The Sing & Grow Programme UK

Themes this local practice example relates to:

  • Families, Parents and Carers
  • General resources

Basic details

Organisation submitting example

Sing & Grow UK CIC

Local authority/local area:

Great Britain & Northern Ireland


The context and rationale

Sing & Grow is an evidence-based music therapy project that involves working with young children and their families who present with complex needs. Programmes focus on strengthening family relationships, building capacity in parents to support their children's development in the early years of life, and encouraging the use of music within communities.

Description
Sing & Grow is a referrals-led evidence-based international music therapy project that provides services within the community for those young children and their families who present with complex needs. Programmes focus on strengthening family relationships, building capacity in parents to support their children's development in the early years of life, and encouraging the use of music within communities. 

The quality of family life has been found to directly impact upon child development with risk factors including family conflict, marriage breakdown, low socio-economic status, parental psychopathology, lack of emotional warmth and support and parental criminality. Sing & Grow targets families experiencing these and other pressures and builds on their existing strengths to enhance attachment and bonding between parent and child. The programme is structured in a way that lends itself to modelling, peer learning and facilitated learning for the parents involved through encouragement of their skills and strengths. Sing & Grow is a strengths-based, holistic approach to early intervention and prevention and is informed by contemporary international literature in the field.

Sing & Grow music therapy programmes are held in accessible venues in collaboration with community organisations such as Children’s Centres, Child Development Centres or Youth Centres. Up to 10 referred families attend weekly sessions (generally over 10 weeks), participating in hands-on music activities that assist children with developmental skills and extend the repertory of parenting skills in relating to children through interactive play. 

Background
Sing & Grow was established in July 2001 in partnership with Playgroup Queensland, Australia. The project has been running continuously and successfully since this time, originally in South-East Queensland, northern New South Wales and targeted regional areas of Queensland before expanding to cover all states and territories across Australia in 2004. It has been funded directly by the Australian Government from 2004 to date. 

In 2010 the project also began service delivery in the United Kingdom, with the establishment of Sing & Grow UK, a Not-For-Profit community organisation. In addition to direct service delivery, the project has promoted and informed the community on the importance of appropriate stimulation and strong family relationships in early childhood and has built capacity in local communities to encourage the continuation and development of music use in many early childhood and parenting activities. There have been 1000+ Sing & Grow programmes delivered internationally to date. Health and Care Professions Council registered music therapists with additional Sing & Grow training facilitate Sing & Grow programmes in the UK.

Knowledge Base
Research on parenting characteristics over the past 20 years suggests that the parenting characteristic having the greatest influence on children’s development is responsiveness. Responsiveness is composed of a range of interactive behaviours including sensitivity, contingency, reciprocity, maintaining and involvement. Responsive Parent-Child Interaction is the most consistent predictor of early developmental outcomes for children at risk, children with disabilities and children from different cultural and racial backgrounds (Mahoney and Perales, 2003). 

Within Sing & Grow we draw on three main models or theories to inform our practice with regards to encouraging parental responsiveness:

• Mahoney, Robinson and Powell (1992) “Responsive Teaching”
• Cooper, Hoffman, Marvin & Powell (2005) “Circle of Security”
• Slade (2005) “Reflective Parenting”

Sing & Grow is further informed by the work undertaken by Bowlby (1969) and Ainsworth (1978). 
Sing & Grow is the most comprehensively evaluated music therapy parenting intervention to date (Abad and Williams 2007; Docherty et al. 2007; Nicholson et al. 2008; Williams 2006). Each programme consists of ten sessions conducted weekly for groups of up to 10 parent-child dyads. One evaluation of this programme collected post intervention data for 683 disadvantaged families. The results indicated high levels of parent satisfaction, a perceived positive impact on parent/child relationships and improvements in children’s cognitive, physical and social development (Abad and Williams, 2007).

