., & Thompson, A. (2012). Interpretative phenomenological analysis. In A. Thompson & D. Harper (Eds.), Qualitative research methods in mental health and pyschotherapy: A guide for students and practitioners (pp. 99-116). Oxford: John Wiley & Sons.

Lee, J., & McFerran, K. (2012). The improvement of non-verbal communication skills of five females with profound and multiple disabilities using song-choices in music therapy. Voices: A World Forum for Music Therapy, 12(3), doi:10.15845/voices.v12i3.644.

Lee, J. (2014). A phenomenological study of the interpersonal relationships between five music therapists and adults with profound intellectual and multiple disabilities. Qualitative Inquiries in Music Therapy: A Monograph Series, 9, 43-86.

McFerran, K. (2008). Who says I can't sing?: Musical justice for people with intellectual disabilities. Melbourne: National Music Therapy Research Centre, University of Melbourne.

McFerran, K. (2016). Understanding the NDIS: How does the scheme view music therapy? The Conversation. Retrieved from https://theconversation.com/understanding-the-ndis-how-does-the-scheme-view-music-therapy-59669.

McFerran, K., & Grocke, D. (2007). Understanding music therapy experience through interviewing: A phenomenological microanlysis. In T. Wosch & T. Wigram (Eds.), Microanalysis in music therapy: Methods, techniques and applications for clinicians, researchers, educators, and students. London and Philadeplhia: Jessica Kingsley Publishers.

McFerran, K., Tamplin, J., Thompson, G., Lee, J., Murphy, M., & Teggelove, K. (2016). Music therapy and the NDIS: Understanding music therapy as a reasonable and necessary support service for people with disability (Australian Music Therapy Association NDIS White Paper). Retrieved from http://www.austmta.org.au/content/ndis-white-paper.

Miyake, H. (2014). Bio-political perspectives on the expression of people with disabilities in music therapy: Case examples. Voices: A World Forum for Music Therapy, 14(3), doi:10.15845/voices.v15814i15843.15800.

Murphy, M. (2018). From social connectedness to equitable access: An action research project illuminating the opportunities and the barriers to accessing music for young people with disability transitioning from school to adult life (PhD), The University of Melbourne, Australia.

Murphy, M., & McFerran, K. (2016). Exploring the literature on music participation and social connectedness for young people with intellectual disability: A critical interpretive synthesis. Journal of Intellectual Disabilities. doi: 1744629516650128.

Pienaar, D. (2012). Music therapy for children with Down syndrome: Perceptions of caregivers in a special school setting. Kairaranga, 13(1), 36-43.

Rickson, D. (2014). The relevance of disability perspectives in music therapy practice with children and young people who have intellectual disability. Voices: A World Forum for Music Therapy, 14(3), doi:10.15845/voices.v15814i15843.15784.

Rolvsjord, R. (2010). Resource-oriented music therapy in mental health care. Gilsum, NH: Barcelona Publishers.

Shiloh, C. J., & Lagasse, A. B. (2014). Sensory friendly concerts: A community music therapy initiative to promote neurodiversity. International Journal of Community Music, 7(1), 113-128. doi:10.1386/ijcm.7.113_1

Smith, J. A. (2007). Hermeneutics, human sciences and health: Linking theory and practice. International Journal of Qualitative Studies on Health and Well-being, 2, 3-11. doi: 10.1080/17482620601016120

Smith, J. A., & Eatough, V. (2007). Interpretative phenomenological analysis. In A. Coyle & E. Lyons (Eds.), Analysing qualitative data in psychology: A practical and comparative guide (pp. 35-50). London: Sage.

Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method, and research. Los Angeles, CA: Sage.

Stevenson, K. (2003). Music therapy assisted communication with children with severe disabilities. New Zealand Journal of Music Therapy, 1, 82-92.

Stige, B. (2009). So you're already doing Community Music Therapy: But why? Paper presented at the Free Public Lecture by the Macgeorge Visiting Speaker, University of Melbourne.

Stige, B. (2010). A society for all? the cultural festival in sogn og fjordance, Norway. In B. Stige, G. Ansdell, C. Elefant, & M. Pavlicevic (Eds.), Where music helps: Community music therapy in action and reflection (pp. 115-147). Burlington, Vt.: Ashgate Publishing Ltd.

