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Music Therapy Survey

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Dear Friend of ASO:

We were asked to help circulate this survey. Please answer the survey if you are able. Please share.

Sincerely,

Barbara C. YavorcikPresidentAutism Society of Ohio701 S. Main St.Akron, OH 44311(330) 376-0211fax: (330) 376-1226email: askASO@...home: byavorcik@...web: www.autismohio.org2005 ASO Bi-Annual Conference"Reaching Beyond the Horizon - Challenging the Autism Spectrum"Friday and Saturday, October 14-15, 2005 Kingsgate Marriott in Cincinnati, Ohio Please note: This is provided for information purposes only. The ASO does not endorse or recommend any providers, methodologies or services. Providing this information should not be construed as an endorsement by the ASO, either explicit or impiled.

-------------------------

The Cleveland Music School Settlement

Group Home Music Therapy Needs Survey

Dear Group Home/Assisted Living Providers:

We would appreciate your taking 5 minutes to complete the survey below, to help our Music Therapy Department learn more about the needs of individuals with special needs in our community and state. With the information you provide, we hope to then be better able to serve you and your clients. Thank you very much for your assistance in this important project. Please return your surveys in person or by mail to Ronna Kaplan, MA, MT-BC, Director of Music Therapy, The Cleveland Music School Settlement, 11125 Magnolia Drive, Cleveland, OH

44106 by May 27, 2005.

Name: _________________________ Email address: ___________________

Position: _______________________ Group home phone number: _________

Group home name: ________________________________________________ Group home address: ______________________________________________

1. How do you use music currently in your group home? (Check all that apply)

q Residents listen to live or recorded music in own or common rooms

q Residents dance to music in their own or common rooms

q Residents sing to recorded or live music in their own or common rooms

q Residents play instruments in own or common rooms

q Staff member plays instrument in common room

q Staff member and residents play instruments together in common room

q Residents attend musical event in community with staff member

q Residents go to store to purchase own recordings

q Other: ________________________________________________

2. Presently what are the purposes of your use of music in the group home? (Check all that apply)

q Music to assist routine and transition

q Music to enhance events and traditions

q Music for calming/relaxation/background

q Music for stimulation

q Music for leisure skills

q Music to enhance self-esteem

q Music to enhance social interaction with peers

q Music to enhance communication

q Music to enhance motor skills

q Music to enhance cognitive skills

q Other: ________________________________________________

(over)

Group Home Music Therapy Needs Survey (continued)

3. How important do you feel it is to use music with your residents? (Check one)

q Not important at all

q Unimportant

q Somewhat important

q Important

q Very important

4. How competent do you currently feel in your ability to use music with your residents? (Check one)

q Very incompetent

q Incompetent

q Somewhat competent

q Competent

q Very competent

5. Would you be interested in a one-time in-service from a music therapist for consultation and training as to how to use music in your group home? (Check one)

q Yes

q No

6. Would you be interested in the periodic services of a music therapist for consultation and training as to how to use music in your group home? (Check one)

q Yes

q No

7. How much would you be willing to pay for this service?

q $41-60/hour

q $61-80/hour

q $81-100/hour

8. With this service, what would you hope to be the future purposes of your use of music in the group home? (Check all that apply)

q Music to assist routine and transition

q Music to enhance events and traditions

q Music for calming/relaxation/background

q Music for stimulation

q Music for leisure skills

q Music to enhance self-esteem

q Music to enhance social interaction with peers

q Music to enhance communication

q Music to enhance motor skills

q Music to enhance cognitive skills

q Other: ________________________________________________

9. Comments: __________________________________________________

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