Posts Tagged ‘Health’

Hearing Conservation Guidance for the Performing Arts: A Consultation

Tuesday, November 26th, 2019

BAPAM has produced new best practice guidance for hearing conservation in the performing arts. You can download the consultation document here.

The guidance is being consulted on until February 2020. All comments are very welcome and respondents are encouraged to discuss with colleagues and use this online survey to provide feedback. The final guidance document will take account of responses.

The document has been authored by:

Rob Shepheard, Consultant Audiologist
Dr. Finola Ryan, Occupational Health Doctor
Paul Checkley, Audiologist
Claire Cordeaux, Director, BAPAM

Summary of key recommendations

Healthy hearing is essential for musicians.

Education providers and industry organisations recognise the potential risk of sound exposure to performers and have a duty to identify hazards to health, and take appropriate steps to minimise the risk of causing harm.

Modification of environment, repertoire and rehearsal schedule all contribute to level of exposure and must be carefully planned in advance.

Hearing tests are vital for health surveillance. Early recognition of changes to musicians’ hearing is best identified with a hearing test called ‘Otoacoustic Emissions’.

Personal protection with custom moulded earplugs must be verified to ensure adequate protection.

Instruction and continuous education for all staff and students must be available and recorded.

Laryngeal Manual Therapy (LMT) and Head and Neck Massage: BAPAM Guidance

Tuesday, November 26th, 2019

In the light of recent press about a death following manipulation (www.bbc.co.uk/news/uk-england-york-north-yorkshire-50397867) and the publication of research last year on the dangers of head and neck massage if practised by improperly trained salon employees (“Crick” in Neck Followed by Massage Led to Stroke …), we at the British Association for Performing Arts Medicine, along with our clinical colleagues, thought it would be useful to provide guidance on Laryngeal Manual Therapy (LMT) and Head and Neck Massage, which is often used by professional voice users.

We recommend that manual therapy techniques applied to the head, neck and larynx should only be performed in clinical environments by the following registered professionals:

Physiotherapist – registered with the Chartered Society of Physiotherapists (CSP)

Osteopath – registered with the General Osteopathic Council (GOC)

Speech and Language Therapist – registered with the Royal College of Speech and Language Therapists (RCSLT)

Chiropractor – registered with the General Chiropractic Council (GCC)

Sports Therapist –registered with the Complementary and Natural Healthcare Council (CNHC), Federation of Holistic Therapists (FHT) or British Association of Sports Rehabilitators (BASRAT).

Massage Therapist –registered with the Complementary and Natural Healthcare Council (CNHC) or Federation of Holistic Therapists (FHT). Massage Therapists should be qualified to diploma level and registered with the CNHC or FHT, which are the only Registering bodies for Massage Therapy that are accredited by the UK Professional Standards Authority. While there are many organisations that provide training in massage, only some of them provide training at a level that provides a route to registration with CNHC or FHT.

Membership of a registering body accredited by the Professional Standards Authority is a guarantor of professional standards. It indicates that the practitioner operates within a structure that oversees qualifications, working practices, ethical behaviour etc. and can investigate complaints and impose sanctions on practitioners who fall short.

The BAPAM Directory also lists BAPAM-Registered Vocal Rehabilitation Coaches (VRCs). A VRC is a type of specialist voice coach who works as part of a multidisciplinary team that includes clinicians such as Speech and Language Therapists and Laryngologists. BAPAM-Registered VRCs have undertaken training to carry out palpation assessment. This is to assess tension only, and for onward referral, not to perform manipulations. Training in palpation assessment should be provided by a clinically qualified practitioner such as an Osteopath or Physiotherapist. Like clinical professionals, VRCs require clinical supervision from a Laryngologist, Speech and Language Therapist and sometimes a Psychotherapist.