Stige, B., & Aaro, L. E. (2011). Invitation to community music therapy. New York, NY: Routledge.

Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (2010). Where music helps: Community music therapy in action and reflection: Ashgate Publishing Ltd.

Thaut, M. H., & Volker, H. (Eds.). (2014). Handbook of neurologic music therapy. New York: Oxford University Press.

Wang, T.-H., Peng, Y.-C., Chen, Y.-L., Lu, T.-W., Liao, H.-F., Tang, P.-F., & Shieh, J.-Y. (2013). A home-based program using patterned sensory enhancement improves resistance exercise effects for children with cerebral palsy: A randomized controlled trial. Neurorehabilitation and Neural Repair, 27(8), 684-694. doi:10.1177/1545968313491001

Warner, C. (2005). Music therapy with adults with learning difficulties and 'severe challenging behaviour': An action research inquiry into group music therapy within a community home. (Doctoral dissertation), University of the West of England, Bristol.

World Health Organization. (2001). ICF: International Classification of Functioning, Disability and Health. Retrieved from doi:10.4135/9781412950510.n454

Appendix 1.
An example of an idiographic analysis in stage 1

   Alicia/NDIS Planner                                 What matters to
                                                       Alicia?

1  It's making their goals and working with them       Finding the right
   to look at what supports they have currently        supports for the
   and looking at the support, not just funded         participant
   support so we also look at their informal
   support network and how they can assist
   with achievement of the goals, as well as
   looking at what's out there in the mainstream
   and community... looking at how mainstream
   services and community supports can get by
   that participant in helping them meet their
   goals and then we look at funded support
   after that, after we've exhausted what's out
   there already.
2  They get to have choice and control of it, the      Finding the right
   participant, and lots of the modality and           support for the
   therapy that they want to choose. And often         participants to
   they'll come to us and say "well what else can      achieve the goals
   you give me? Or what would someone like
   me... what else is there?" But we don't really
   look at it like that. We look at what your
   goals are and we look at what supports we
   can put in place around those goals. So, we
   don't throw the whole catalogue of supports
   at you and say tick tick tick like a shopping
   list, pick what you'd like. Some parents do
   come in with that list. They've been through
   the catalogue and they are aware of what
   can be funded under NDIA so they want
   everything that they can get for their child
   which is understandable. So it can work both
   ways a bit but primarily it's just developed
   around their goals.
3  I've only funded it (music therapy) 2 or 3 times    Whether funding
   and all sort of for different reasons. So, I've     music therapy
   funded it for one 15 yo with a lot of behavioural   will be
   problems. He had autism, was non-verbal and         beneficial to the
   very difficult to self-regulate so mum was a        participant to
   single parent finding it very challenging. And      achieve the goals
   there'd been some music therapy at school that
   had been, well they anecdotally said, that it had
   been successful. So we put that in the plan to
   look at self-regulation: breathing and calming.
4  There was a 14-year-old boy born without any        Whether funding
   eyes so I funded Music Therapy (MT) for him         music therapy
   because he participated in bands and he             will be
   wasn't able to access the music. It was not         beneficial to the
   typical MT I funded, but I funded a RMT to help     participant to
   him access print music so they're adapting the      chieve the goals
   print music into a suitable format for him. He
   can then memorise the music cause that's how
   he learns it. His parents paid for trumpet lessons
   each week--if it's something that all parents
   would be expected to pay for, then it's not
   something that we'd fund.
5  We wouldn't, or I wouldn't consider music           Whether the
   lessons. To me that would be an ordinary            request of a
   cost of parents. It's just expected that            certain service
   parents would cover any cost of music               is directly
   lessons. So that's one our principles in            related to his
   looking at a reasonable and necessary               /her disability
   support, is whether it's a day to day living        or not
   cost by a parent. So even though it might
   be related to a disability, if it's something
   that all parents would be expected to pay for,
   then it's not something that we'd fund.
6  You can amend the plan in that 12 months            Whether the
   if you get a progress report saying they've         participant was
   made these amazing gains and we've still            gaining outcomes
   got these goals... we're looking at these           to get more
   goals for the next 10 sessions, then you            funding for
   might look at funding another 10 sessions if        music therapy
   you think it's reasonable and necessary.
   But yeah, it doesn't mean that it's only 10
   necessarily for the entire 12 months. But
   maybe it does keep it accountable that there
   is progress being made, and the therapist
   needs to get back to you with those
   outcomes.
7  I think I'd like info on music therapy as well      Making a right
   and when we might actually implement it and         decision when to
   when we might not. Because it is, music             fund music
   therapy is a bit of a grey area. It's not           therapy or not.
   requested very often.

