• Matthew Richards


Engage & Immerse - Therapeutic Music for Additional Needs.

PAPA for PMLD: A practical model for delivering effective music provision for individuals with profound and multiple learning difficulties.

Learning Difficulties are a collection of conditions that effect the way an individual interacts with the world and processes information, usually presenting as communication, social, intellectual and adaptive behaviour deficits.

PAPA stands for:

Positive – Present well. Aware – Enquire and observe. Person-centered – Meet the individual where their interests lie.

Adaptable – Hold your approach lightly.

Embodying the four key principals characterised by the PAPA model will be invaluable in helping you cultivate a long term, trust-based engagement.


Effective communication is paramount.

Keep your tone of voice upbeat.

Reinforce speech with Makaton or equivalent.

Offer praise, encouragement and reassurance when necessary.

Be expressive with your voice (prosodic awareness i.e. intonation, stress and rhythm).

In terms of non-verbal communication and presentation think about posture, smiling, eye contact and gestures. Opt for smooth, graceful motion and avoid jerky, angular movements.


This is a two-part point:

Enquire - Liaise with support staff/carers/parents before the session in order to get a clear picture of where the individual is in their head and in their body. The following examples are not exhaustive.

How have they slept.

When and what did they last eat.

Present state of any health concerns specific to the individual (likely to be wide-ranging).

Any challenging behaviour displayed in the last 24 hours.

Only with a thorough handover will you be able to select the appropriate pace for the


Observe – Be aware during the session re anything pertaining to the handover that may impact the session negatively. Monitor the level of sustained and meaningful interaction with the instruments or musical stimuli. Observe the processing time needed for instruction/direction. Assess potential risks posed by self-injurious or destructive challenging behaviours. For example, an individual could use a drum stick as an object for self-harm, or a nearby window could become a target for smashing.


Information can be gleaned from the individual’s person-centered planning (or equivalent) with regard to what is important to them in three key areas:


Memory recall and auditory processing are strongly linked within the brains neural pathways so find out about the individual’s musical history. You might discover that he or she grew up in a musical household, with songs played on the piano by family members. Ask what those songs were, learn them in a format that plays to your strengths and include them – anything from a brief feature to building an entire session around them.


Integrate music and instruments that are relevant now. Has the individual been listening to any specific songs recently? Learning and playing these (once again in a conducive format) are likely to inspire meaningful and sustained interaction.


The individual might have an outing or even a holiday coming up that could be represented in the session. An upcoming trip to Disneyland might warrant the inclusion of Disney tunes. An outing to a night of musical theatre might call for songs that will be featured in that performance. A trip to France could be coming up, in that case do you have an accordion, or an accordion preset on a keyboard? A trip to Ireland? Time to blow the dust of your Bodhran.


During the course of the session, don’t be afraid to change something if it isn’t working. Indicators such as frustration, unwillingness to participate and anxiety should be steered away from as quickly as possible. You can be adaptable in four main areas:

Content – This is what you are doing. Structure – This is the order in which you will do it.

Time – This is how long you will do it for. Place – This is where you will do it.

These are variables that should be used in the right quantities depending on the needs of the individual. Be prepared to be in a state of flux. Rigidity is the enemy. If for example you are engaged in intense drumming with the individual and you notice a downturn in mood, behaviour or participation, have a contrasting instrument or stimulus close by (wind chimes, an ocean drum, ambient music etc.)

If the individual wants to physically move to a different part of the room during the session, support them to do so providing they are safe.

Cease all activity and end the session if you feel the individual is not benefiting from it. This does not mean that the individual won’t benefit in the future, just that today is not the day for a music activity. Accept the reality of a premature end to the session before you begin. Being adaptable is easier if you have a broad range of instruments, stimuli and musical activities that can be switched in or out. Generally speaking, avoid coming to a session with the intention of doing one thing and one thing only.


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