Mental Health and Wellbeing Services for Performing Artists: Guidance for the Performing Arts Sector

Tuesday, July 30th, 2019

Consultation Paper

BAPAM is pleased to have brought together a working group of clinicians and performing arts organisations interested in addressing challenges to the mental health and wellbeing of those who work in the sector. The group has produced guidance to support the development and delivery of services specifically for performing arts professionals and students. The guidance is designed to be used by:

• organisations commissioning or wishing to commission mental health services for performing artists

• organisations and practitioners providing mental health and wellbeing services for performing artists

• education providers offering mental health and wellbeing support to students

• individuals and agencies wishing to support best practice for performing artists

• performers and other performing arts professionals wishing to understand the standard of practice they can expect from services.

This guidance has been developed by BAPAM’s Psychosocial Working Group. We aim to make a real difference to the quality of services available. The purpose of the group is to provide a forum in which approaches to prevention, care and support can be discussed, and clinical leadership can be provided for developing and maintaining an evidence-based service designed to support performing arts professionals and students with vocation-related mental health issues. The group has drawn on the clinical evidence base, including National Institute for Clinical Excellence (NICE) guidelines, which contain reviews of published evidence for healthcare interventions from clinical and cost-effectiveness perspectives, to produce this guidance for the performing arts sector. There are seven key areas of focus:

1. Preventing Mental Health Problems
2. Early Clinical Assessment
3. Brief Intervention
4. Peer Support
5. Ensure Links with the NHS
6. Multi-disciplinary Team Approach
7. Managing a Crisis

We are publishing this paper for consultation and welcome all comments which will be considered prior to the final launch.

Read or download the paper here:

Mental Health and Wellbeing Services for Performing Artists: Guidance for the Performing Arts Sector – A Consultation Paper

Comments can be posted via the online survey here: https://www.surveymonkey.co.uk/r/NKRFVGD

The consultation is open until 15 September 2019.

NHS Specialist Voice Clinics Vocal Rehabilitation Coach Pilot

Friday, May 10th, 2019

BAPAM is excited to announce the start of a new pilot project, in which we are funding a Vocal Rehabilitation Coach (VRC) to work alongside clinicians in NHS Professional Voice User Clinics.

Vocal health problems in singers and actors are often multifactorial, requiring a specialised multi-disciplinary approach to diagnosis, in order to get patients onto the right pathways of treatment and rehabilitation and back to performing as quickly as possible. Over the last two years, we have been working with a group of clinical experts in this area, including Laryngologists and Voice-specialist Speech and Language Therapists, who have advised us that adding a Vocal Coach into this team – an experienced singing teacher with understanding of the clinical processes in vocal health – would further help the diagnosis and rehabilitation of performer patients. Lewisham and Greenwich NHS Trust already employ a Vocal Rehabilitation Coach and BAPAM has agreed to fund a VRC post across up to three NHS hospitals for a pilot year, with funding support from PPL, Help Musicians UK, Musicians’ Union and Equity, following which the pilot will be independently evaluated to assess the requirements for the VRC role and the effectiveness of this model in the care of performers. Dane Chalfin, an experienced VRC and singing teacher, is taking on the role for the initial 12 months’ pilot. The first of these BAPAM-funded clinics has just started at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust. Guy’s and St. Thomas’ NHS Foundation Trust is expecting to start to offer this additional service from September, and a third NHS Trust is expected to be confirmed soon.

BAPAM undertook a survey across existing specialist Voice Clinics in order to develop the competencies required to work in this new role and these were reviewed and approved by our Vocal Health clinical experts and adopted by the BAPAM Medical Committee. There is currently no professional body able to provide formal registration of VRCs and BAPAM hopes that by facilitating a process whereby experienced vocal coaches can demonstrate that they meet a set of competencies, we can help provide a level of confidence in this role both to the NHS and to performers themselves, and reassure our funders that we are investing in the best services. Four practitioners who meet these competencies have so far been approved to join a new section of the BAPAM Directory of Practitioners as VRCs, and we are hoping to expand this number in the near future. We can provide guidance to practitioners interested in this field towards appropriate training that may be required to meet our competences.