In a second study, changes from pre to post intervention were compared for 358 families attending programs for young parents, children with a disability and disadvantaged families (Nicholson et al. 2008). For all three types of participants, improvements were found for clinician observed parent and child behaviours, parent-reported irritable parenting, educational activities in the home, and child communication and social play skills.

A list of some of the research papers evaluating Sing & Grow as an effective parenting/early intervention approach is available from the C4EO team at the NFER.

To maintain Australian Government funding Sing & Grow was extensively researched and evidenced over a three-year period by Queensland University of Technology (Nicholson, J.M., Berthelsen, D., Williams, K. & Abad, V. National study of an early parenting intervention: Implementation differences on parent and child outcomes. Prevention Science. Accepted 3 May 2010. DOI: 10.1007/s11121-010-0181-6).

Aims & Outcomes
The aims of Sing & Grow for participating families are to:

• Encourage and increase parent/child interactions, secure attachment and bonding
• Increase parents’ own capacity to support their children’s development in the early years of life.
• Build parent confidence, knowledge and resilience.
• Enhance social connectedness between families AND their communities.
• Improve child development outcomes within a “school ready” framework.
• Improve outcomes for all children and reduce the inequality gap for the most disadvantaged.
• Create opportunity for participation in an enjoyable strengths-based parenting programme.

The aims of Sing & Grow for participating partner organisations are to:
• Increase the use of music with families by multi-agency workforce to support positive and secure attachment/bonding.
• Empower multi-agency workforce to support families post Sing & Grow with key childhood development messages and practical help/activities.
• Provide an assessment/evidence base within an outcomes-led approach for partner organisations to use in support of their work with families.

Sing & Grow uses bespoke and standardised evaluation tools to evidence the programme’s outcomes. These include:
• Pre- and post-programme clinician led assessments. 
• Parent pre- and post-programme evaluations.
• Partner organisation pre- and post-programme evaluations.
• Focus groups with parents.
• Three month follow-up interviews/questionnaires.

Sing & Grow links into current Early Years frameworks in England, Wales, Scotland and Northern Ireland and we encourage our partner organisations to assess children’s progress using relevant early years profile score tools to gauge improvement in capacity if such assessments are appropriate.

The Difference We Want to Make
Through the delivery of Sing & Grow we hope to see:

• Children that are ready to start school with competent age-appropriate communication and language skills, pro-social behaviours, self confidence and physical development skills.
• Stronger relationships between family members resulting in happier more resilient family units.
• Multi-agency workers confident to use music with families to support child development outcomes.
• The community’s use of music as a child development tool better understood and practiced.
• An enhanced model for multi-agency cooperation in support of families with young children.
• Community/3rd Sector access to a highly evaluated evidence-based parenting programme.

The practice

A Sing & Grow programme occurs as a partnership between a community host organisation (HO), such as a children’s centre, and Sing & Grow UK. After an initial contact is made, we present the approach and its resources to the HO and other multi-agency workers who may be involved in an aspect of the referral process, the delivery process or the exit strategy. These can include: health visitors, portage workers, social/family support workers, head teachers, behaviour support services staff among others. Sing & Grow covers all aspects of the approach and the wider impact of the programme in this presentation including: programme logic model, child protection, assessment/evaluation, reporting, HO staff training, the referral process and Sing & Grow’s evidence base since 2001.

Following this series of meetings, programme start dates are agreed, contracts are signed and our referral process begins. We use a secure online referral form that HOs complete for each referred family. We do not require any identifying information about family participants and the information provided in the referral is only shared with the music therapist leading the relevant programme. A pre-programme meeting is held between the Sing & Grow music therapist and the HO in the week prior to Sing & Grow starting to discuss the referrals and for the HO to highlight their child protection policy/procedures to the music therapist.

Our referral process is structured via a secure online form sent to the HO prior to a programme starting. We do not require any identifying information (surnames, dates of birth or contact details). The HO completes the short form for each family invited to take part. 

