Each finding below touches on outcomes relevant to IOP settings: engagement and retention, emotional regulation, trauma processing, identity development, and reduction of substance use. Direct links to each study are included so you can evaluate them independently. Every research entry also includes a voice from inside the Refresh Collective program that illustrates a related moment in practice.
About Refresh Collective: Refresh Collective is a professional music production and creative arts organization based in Northeast Ohio. We provide structured, trauma-informed hip-hop music creation experiences — including beat production, lyric writing, and studio recording — designed for teens in school, mental health, and recovery settings. Our programs are not music lessons. It is a therapeutic modality that uses music creation as the vehicle for the same emotional processing, identity work, and relational skill-building that IOP programs prioritize — delivered in a format that adolescents trust, engage with, and look forward to.
This peer-reviewed clinical study compared adolescent participants' perceptions of usefulness across rap-based group therapy sessions versus traditional group therapy — tested across three groups: violent offenders, status offenders, and a control group of high school students with no criminal history. Participants in the rap-based groups rated the sessions significantly more useful and engaging, with stronger prosocial skill development outcomes. The study built on Dr. Don Elligan's foundational work on rap and music as culturally resonant clinical tools for adolescents who enter counseling apprehensively.
Read full study →Teen IOP programs consistently struggle with engagement and "buy-in." This study validates the core mechanism: meeting youth inside a cultural form they already trust eliminates the initial resistance that derails many adolescents in structured treatment. Notably, this was tested specifically with youth who had already been in conflict with systems — exactly the population most likely to resist traditional therapy and most likely to be in IOP.
In his foundational clinical work, Dr. Elligan argued that hip hop functions as a primary language for urban youth — and that therapy must speak this language to meet clients where they are, rather than where clinicians wish they were. Practitioners who speak only the language of clinical treatment, he observed, are often tuned out entirely by the adolescents who most need help. Paraphrase of Dr. Don Elligan's central argument. Sources: Elligan (2000), Journal of African American Studies; Elligan (2004), Rap Therapy, Kensington.
"Being able to express myself through music and through these lyrics is a blessing I'll value forever."
"This is the first program here that I've seen where students were fully engaged the whole entire time."
"I'm so happy, especially for a few students that have a chance to be a part of a group. Trust me when I tell you they are glowing! It's a beautiful sight to see."
This study is the most direct research parallel to what Refresh Collective does. Levy and Travis developed and tested the Critical Cycle of Mixtape Creation (CCMC) — a structured group counseling model in which youth write emotionally themed lyrics, record them over beats, and perform the finished songs. All three groups tested showed statistically significant reductions in both stress and depressive symptom levels. The "semi-structured" group produced the most significant reductions.
The research interpretation is intuitive — too much facilitator control removes the sense of authorship that makes the process therapeutic; too little leaves youth without enough support to go somewhere meaningful. Refresh Collective operates squarely in the semi-structured range. The study's co-facilitation model — a music producer/audio engineer working alongside a counselor — is essentially the RC staffing model.
Supporting reviews: Rodwin, Shimizu, Travis et al. (2023) reviewed 26 music-based intervention studies and found significant effects for mental health outcomes including reductions in depression and anxiety (Child and Adolescent Social Work Journal, 40:4); Jefferson et al. (2024) examined 10 hip hop-specific intervention studies and found consistent increases in emotional awareness, empowerment, and ability to process difficult emotions (Journal of Creativity in Mental Health, 20:1).
Read full study →For a clinician evaluating whether this specific format — not just music therapy broadly, but the actual process of making beats, writing lyrics, recording, and performing — produces measurable mental health outcomes: this study answers that question directly. The significant reductions in stress and depression occurred specifically because youth went through the full creative pipeline. The group format, the therapeutic mechanism, and the co-facilitation model all translate directly to an IOP setting.
Results suggest statistically significant reductions in stress and depressive levels [across all three group formats tested]. Levy & Travis, Journal for Specialists in Group Work, 2020
"The team at Refresh Collective has empowered our patients to find their voices and grow more confident in sharing their unique stories. I've witnessed first-hand how their team works to personalize the song writing process, allowing patients to feel safe and heard. I strongly believe there are so many therapeutic benefits for youth."