We hope that this pilot will provide some initial evidence to support the involvement of practitioners with an educational background in the rehabilitation of performers and, specifically, the wider adoption of this practice to improve patient care in vocal health. If the pilot is successful, we hope to be able to secure funding to support substantive VRC appointments going forward via an open appointments process. This work takes place against a backdrop of developing education and science in vocal health, with practitioners at the UCL Performing Arts Medicine MSc and the MA in Vocal Pedagogy at the University of Wales undertaking exciting new studies which are increasing our understanding in this area of performing arts health. BAPAM is pleased to be able to make this small contribution to continuing improvement in vocal health for performers.

Further enquiries are welcome via info@bapam.org.uk

Related information:

BAPAM VRC Competencies

BAPAM Psychosocial Working Group

Tuesday, May 7th, 2019

BAPAM has convened a Psychosocial Working Group to bring together clinicians including doctors, clinical psychologists, psychotherapists and counsellors, charities working with performing arts professionals to support mental health, and academics conducting key research.

The group provides a forum in which approaches to care and support can be discussed, and clinical leadership can be provided for developing and instantiating a service designed to support performing arts workers with issues related to vocation-related physical and mental health issues. We are using the NHS-approved evidence base produced by the National Institute for Clinical Excellence (NICE), who review the published evidence for healthcare interventions from a clinical and a cost-effectiveness perspective, to map the services available to performing artists against the clinical evidence for best practice and identify gaps in those services.

The prevalence of mental health problems is considerably higher in the performing arts community than in the general population, and suicide rates are well above the national average. There is an acute awareness of the problems within the performing arts industry and many artists have been sharing their mental health experience in the context of their work.

The group has mapped many of the initiatives developed to support performers including Help Musicians UK’s Music Minds Matter helpline, Theatre Helpline, Music Support, which has a particular focus on addictions, Equity supported Wellbeing Drop-in sessions at the Actors Centre,  Music & You, Music for Mental Wealth and BAPAM’s own free service, which provides clinical assessments for performers across the UK. In addition, there is a growing number of practitioners who have trained to work in this area, building on insights gained from previous careers in the arts industries, for example, the Music Industry Therapist Collective.

We are grateful to have had so many valuable insights from practitioners and agencies involved in this important work and together we’ve begun identifying what is available, what is missing and how we should work together to support a comprehensive approach to mental health services for performers.

Mental illness is not a straightforward condition. Some people will experience just one episode of mental ill-health in their lives. Of those who receive a brief intervention, half will recover and never have another one. Others, however, experience recurrent episodes and will continue to do so through their lives even though they may be well for significant periods of time. It is essential that performing arts professionals experiencing challenges to their mental health receive accurate diagnoses as quickly as possible to ensure they access the right care. Where brief interventions are indicated, these should be delivered by practitioners who have a track record of working with performing arts clients. Healthcare practitioners, however they are employed, need to be able to access professional support from mental health specialists to ensure they are making the right diagnoses and to refer on if necessary.

Discussions to date have identified many areas for action, but the immediate areas to take forward have been identified as follows:

  1. Development of guidance for the performing arts industry covering points of best practice for performers, care providers and all organisations commissioning care for performers
  2. Rapid access to clinical assessment to determine the best care pathway
  3. Provision of brief interventions tailored to the needs of performing artists,  focusing on performance anxiety
  4. Access to mental health specialists (e.g. psychiatrists and clinical psychologists) for advice on the management of patients’ complex needs, for practitioners working outside the NHS
  5. An annual CPD event for psychosocial practitioners working in, and developing their career in performing arts health care
  6. A collective effort to support fundraising which aims to meet identified gaps for all practitioners

Hand Surgeon and Professor of Piano joint BAPAM clinic

Wednesday, May 1st, 2019

There are intrinsic relationships between health and performance excellence, and educational and clinical expertise in the performing arts. In overcoming medical problems, specialist diagnostic and medical expertise can be complemented by performance technique and lifestyle and health-related guidance. In a new joint clinic at BAPAM, Mr Mark Phillips, Hand Surgeon, and Penelope Roskell, Professor of Piano at Trinity Laban, are exploring this opportunity for clinicians and educators to provide each other with unique insight and feedback. We asked them to tell us more about this innovative approach.