    What that means to Alicia?

1   Identifying goals to achieve is more important than finding services
    and support
2   Identifying goals to achieve is more important than finding services
    and support
3   Justifying my decision to fund music therapy is important.
4   Justifying my decision to fund music therapy is important.
5   Making decisions according to our principles regarding funding
    reasonable and necessary supports is important.
6   Making decisions whether to continue the funding is up to the
    participants' outcomes.
7   Alicia feels she needs to be informed more to make right decisions.

Appendix 2.
Ten funded music therapy cases as described by participants

Case   Interviewee    Age/     Diagnosis
       reporting the  Gender
       case           of the
                      client

 1     Alicia/NDIS    15/M     Autism, Non-verbal, Difficulties to
       Planner                 self-regulate
 2     Alicia/NDIS    14/M     Born without eyes
       Planner
 3     Diana/RMT       2/M     Born premature resulted in developmental
                               delays
 4     Diana/RMT       8/M     Functional Disability resulted from
                               Cancer - one of his eyes removed
 5     Emma/           3/F     Not specified
       RMT
 6     Emma/          Teen /M  Autism
       RMT
 7     Emma/          30's/F   Not specified
       RMT 2
 8     Florence/       5/F     Not specified
       RMT
 9     Florence/       6/M     Speech Delay
       RMT
10     Florence/      15/F     Mental Health Issues/Obsessive Compulsory
       RMT                     Disorder (OCD)

Case  Interviewee     Age/     Other Personal Circumstance
      reporting the   Gender
      case            of the
                      client

 1    Alicia/NDIS     15/M     Mother is a single parent finding it
      Planner                  challenging and previous music therapy
                               history at school reported to be
                               successful so planner was happy to put
                               music therapy in the plan.
 2    Alicia/NDIS     14/M     He participated in bands but wasn't able
      Planner                  to access the music (sheets). His parents
                               paid for trumpet lessons each week. If
                               it's something all parents would be
                               expected to pay for, then it's not
                               something that we'd fund.
 3    Diana/RMT        2/M     Family visited RMT's group session
                               conducted in an organisation and noticed
                               the child was positively responding to
                               music.
 4    Diana/RMT        8/M     When they got NDIS funding, his mum
                               asked for music therapy and then I got
                               contacted. But NDIA had already put on
                               the plan for group music therapy but we
                               were unable to provide group music
                               therapy so we ended up only providing a
                               shorter amount of sessions because they
                               wouldn't give us more funding for
                               individual sessions. So that was a bit
                               of a different process because we really
                               had to advocate for him and say that "no,
                               we thought that individual would still
                               work."
 5    Emma/            3/F     She was having music therapy before she
      RMT                      joined the NDIS a couple of years ago,
                               so obviously her parents just came in
                               and said we really like music therapy
                               and we'd like it to continue. So that
                               was easily done. They may have asked me
                               for a report.
 6    Emma/           Teen /M  A musician who was working with a lad
      RMT                      who has autism. And I don't know what
                               funding stream... oh Occupational Therapy
                               (OT) I think. I do know that this
                               musician is not being paid same as an OT,
                               they stretched the funding but it's under
                               the OT line, whatever they call it. That
                               was quite a long time ago now and I've
                               done it twice. So, what they've asked is
                               that they have a music therapist write
                               a report about what's going on in the
                               sessions and then they claim it through
                               OT.
 7    Emma/           30's/F   Those songs written in music therapy
      RMT 2                    sessions are all recorded onto a cd and
                               she gives them to her family and
                               extended family that are also overseas,
                               so it's a way for her to connect with
                               all sorts of people that she doesn't see
                               very often - her family don't live
                               nearby.
 8    Florence/       5/F      On the one hand, I had a client who rang
      RMT                      me saying, "we have music therapy on
                               our plan, what is it?" so then I told him
                               what music therapy was and then, just
                               based on what he had told me about his
                               daughter, what I might possibly be able
                               to work on with his daughter. And he
                               said "Oh that sounds perfect. When can
                               we start?" But I've only had that once
                               and it does seem unusual.
 9    Florence/        6/M     One of my clients has been under an
      RMT                      organisation doing all sorts of early
                               intervention stuff. Then they come up for
                               NDIS so they go "well we're happy with
                               this organisation we want to stay with
                               them." They're an organisation that is
                               registered with NDIS to be a provider.
                               Obviously, there is communication with
                               the family as well but there is someone
                               from that organisation who I think also
                               is in the planning meeting and helping
                               develop the plan. Then that organisation
                               is given a bulk amount of money or
                               funding to then provide OT, speech,
                               physio, whatever it is.
10    Florence/       15/F     She's got a lot of insight and she's
      RMT                      quite articulate but when it comes to
                               connecting, she finds what's happening
                               physically and emotionally a bit tricky.
                               This girl has OCD and she won't touch
                               any instruments so we do a lot of
                               singing. Self-expression, self-esteem
                               and confidence are important because she
                               also suffers with depression and low self
                               -esteem so her family are very keen to
                               have opportunity for achievements and
                               positive experiences.