Over the course of a ten week Sing & Grow programme the HO is given specifically designed resources and staff training to enable and encourage high quality music making with families outside of a therapy context. Participating families are also given a series of resources including for use during and after Sing & Grow including:
• Sing & Grow Together CD
• 3 Key Parenting Message Cards
• About Sing & Grow info sheet
• Making musical instruments at home
• Sing & Grow and Child Development information sheet.

This allows time for each resource to be discussed and processed with families for better ‘digestion’ of the parenting information. The resources support families to continue to use music/Sing & Grow at home during the programme and afterwards. We aim to have the beneficial outcomes and changes in parenting style/capacity that we see in the sessions generalised within the home environment. The resources form our bridge into families’ homes and support the process of normalisation and generalisation.

Parents are asked to complete a short Parent-Child Details Form, requesting information about the target child, any siblings/other family members attending and also brief socio-economic details. It is an opportunity for the parent to identify what they would like to get from participating in Sing & Grow and this information is considered when tailoring the sessions to individual needs. 

Over the course of 10 weekly sessions, a structured session plan (see Table 1 below) is used by the Sing & Grow music therapist, who is trained to plan and lead the sessions with consideration to the dynamics of the group, and in line with the stated and evolving referral information.

Table

During weeks 1 and 2, the music therapist completes a series of baseline assessment observations for all referred children and adults. This assessment is undertaken again in weeks 9 and 10 to provide a pre/post assessment framework. Further details of the assessment tools are set out in the next section. During weeks 9 and 10, parents and the HO are asked to complete a series of feedback/evaluation forms providing important qualitative outcomes data. 

This is used along with quantative assessment data from the pre-post series of assessments undertaken by the clinician music therapist. The assessment tool has been developed for Sing & Grow and is © Berthelsen, D. & Nicholson, J. (2006). Observation of Interactions Scale. Brisbane, Queensland University of Technology. 

Outcomes data can and is routinely shared with HOs enabling them to evidence the work undertaken in partnership with Sing & Grow. This is normally in the form of a ‘Report Card’ which presents assessment data in pictorial/graph formats, alongside qualitative comments from participant families. 

Outcomes data is entered into a central database allowing for international comparisons with data from Australian programmes.

Evidence and evaluation - making a difference to children, young people and families

Sing & Grow UK measure the success of interventions using both qualitative viewpoints/feedback and quantitative data. Qualitative and quantitative data gathering tools have been created specifically for use by Sing & Grow. Quantitative assessment tools are © Berthelsen, D. & Nicholson, J. (2006). Observation of Interactions Scale. Brisbane, Queensland University of Technology, whilst the qualitative data tool was developed ‘in-house’ by Sing & Grow colleagues over the past 10 years. 


Quantitative Data – Summary
Each cohort of families that participate in Sing & Grow are assessed pre- and post- intervention, normally in sessions 1 and 2 and again in sessions 9 and 10. Using the Observation of Interactions Scale, the music therapist clinician assesses the capacity of each child and each adult in a number of key areas. 

Primary Parent (Adult) Behaviours assess capacity in the follow areas:
Sensitivity to the Child
Effective Engagement of the Child
Acceptance of the Child.

Child Behaviours assess capacity in the follow areas:
Responsiveness to Parent/Carer
Interest and Participation
Social Engagement with other Adults & Peers.

The clinician gives ratings on a five-point scale linked to definitions of identified behaviours and also rates environmental factors including session setting, external staff preparation and the general participation/engagement of the group. In line with best practice, 10% of ratings from the Observation of Interactions Scale are subject to a validation and consistency check undertaken by the programme’s clinical supervisor. This ensures the consistency of ratings across all the programmes in the UK and internationally.

HOs are able to draw on programme data to identify reported changes in families participating in Sing & Grow pre- and post-intervention.

Attendance records are maintained each session (who attended; any additional children/adults in attendance) as is data regarding the number of children or families participating who are involved with Child Protection services. All data collected allows families to remain deidentified/anonymous.