Could you explain the idea behind the joint clinic and why you decided to do it?

Mark Phillips: In my experience when treating musicians I found quite an overlap between the physician’s knowledge and the specialist physiotherapist/hand therapist’s knowledge, who’s an expert in musicians. But I soon realised there was a huge gap for the third element which is filled by the expert tutor on that instrument. I happen to be a trumpet player so as a musician I have some insight into the patient but that’s not enough when it comes to some of the issues they face. I can relate to some of the psychological performance issues, but the expectation patients have is of someone that can really understand how the technical demands of the instrument interface with the physiological problems they’re having and anatomical problems they may have and the outcome of the clinical assessment.

Penelope Roskell: The knowledge we have between us is enormous. My students have included musicians with injuries for 40 years, and so we fill in the gaps. Seeing musicians together in a joint clinic is very important because you can then see the whole picture and then decide on the best way forward. Sometimes it may be steroid injection and sometimes it may be surgery. But sometimes it may be that a tweak or a change of technique will solve that problem and reduce the need for further intervention. So, seeing them together we can get to the root cause, which we can’t always do if seeing them independently.

How do you decide if a patient would benefit from this dual approach? What can a patient expect at a typical joint session? How do you each approach the patient?

How do you prepare for a joint clinic session?

Mark Philips: Normally I will contact Penelope to say I’ve got a patient or she may say she has a student. We will both select patients for this clinic.

Penelope Roskell: Sometimes Mark will send me over a video of that person playing, so I’ll have a chance to look at it and pick out the obvious problems about what I think may be causing it. I’ll also have a clinic letter which will give some sort of background.

Mr Phillips: We then meet up for a coffee and chat about the patient. So then the patient comes in, and if it’s my patient I present it to Penelope and on one occasion Penelope presented the patient. And then we do the history in the normal way, present findings and run through it all. I then suggest what may be the anatomical or physiological problem and how that relates to this person’s technique. The technique may have worked well for a long time but now there’s a problem which is unique to them. Looking at the technique can help if I’m referring to Penelope. Or similarly if Penelope is referring to me is there a way that some of my interventions such as hand therapy or injections or my approach to examination would throw some light on the matter. It’s that overlap which is invaluable really.

Penelope Roskell: So for instance one of my students came to the last clinic and she had problems for the last year and had come to me for that reason. And Mark gave her quite a different diagnosis to what she had been given in the past, which then informed me. So now we are working slightly differently in the lessons that I have with her privately, having now had this intervention from Mark and he also suggested a steroid injection which we are waiting to see the results to. We can then see the whole picture about the ways forward, because there isn’t always one solution. A patient may need a steroid injection or piano playing adjustments to the technique.

Mark Phillips: It’s multi-faceted, there may be Alexander Technique, hand therapy and it may be someone looking at their posture. I learn so much by looking at Penelope tutoring at the piano in terms of elbow position, shoulder position and what impact that has in terms of the way the fingers lie on the key for example. Each presentation has its own unique cocktail of remedies really.

There are complex multi-faceted problems by the time they come here and it comes down to how we triage these patients essentially. I don’t bring every pianist to this clinic.

Penelope Roskell: It’s inevitably going to be someone with a piano related injury. If they’ve broken their wrist by falling down the stairs then they should go straight Mark. Whereas it’s different when it’s something like accumulated stress from years of playing with a technique which is a tiny bit off balance. They may be very experienced players and their technique has lasted them well, but there’s something that just tips it over.