Case   Interviewee    Age/     Music Therapy Goals
       reporting the  Gender
       case           of the
                      client

 1     Alicia/NDIS    15/M     To promote self-regulation through
       Planner                 breathing and calming
 2     Alicia/NDIS    14/M     To help him access print music so they're
       Planner                 adapting the print music into a suitable
                               format for him and then memorise the
                               music cause that's how learns it.
 3     Diana/RMT       2/M     To improve speech, working on to begin
                               with any words and then two words and
                               now it's putting the word on the end of
                               a song
                               To upskill parents and grandparents to
                               share musical activities with him at home
 4     Diana/RMT       8/M     To build coping skills like reducing
                               anxiety and dealing with negative
                               emotions such as frustration through
                               song-writing
                               To express emotions through keyboard
                               playing and improvisation
                               To provide creative emotional outlet and
                               build confidence by leading and
                               directing music-making process
                               To use music with mother at home
                               throughout daily routines
 5     Emma/           3/F     To exercise choice and control by
       RMT                     indicating her preference of song,
                               instrument or activity through head
                               movement, pointing, reaching out or
                               vocalising
                               To maintain and increase body awareness
                               and tactile experiences through different
                               types of touch and active movement
                               To maintain and increase her non-verbal
                               communication
                               To increase gross motor control through
                               playing instruments
                               To have opportunities for increased self
                               -expression and communication
 6     Emma/          Teen /M  To fulfil some OT needs by building up
       RMT                     an repertoire of songs which they sing
                               together
 7     Emma/          30's/F   To expand her repertoire in music by
       RMT 2                   playing keyboard and learning new songs
                               To articulate and express different
                               aspects of her life through song-writing
                               To increase confidence through shared
                               music-making
                               To create an expressive outlet through
                               song-writing and recording
                               To extend non-verbal communication
                               To increase self-awareness, control and
                               autonomy
                               To gain independence in music-making
                               outside the sessions
 8     Florence/       5/F     Not specified
       RMT
 9     Florence/       6/M     To improve speech and motor skills
       RMT                     To improve emotional expression and
                               articulation of emotions and experiences
10     Florence/      15/F     To reduce anxiety through relaxation and
       RMT                     breathing techniques
                               To gain looking at emotional expression
                               and emotional understanding and
                               articulation as well as body awareness
                               in relation to emotions
                               To discuss about emotions expressed in
                               music through active listening to music

Case   Interviewee    Age/     NDIS Funding
       reporting the  Gender
       case           of the
                      client