Qualitative Data – Summary
Each cohort of families that participate in a Sing & Grow programme are asked to complete pre- and post-questionnaires. The pre-intervention questionnaire (Parent/Child Details Form) allows parents to tell us what they hope to get out of taking part in Sing & Grow (Verbatim responses and multiple choice answers), as well as further information about their child and some socio-economic information. The post-intervention questionnaire (Parent Feedback Form) allows parents to rate the quality and enjoyment of the intervention, whether they would recommend it to other parents, verbatim comments about what they found most useful during the programme, and via multiple choice, they identify what benefits they received from Sing & Grow and whether this matched their expectations.

The HO is also given a detailed questionnaire about their experience of hosting Sing & Grow, and is asked to comment on its impact on the cohort of families taking part.

Evaluation
The evaluation process happens over the course of a 10 week programme via clinical supervision, and at the end of the programme. Each music therapist clinician is asked to attend 3 x 1 hour long supervision sessions per programme, with one of these taking place after a session observation by the supervisor. Clinical supervision allows for professional reflection to occur, and address any issues within the programme that may arise. At the end of the programme, the quantitative and qualitative assessment data and all other feedback and comments is discussed in a final supervision between clinician and supervisor; data is then entered into the Sing & Grow database for statistical evaluation, which forms the final part of the evaluation process.

All our music therapist clinicians are required to attend an annual national training day where training updates, best practice (in-house and within the profession), child protection updates and other information is shared across the team. This training event is coordinated with colleagues in Sing & Grow Australia in order that best practice is shared internationally wherever possible.

The Difference Made
Since its creation in 2001 outcomes data and feedback from clinicians, parents and HOs has been used to develop the work of Sing & Grow. This is evident in the range of resources provided to parents, in the evolution of assessment tools, and within HO staff training options. Sing & Grow continues to undertake this process.

As part of a longer term evaluation process, permission is sought from parents for follow up contact 3-6 months after their programme finishing. Historical evidence from this suggests that there are at least four key outcomes highlighted by this process:
1. A reduction in angry-coercive parenting.
2. An increase in parents undertaking activities with their child at home.
3. A reduction in parent mental health symptoms.
4. An increase in child communication and social play skills.
(From Impact of Music Therapy to Promote Positive Parenting and Child Development, 
Nicholson, J. et al, 2008).

Data from music therapist clinicians from UK programmes facilitated between April – July 2012 and taken via the Observation of Interactions Scale highlights improvements from pre- to post-intervention (where data was gathered) in the following areas, with the % change in the group shown in brackets pre to post: 
• Sensitivity to the Child (+22%) (Parent/Carer)
• Effective Engagement of the Child (+23%) (Parent/Carer)
• Acceptance of the Child (+22%) (Parent/Carer)
• Responsiveness to Parent/Carer (+20%) (Child)
• Interest and Participation (+21%) (Child)
• Social Engagement with other Adults and Peers (+24%) (Child).

Furthermore the difference that parents report and their satisfaction with the intervention has remained consistently high, with data from 2011 suggesting that surveys completed in the final week by participating parents indicated:
• 99% were satisfied/very satisfied with the programme
• 96% would like to do it again
• 96.8 % would recommend it to other parents.

Evidence gathered from partner organisations highlights a number of areas in which their practice has been developed through contact with Sing & Grow. This evidence suggests that the legacy impact of Sing & Grow on hosting organisations falls into a number of areas including: 
• An increase in the use of music to work with families and young children.
• An increase in the skill-set of staff around music.
• An awareness of Sing & Grow music therapy as a useful validated approach. 

Feedback
Sing & Grow encourages feedback from all stakeholders, participants and partners. Here is a collation of parental & organisational feedback comments from our post programme feedback process for UK programmes delivered in 2012.

Parents
• “Sing & Grow has helped me to find new ways to engage with my children.”
• “Enjoyed having fun and singing with my child, and hearing new ways to make things at home more fun.”
• “I had so much fun seeing my child really grow in confidence and be happy and joyful.”
• “This programme has changed my family’s life as we now know about signing and communication with our child!”