Mark Phillips: What I see in my patients is that half of them have the same problem as everybody else and that may affect how they use their instrument. And the other half have instrument related problems and it may be a combination of the two. And say if someone broke their wrist a year ago and it may be throwing out their elbow, their shoulder or their posture and it may well be a good way down the line that it’ll come to me that a session with Penelope would be helpful. Because it may be to do with their elbow and shoulder which may be making some notes inaccessible and we can work around. They’re so unique each of these cases an each of them would have their own relative roles for the two of us sitting together and discussing the case. It would be good to extend this to guitar, violin and cello and get tutors to do a similar thing. And it’s pretty unique, I don’t think there’s anyone else out there in the world doing it.

What do you feel are the benefits of having an educator in a clinical setting?

Penelope Roskell: It is a very formal environment which is a positive thing and it focusses everything which is very important.

It is a sort of pilot, it’s the first of its kind and I think it is very valuable and let’s hope that other clinics may take the idea from this and develop that further.

What are the direct benefits for patients of having the educator and clinician in the same room in a clinical setting?

Mark Phillips: We often find that patients are often reticent about coming to these clinics. They really don’t want to look at their own techniques and I suppose they remember back to days when they were being tutored and they feel self-conscious. They have to want to come to this clinic and to be looked at. It isn’t like going for a piano lesson or being taught. We are looking to see whether there’s anything about their technique that may be in anyway connected to the clinical problem they have. So we’re not trying to look at the way they play from any other perspective than that. People play in lots of different ways. Also videos are really useful, anyone with a smartphone can record themselves. When we look at them we can slow them down, go back over a sequence, look at it carefully, look at it together and see how that relates to their clinical problem.

Penelope Roskell: There is something different about the joint clinics, because I’m there involved in the consultation I’m able to ask them questions from my own point of view so that I’m well informed as to how best to help them in the future. Because a piano teacher is not qualified to diagnose and that is absolutely number one and nor am I qualified to answer questions that students sometimes ask me, like should I have that steroid injection or that operation and it’s not for me to advise on that but in this situation between the three of us we can discuss the best way forward viewing it from all the different angles.

Any challenges you are finding with the joint approach?

Mark Phillips: It’s 30 minutes long, which is short. We are just getting into our flow by half an hour.

We haven’t had a chance to find out what patients think, especially how they feel about the added value of seeing us both together.

The four patients we have seen in this format have individually expressed to us they thought it was a good session and it stimulated a lot of discussion and ideas. It would be great in the future to include a hand therapist and do a proper multi-disciplinary clinic. Hand surgeons always work very closely with hand therapists. Because there are so many different joints in the hand and different diagnoses. In the hand you’ve got unique problems to one finger or there will be a combination of problems. So your hand therapy is always bespoke, it’s all tailor made to that patient so you have to discuss each patient individually and with musicians it’s even more so.

Certainly with the three most commonest instruments this is going to be a major area of growth in the next ten years and it’s very exciting.

During the half an hour the patients sense the trust we have with each other (Penelope: we work very well as a team, we both have a lot of respect for each other’s knowledge. So I think they go away feeling they’re whole picture has been seen and assessed and we are seeing them as an individual with a problem that can be resolved.)

All patients have been bought over by the end of the 30 minute sessions. You can see the reticence and slight nervousness at the start of the half an hour turning into trust and outpouring of confidence and sharing of the problem and by half an hour we are in to the nitty gritty aren’t we. The output of that is usually I will see them again or Penelope will see them again.

What they can do is continue seeing Penelope for a while and see me in the clinic two months later and see how things have been going on in the meantime. And because we know each other well we can send secure emails back and forth and stay in touch.

New Clinics in Liverpool and Belfast

Wednesday, April 17th, 2019

As part of our commitment to reach and support performers throughout the UK, we are pleased and excited to announce new regional clinics, this time in Liverpool and Belfast starting in May 2019. 

BAPAM are delighted to be working with the Royal Liverpool Philharmonic Orchestra, who will host the clinic at the Philharmonic Hall, and Dr Marie McKavanagh, a Performing Arts Medicine specialist GP (and musician).