 1     Alicia/NDIS    15/M     Not specified
       Planner
 2     Alicia/NDIS    14/M     Not specified.
       Planner
 3     Diana/RMT       2/M     20 individual sessions funded
 4     Diana/RMT       8/M     Initially got four individual sessions
                               and then we had to write a progress
                               report. Then I think he got ten. And
                               then now we've just had 20 funded for
                               him. But they've been a lot more, this
                               was earlier on and they didn't want to
                               fund as many as 10 individual sessions.
 5     Emma/           3/F     Music therapy is part of an
       RMT                     interdisciplinary package she's got.
 6     Emma/          Teen /M  2 music therapy assessment sessions
       RMT
 7     Emma/          30's/F   Ongoing regular sessions over several
       RMT 2                   years and the RMT has been submitting
                               report every 6 months.
 8     Florence/       5/F     Initially 10 hours funded for music
       RMT                     therapy assessment.
                               Then I've just written a report for them
                               so that can get reviewed and then they're
                               planning to have more music therapy.
 9     Florence/       6/M     Transdisciplinary Early Intervention
       RMT                     Package. When it came to me doing music
                               therapy with him because music therapy
                               wasn't listed separately, NDIS told me
                               that I had to go through this
                               organisation and that it would come under
                               their funding. This is extra admin for
                               us so how about we charge you like 10%
                               or something.
10     Florence/      15/F     Not specified
       RMT

Appendix 3.
The participants' statements

Final Theme 1: The unknown decision-making process of the NDIS planners
revealed

Emergent Theme N1: It's important for the NDIS planners to justify
their decisions to fund music therapy.
There was a 14-year-old boy born without any eyes so I funded Music
Therapy (MT) for him because he participated in bands and he wasn't
able to access the music. It was not typical MT I funded, but I funded
a RMT to help him access print music so they're adapting the print
music into a suitable format for him. He can then memorise the music
cause that's how he learns it. His parents paid for trumpet lessons
each week--if it's something that all parents would be expected to pay
for, then it's not something that we'd fund. (Alicia 4)

Emergent Theme N2: The NDIS planners have personal beliefs about the
certain benefits of music therapy.

If a child has speech delay I would say music therapy. The goal would
be something like 'be assisted by speech pathologist and music
therapist to help with learning to speak'. I mean that's just... I
wouldn't word it like that but that's how I would link the goal to the
service. I think for music therapy... the only time I've put music
therapy in a plan is when it's speech delay, cos that's where I see it
as an amazing type of therapy for children with speech delay. (Cheryl 6)

Emergent Theme N5: The NDIS planners should be careful in supporting
music therapy because not everyone is convinced about the effectiveness
of music therapy

We'd all under plans I guess, work together if someone's got expertise
in an area. We talk amongst each other to get some idea of how to put
the plans together for different cohorts. (Cheryl_1)/As I said,
planners don't recommend therapies. I did once recommend music
therapy--I just said "I've heard it can be really great for speech
delay" and they were really interested. But as we discussed it's not
the general approach. I think getting the information to planners as
well would be great because there's so much debate or controversy about
supports." (Cheryl_9)

Emergent Theme R7: It is not about only the choice of services but also
how to make a good argument for that choice/NDIA planners should
understand music therapy more but RMTs also need to use right language
for effective communication.

It (allocated financial amount) does matter but it's on a needs basis.
So if you can put forward a really good argument for something you can
have... I know some people seem to have a huge plan. I'm working with
one 3 yo, and her parents think that she may have the biggest plan yet!
But within that, it seems that there are some limitations as well. So I
think they have to put forward a good argument and that family are
really arguing strongly for as many services as they can for their
child. (Emme_3)/I guess a lot of confusion on both parts, like the
planners not really understanding music therapy, not really
understanding what we can offer. Also me trying to find the right
language to communicate to them in a way that they're going to
understand what we're talking about as well. Because often if they've
not heard it before they get a bit confused or lost. (Diana_19)
Final Theme 2: The impact of the NDIA's decisions on the participants
and the RMTs' practices was revealed and RMTs expressed desires to have
more channels of communication with the NDIS

Emergent Theme P1: Depending on the planner's knowledge about music
therapy, funding outcomes are different and inconsistent.