Host Organisations
• "There has been wonderful interaction between child and parent/carer and within the whole group - lovely experiences of closeness were witnessed."
• "Other professionals have been welcomed and thoroughly impressed. The sessions have been well structured, with great resources to help encourage further music in the home."
• "It has been lovely to observe changes in children's behaviour e.g. sharing, turn-taking, listening, and watching their parents growing in confidence."
• “The team is very passionate about the benefits of the Sing and Grow programme for young children and their familes. Their professionalism and attention to detail ensures a smooth and focussed working relationship.”

A list of current and past partnership organisations is available from the C4EO team at the NFER.

Helping others to replicate your practice

Sustaining Practice

Programme delivery manuals, staff training and development structure/content and the resources that are provided to families as a result of reflecting on our approach are regularly updated. Parent & HO satisfaction with Sing & Grow as an early intervention has not declined during this process and has continued to show very high satisfaction levels.

Over the course of the last 12 months internal procedures around all elements of programme delivery to successful work in partnership with organisation across the UK and Northern Ireland have been updated and modified.

Two additional services in response to feedback from partner organisations have been developed. 

1. The Place-Based Model of work enables the delivery of intensive music therapy interventions to targeted families. We continue to collaborate with existing family-focused agencies, and provide music therapy services designed to better engage families who, for a range of reasons, may otherwise not participate in our regular 10 week programmes. Service delivery can include home visits, 1:1 sessions, workshops and group programmes that extend beyond the traditional 10 week timeframe. Sing & Grow facilitates a weekly community placement over a minimum of 24 weeks/6 months. 

This enables rapport and capacity building, along with the transition of families into other community services. The Sing & Grow Place-Based approach supports the concept of Integrated Service-Delivery and requires committed support and collaboration from organisations already engaged with young families in the relevant community. The Place-Based approach requires a greater level of commitment from partner organisations, but offers a reduced cost per programme due to the up-scaling of the approach.

2. The Facility-Based Model of work enables the delivery of intensive music therapy interventions within one partner organisation, for example a hospital. Service delivery can include 1:1 sessions with patients in wards or private rooms, staff training workshops and group programmes that extend beyond the traditional 10 week timeframe. The minimum timeframe for this approach is 24 weeks/6 months. 

This enables rapport and capacity building, along with the transition of families into other community services. The Facility-Based approach supports the concept of Integrated Service-Delivery and requires committed support and collaboration from the partner organisation. 

Costs and Benefits
The costs for the main services are set out below (Costs as of January 2013):
• The Sing & Grow Programme
10 week/2hrs per week programme for up to 10 families
£2500 or £250 per week. 

• Facility or Place-Based Services
24 weeks/4hrs per week (half day)
£6,000 or £250 per week.

• Facility or Place-Based Services
24 weeks/8hrs per week (full day)
£9,950 or £415 per week.

Costs associated with either Facility or Place-Based Services that run for more than 6 months are subject to negotiation.

Costs are based on guidance from the British Association of Music Therapy.

Learning from the Experience
Sing & Grow has a track record of over 10 years and more than 1000+ programmes delivered internationally within that time. The following learning experiences have been identified from programmes delivered using this tried and tested model in the UK during 2012.

• Parental engagement and uptake of child development information is enhanced when seen to be linking the musical activities undertaken and the home environment. For example, explaining when children learn to grip the hand bells in their palms in Sing & Grow, they are also learning how to hold and use a spoon or a hairbrush or a toothbrush at home.

• Our most vulnerable families benefit from lots of pre-programme intensive 1-2-1 input before they feel able to attend a group. This may include working alongside Portage with families at home for a number of weeks, as a stepping stone to their participation in a group at the local children’s centre. With these families our Place-Based service appears more appropriate than our standard 10-week programme model.

• Learning how to incorporate newly designed resources for families (Key Parent Message Cards) into a familiar and tested structure.