Liverpool Philharmonic have pioneered an exemplary approach to developing and supporting performance excellence through providing specialist health and wellbeing services to orchestra musicians. The positive effects of this investment are proving that performer wellbeing and artistic excellence are interlinked. Taking care of both also makes good business sense. Performers are healthier, happier, take less time off sick and are better prepared for elite performance. Through their key support for the new BAPAM clinic, Liverpool Philharmonic are now helping to bring this approach to the whole performing arts community.

The first clinic will be held on Wednesday 1st May. 

Belfast

BAPAM are also delighted to be working with the Oh Yeah Centre, Belfast’s music hub, who will host the clinic, providing vital support for a healthy and vibrant performing arts community.

The clinic is led by Dr Christine Hunter, a BAPAM and  NHS GP and Medical Adviser to the Ulster Orchestra.

BAPAM’s Belfast Clinic will be held monthly from May 22

Who is the clinic for?

If you make a proportion of your living from, or study in the performing arts, and have a physical or psychological health problem related to your work, BAPAM can help you. BAPAM clinicians can provide an accurate diagnosis and information to help you overcome problems. The BAPAM team can identify the best sources of ongoing care, both in the NHS and from other specialists, and advise you about sources of financial support for people experiencing health problems affecting their ability to work or study.

Other regional clinics:

Glasgow: Friday 10th May, 7th June

Leeds: Thursday 2nd May

How to book a FREE confidential appointment?

Call 020 7404 8444 to register | Or email info@bapam.org.uk

The Relationship Between Occupational Demands and Well-Being of Performing Artists: A Systematic Review

Friday, March 29th, 2019

Simone Willis,  a Performance Science researcher at Cardiff Metropolitan University, has shared with us this recently published paper on the relationship between occupational stress and well-being in performing artists. The aim of this systematic review was to evaluate and synthesise data arising from 20 previous studies. The article is open access and can be read here in Frontiers of Psychology.

The review highlights the need for more high quality research on the relationship between occupational stress and well-being.

 

Psychosocial Practitioner Peer Supervision Group

Wednesday, March 27th, 2019

BAPAM is pleased to support the Peer Supervision Group for psychosocial practitioners who work with performing arts clients.

This group, whose inaugural meetings took place in 2018, opens up the conversation between performing arts and psychological practice. It is developing a growing professional network for counselling, coaching and psychology practitioners who work with performing artists of all kinds. The group meets regularly, roughly every 8 weeks, in central London.

As well as discussing clinical cases and case issues, there is interactive exploration, mutual consultation and support on more general professional practice issues, including ethical issues, boundary and confidentiality areas. Such exchanges of expertise and experience enable members to reflect on and refine best practice in working with performers. The Group offers members the chance to share specialist expertise of particular problem areas and to provide interventions, guidance, information and professional support within a rigorous evidence-based practice and practice-based evidence framework in this developing field. The Group acts as a forum not only for encouraging and developing the highest standards of practice but also for identifying, promoting and supporting new research in the field.

Members of the group use a variety of approaches and come from a range of career backgrounds. Some members bring specialist expertise within the field, for example, working with people in particular arts professions or with certain types of problem. The Group is sensitive to BAME, LGBT+ and other dimensions of difference.

It is hoped that specialised supervision of this type will become available and accessible to many more practitioners on the BAPAM Directory and the Group is keen to encourage this in whatever ways it can. Members are happy to offer advice and suggestions to practitioners wanting to start their own peer supervision group and to find ways of welcoming practitioners new to the Directory to join.

Practitioners interested in finding out more, joining the London group or starting a group of their own are invited to contact Dr Carol Chapman by email at carol@carolchapman.co.uk

Trustee Recruitment

Tuesday, February 19th, 2019

We are are looking for skilled and experienced individuals to join our Board of Trustees and help guide the organisation in assuring service quality, developing new and existing partnerships and expanding our services throughout the performing arts industry.

To apply, please download the Application Pack and return it to BAPAM Director, Claire Cordeaux. You are welcome to contact us for further information.