If your planner is clear enough to know how the different disciplines
work and what they try to achieve and are cluey enough to sit there and
go "Right. Sounds like William's struggling with that. Why don't we get
an assessment done on this and say whether or not therapy would be
worthwhile?" Then, it's great. It gives you a hint of where to start.
But for the everyday person, there's no way. If it was not something
that they've been familiar with before. The planners certainly use it.
Subsequent to that I've now got a different planner, and that planner
hasn't offered or suggested anything different. (Iris 10)

Emergent Theme PR6: The planner's lack of understanding of music
therapy negatively impacted William's access to music therapy

So every time at the end of that block then, like the plan comes to an
end and you have to provide a progress report so it's always uncertain
about whether music therapy is going to continue and that's also
something that I've raised with the planner. Because last time before
this child got 20 sessions, we only had one session left and mum was
due to have her plan reassessed in a month, and we'd been meeting
fortnightly and so I contacted the planner and said that's the
likelihood of this continuing? You know we've only got one session left
and the mum knew that she had flexible support so the mum thought that
she could actually take some from speech that she hadn't used and use
it for music therapy... But the planner was like we won't know until
the day of the plan and I'm talking about, but that's not appropriate
for closure. I've been working with this child for so many sessions
now, he's really engaged, mum's saying he wants more music, he's saying
he wants more music - where do we sit? And she's like just have the
final session or hold onto one of your sessions until we know. And I
said but that's still not actually enough, because I started these
discussions when I still had a couple and then it took that long. And
then I had that discussion with them and said that actually for
therapeutic closure, that's not appropriate for a child who's highly
anxious and had all that trauma in his life. And then so she said she
was going to take that up to NDIA but I haven't heard anything back. So
that's a big issue as well. The new plan meeting happened after the
first plan ended. There was like a lapse. (Diana 9)

Emergent Theme NPR4: Reports are important and RMTs should be
thoughtful and clear about what they write in reports.

I guess cos we 're not, like most planners aren't therapists or if they
are, only in a specific area generally, I always say... if a
participant says "I want music therapy or I want my child to have music
therapy" I don't say... I don't have any knowledge of whether it would
be a good thing or not so I would put in an assessment for music
therapy. So I'd put in probably 10 hours and say, "If I could get a
good assessment from the music therapist as to why this is a good
support, and how many hours they think is required, then I would go off
the report." I would make the determination myself. (Cheryl 3)

Emergent Theme R3: Getting into NDIS system was a slow and complicated
process for RMTs.

When you are trying to chase up, like I've been trying to find out if
this person does have funding before I've provided the service, like
the communication between myself and the NDIS is quite slow. They say
about 5 business days to answer any email... most of the time when I've
rung up, the person on the phone is more just a general call centre
sort of person, and if they're not aware of individual cases they'll
say well send an email to whoever is dealing with it from that end. So
when you have clients that are waiting for a service or if you have
issues with looking up their funds and stuff it can be quite a slow
process. (Gabriella 6)

Emergent Theme R1: RMTs need to know how the NDIS works.

With this next client, I've got coming on I'm thinking I'm gonna try
sorting things out a bit further... I mean I don't really care how
it's, I mean if I get paid at the end of the day that's fine like I
don't really care. But the way it's set up in terms of when it's on
their plan separately and I just keep invoicing NDIS, it's so simple
and it works really well. And this other system through the
organisation works as well now that we've got it set up. Like I just
invoice them and they pay me. Now that we've done that it probably will
be okay with the second client. But I'm also thinking well, with any
clients I'm advising them that if you want music therapy try and get it
as separate item on your plan - that's much simpler. (Florence_8)/Not
everybody gets a copy of the NDIS plan. I purposely went out of my way
to request them. Because you really need them to know whether you're
helping them achieve their goals. So I had to request them (Hannah 9)

Emergent Theme R5: RMTs reports and recommendation about the amount of
sessions were not respected by the NDIA.

There's been no input or request from the NDIA at all from me. Except
for formally but they don't even seem to follow up with that. They say
they want a report every 6 months and I've been doing that fairly
consistently but they've never chased me for it. So I've just written
what I always write for reports which is goals and what's happening in
the session and the outcomes. (Emma_15)/During school terms once a
week. I think I asked for forty sessions. She came back and said they
do either 48 (half an hour) or 24 (an hour). The other thing I got to
ask her which I was just assuming but hadn't clarified with anyone, was
... It's by the hour.... And I said "is that inclusive of chatting to
mum, doing the reports, doing an assessment, admin type stuff as well?"
Because I assumed it was. And she said that it was, she clarified that
it was. (Florence 16)

Emergent Theme 3: This is an important time to raise awareness of music
therapy and RMTs can be active in this process to advocate for music
therapy as a necessary service

Emergent Theme N3: The NDIS planners hope the other planners get some
information about music therapy and RMTs.