Challenges
• Working with host organisations to ensure their key staff understand the approach before programmes get underway, so they are able to have accurate ‘invitation’ conversations with potential families.

• Ensuring that host organisations have thought through the potential needs of families in the areas of transport (accessing community venues) and their capacity to commit to a 10 week programme.

• Growing from a small organisation operating regionally in 2011 to an organisation operating throughout the UK and Northern Ireland in 2012.

Replication
Because Sing & Grow is a music therapy project led and delivered by Health and Care Professions Council registered music therapists, requests to replicate or bring the project to new areas or organisations will always require our support. 

For example if a council in London would like Sing & Grow in their area, we would work in partnership with them to make this happen, and provide one of our Sing & Grow trained music therapists to facilitate whichever range of services the council had commissioned.

We are always looking to develop new partnerships across the UK & Northern Ireland, and as a not-for-profit Community Interest Company, we are able to apply for grant funding so making it easier for organisations to work with us in the current financial climate.

Core leadership behaviours
The following eight core behaviours have been identified as part of successful elements of leadership (see National College for Leadership of Schools and Children’s Services/C4EO (2011). Resourceful leadership: how directors of children’s services improve outcomes for children. Full report. Nottingham: NCSL. 

i. openness to possibilities – we have quarterly team meetings where one of the core objectives is to assess and develop our approach, resources and capacity in all areas. This process has helped us develop our services to better meet the needs of the organisations and their service users we work with.

ii. the ability to collaborate – Sing & Grow is only truly successful when a strong partnership is created from the outset with the HO, its staff, their families, our music therapist and our “back office” team. Working alongside such a range of organisations as we do, being flexible whilst maintaining clinical effectiveness and our core approach has been critical. For example with one HO, due to client confidentiality, we were asked not to use any forms at all during the process, however we were able to use a Focus Group approach and Post-It Notes to gain families feedback at the end of the programme.

iii. demonstrating a belief in team and people - Sing & Grow is only truly successful when a strong partnership is created from the outset with the HO, its staff, their families, our music therapist and our “back office” team. Moving from small-scale regional delivery in 2011 to nationwide delivery in 2012 has allowed us to develop a stronger belief and trust in our core team and our music thaerpists who deliver our services.

iv. personal resilience and tenacity – all of the team who deliver Sing & Grow have at some point had to face a challenging situation within a session with families or with a host organisation. As music therapists, we have a core commitment to build and sustain value-generating relationships with our families and the organisations that support them. This commitment, our ability to think through presented difficulties and our willingness to improvise and discover outcomes that work for our families and partners requires strong resilience and tenacity. The qualities of resilience and tenacity are also at the core of the impact that we hope to have with our families.

v. the ability to create and sustain commitment across a system – our quarterly core team meetings, national training days for all staff and online access to training and programme material for all staff enables a strong and sustained commitment by all involved in Sing & Grow no matter where they work/deliver. With over 20 music therapists across the UK & Northern Ireland and regional coordinators in the main areas, this approach has allowed a consistency of delivery and training across our working system and models.

vi. focusing on results – outcomes for our families and the host organisations we partner with are always our primary focus as we develop our work. For example we realised that some families do not have CD players, so would find it difficult to listen to and use the Sing & Grow Together CD, which is one of our core resources; therefore we created a downloadable option for families to use, either downloading the CD on a home computer or mobile telephone.

vii. the ability to simplify – we maintain a focus on doing what we do well, and becoming known for excellence in the area of early intervention work with families and young children.

viii. the ability to learn continuously – Sing & Grow in the UK and in Australia is always seeking to learn from programme outcomes and developments, but also from international literature on music therapy, early intervention work, place-based research and any other expertise that could benefit our families. Colleagues from Australia and the UK regularly visit each other for quality assurance reasons, to deliver and receive new training updates, and to share best practice that is being developed in each country.

Contact Us

t. 020 7833 6825
e. contactus@C4EO.org.uk

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