Communities of Practice--setting up groups with differing levels of
expertise for knowledge management and transfer of knowledge across the
NDIA. Music Therapy and therapy services is probably one of those areas
that would fit quite well with that sort of approach. (Bryce_7)/We do
have training sessions... well we're meant to have them anyway
fortnightly. People from various organisations that provide certain
supports come and speak to us. So you could get in touch with the
Engagement Teams in different sites and just say if it's possible, we'd
like to come and have a chat with the planners about the benefits of
music therapy. And that could very well be something that they'd be
interested in cos we are meant to have regular training on different
supports.(Cheryl_10)/I think I'd like info on music therapy as well and
when we might actually implement it and when we might not. Because it
is, music therapy is a bit of a grey area. It's not requested very
often. (Alicia 7)

Emergent Theme P2: Therapists' active role in educating and promoting
music therapy and being acknowledged by other allied health
professionals are extremely important.

Unless where the therapists are engaged they are able to communicate
with those parents, "Look, you've got to get on the NDIS site. You
should consider it." I'm not sure. I sort of think also, perhaps align
disciplines for example. Diana does with William's coordination skills
and things like that that he struggles with, like it's an Occupational
Therapy (OT) goal, but Diana works on that with him as well. She brings
out the keyboard and gets him to attend to his left-hand side using the
keyboard. So yes, we're doing emotional relief, that was the main
purpose of having her, but she's also been able to get him to move
fingers and all sorts of stuff. in terms of increasing a profile, then
we'll also be working with just making yourself really well known, as
to what music therapy can do to support another discipline, so that
when the therapist is writing their recommendation for what services
you might need, that they're suggesting it as well. That's probably how
you get it into the plan. (Iris 11)

Emergent Theme R2: Decisions should be informed by parents' voices and
RMTs might need to prompt and inform them.

It sounds like their hands are ties, like it has to be all from the
parents' voice. I don't even think they can say "look we've had other
people with this diagnosis and they're benefited from you know, x, y,
z." I don't think they can do that at all. So it's sort of I figure out
what they're needing and then I help them jump through the hurdles. So
I pass the message on to the head clinician and I've got to kind of
whisper to her "look you need to inform the parents that they need this
if you want to get it approved" (Hannah 12)

Emergent Theme R4: Awareness of the benefits of music therapy should be
increased in the future.

I believe that they're supposed to click on 'find a provider' and they
can search for what's available. But I'm guessing in general, probably
the awareness of music therapy is probably not quite as high as
awareness of say speech therapy or OT. So they're probably going to
search for those sorts of things before they would search music
therapy. And other than that, unless individual planners are aware of
it and suggest it, then I don't really see the NDIS as kind of
sprouting it. (Gabriella 9)

Juyoung Lee, Kate Teggelove, Jeanette Tamplin, Grace Thompson, Melissa Murphy and Katrina Skewes McFerran

Faculty of Fine Arts and Music, The University of Melbourne, Australia

Address correspondence to:

Juyoung Lee juyl@unimelb.edu.au

To cite this article: Lee, J., Teggelove, K., Tamplin, J., Thompson, G., Murphy, M., & McFerran, K. (2018). Whose choice? Exploring multiple perspectives on music therapy access under the National Disability Insurance Scheme. Australian Journal of Music Therapy, 28, 91-115. Retrieved from https://www.austmta.org.au/journal/article/whose-choice-exploring-multiple-perspectives-music-therapy-access-under-national

In plain language:

This research study investigates how different stakeholders perceived access to music therapy under the National Disability Insurance Scheme (NDIS) in the trial sites between 2013 and 2015. Nine people who had the lived experience of the matter such as NDIS planners, Registered Music Therapists (RMTs) and a parent of a boy with a disability were individually interviewed. Interpretative Phenomenological Analysis reveals that everyone believed that music therapy was not fully understood or received well by everyone, and RMTs need to take more active roles in educating and promoting music therapy to staff in the National Disability Insurance Agency (NDIA), allied health professionals, as well as parents of people with disabilities.

(1) NMT involves "the therapeutic application of music to cognitive, sensory, and motor dysfunctions due to neurologic disease of the human nervous system" (Thaut & Volker, 2014, p.2).

Table 1.
Participant information

Name        Participated   Gender  Region      Involvement   Description
            as a                               with NDIS     of Music
                                               since         Therapy
                                                             Client

Alicia      NDIA Planner   F       NSW-Hunter  2013          2 Clients
Bryce       NDIA Plan      M       VIC-Barwon  2014          N/A
            Support
            Coordinator
Cheryl      NDIA Plan      F       ACT         2014          N/A
            Support
            Coordinator
Diana       RMT            F       VIC-Barwon  2013          2 Clients
Emma        RMT            F       VIC-Barwon  2013          3 Clients
Florence    RMT            F       NSW-Hunter  2013          3 Clients
Gabriella   RMT            F       NSW-New     2013          2 Clients
                                   Castle
Hannah      RMT            F       ACT         2013          2 Clients
Iris        Parent of an   F       VIC-Barwon  2013          Her Son
            8-year-old
            boy

Table 2.
The 14 Emergent Themes

N1    It's important for the NDIA planners to justify their decisions
      to fund music therapy.
N2    The NDIA planners have personal beliefs about the certain benefits
      of music therapy.
N3    The NDIA planners hope other planners get some information about
      music therapy and RMTs.
NPR4  Reports are important and RMTs should be thoughtful and clear
      about what is included in reports.
N5    The NDIA planners should be careful in supporting music therapy
      because not everyone is convinced about the effectiveness of music
      therapy
P1    Depending on the planner's knowledge about music therapy, funding
      outcomes are different and inconsistent.
PR2   Therapists' active role in educating and promoting music therapy
      and being acknowledged by other allied health professionals are
      extremely important.
R1    RMTs need to know how the NDIS works.
R2    Decisions should be informed by parents' voices and RMTs might
      need to prompt and inform them.
R3    Getting into the NDIS system was a slow and complicated process
      for RMTs.
R4    Awareness of the benefits of music therapy should be increased in
      the future.
R5    RMT reports and recommendations about the amount of sessions were
      not respected by the NDIA.
RP6   The planner's lack of understanding of music therapy negatively
      impacted clients' access to music therapy
R7    It is not about only the choice of services but also how to make
      a good argument for that choice and RMTs also need to use right
      language for effective communication.

(*) N: NDIA Staff, P: Parent, R: RMT

Table 3.
Reasons for funding music therapy and decision-making process during
NDIS planning

Example  Reasons for Funding Music        Who Made that Decision?
No.      Therapy

 1       To support a single mother of    Planner found a good
         a son who has behavioural        justification in a unique
         problems and whose previous      situation
         music therapy participation
         at school was successful
 2       To adapt print music for         Planner found a good
         community participation          justification in a unique
                                          situation
 3       To support a boy born            Family accessing
         premature that resulted in       Transdisciplinary Early
         developmental delays and         Intervention Package (TEIP)
         required early intervention
 4       To support a boy with            NDIA not providing sufficient
         functional disability            session amount requested by
         resulting from cancer to         family and didn't regard music
         learn coping skills              therapy as therapy but a group
                                          activity
 5       To support ongoing music         Family accessing TEIP
         therapy that has been
         conducted previously for a
         3-year-old girl as part of a
         TEIP
 6       To fund a music therapist        Planner found good
         to conduct assessment of         justification in unique
         sessions provided by a           situation
         community musician
         focused on OT needs
 7       To support the client to         Planner found good
         communicate with her family      justification in unique
         living overseas, music was       situation
         found to be effective in this
         so her sessions have been
         funded regularly on an
         ongoing basis for more than
         several years now.
 8       To support a 5-year-old girl     NDIA (parent didn't know of
         with developmental delays        Music Therapy but it was given
         in TEIP (parents had no idea     as part of TEIP)
         about music therapy)
 9       To support a 6-year-old boy      NDIA happy to offer TEIP to an
         with speech delays in TEIP       organisation
10       To support a 15-year-old         Planner found good
         girl with mental health          justification in unique
         issues such as anxiety           situation
         and Obsessive Compulsory
         Disorder