"There was not a dry eye in the house as his song was played and how proud he was of creating it with Jeremy. He has shared it with many staff over the past week. It speaks to the power of music and the gift of Refresh."
This systematic review analyzed 40 published studies (34 quantitative, 6 qualitative) on music therapy and music-based interventions in substance use disorder treatment. The authors found beneficial effects on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness across multiple study designs.
We cite this study not as definitive proof, but because even within a mixed evidence base, the direction of findings consistently favors music-based intervention over standard care alone. The review's qualitative synthesis identified four consistent themes across the SUD literature: emotional expression, group interaction, development of skills, and improvement of quality of life — all of which align directly with IOP treatment goals.
Related note on treatment motivation: A randomized study in an adult detox setting (Silverman, Journal of Music Therapy, 2011) found that music-based group formats produced significantly higher change readiness — specifically on Contemplation and Action subscales — compared to verbal group therapy alone. That mechanism is directly relevant to any IOP program where client motivation is a barrier to progress.
Read full study →For a Teen IOP director, this addresses the "does it actually work for addiction?" question head-on. This review is peer-reviewed, published in PLOS ONE (open access), and focused directly on SUD treatment. Reading it in full — including its limitations — is worthwhile. The group music findings are particularly applicable to IOP's group therapy structure.
Beneficial effects on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness were reported — though results were inconsistent across studies, and further research is needed. Hohmann et al., PLOS ONE, 2017
Our teaching artist connected with Mike, understanding both his story and his musical style, and together they found the perfect beat to match Mike's flow. Through this collaboration, Mike discovered a new way to express himself authentically — "I was getting stuck up in that cup / but now I'm here to live it up / clearing up the storms, I see sunny days / and when I see your face I know it's all okay."
"Refresh Collective to me means family because they bring like a family vibe, to help the community so much. Being part of this program made me feel like I wasn't going through things alone."
Beats, Rhymes and Life, Inc. (BRL) — Oakland, CA
Founded 2004 · Operating Nationally Since 2011 · 2026 Peer-Reviewed Outcomes Study
What It Is
BRL runs Therapeutic Activity Groups (TAGs) — 16-week, small-group programs in which trained facilitators guide youth ages 12–24 through writing, recording, and performing hip hop music as a means of processing emotional experiences. These groups operate inside community mental health clinics, in direct coordination with licensed clinical staff. BRL facilitators do not conduct therapy; they create the creative and cultural conditions in which young people do therapeutic work. This is the same model Refresh Collective proposes.
The Research Behind It
In a 2026 peer-reviewed study published in the International Journal for the Advancement of Counselling (Springer), university researchers formally evaluated BRL's program data collected from June 2015 through June 2024 — nearly a decade of outcomes. The study measured effects on anxiety, depression, trauma symptoms, and substance use behaviors in adolescents. Researchers found statistically significant decreases in stress, anxiety, and depressive symptoms. Additional qualitative findings documented improvements in self-esteem, self-confidence, sense of community, and "voice."
Thinking what would get way better if I was better off dead—
Till I met a man told me suicide was not for you young man,
Just keep holding on and pray to God, it's gonna get good young man.
This a letter to my future self, I know you doin better now,
Gun violence was a constant issue on that block you been around,
Lil homie save your life, chase that work instead of chasin' pills,
Sometimes in life, you just gotta chase a dream.
Song after song leads with self-assertion — but it's not empty posturing. These students are constructing identity in real time, defining themselves on their own terms. A powerful thread: identity tied to origin, connection to where I come from, worth declaring even when the world has made it a source of pain.
Several songs go to very dark places — and they should be honored for that. Students confront loss, abuse, silence, and the weight of environments where violence is constant. These aren't songs about giving up. They're songs about having been at the edge and choosing to speak rather than disappear.
These students are not writing in isolation — they are writing toward each other. The word "we" shows up as often as "I." They name the people who weren't there and the ones who were. Someone believed in these students before they believed in themselves, and it shows.
Not everything is heavy — and that balance matters. Some of these songs are simply joyful, playful, funny. These students are not defined by their hardship. For an IOP clinician, this is significant: a program that can hold both grief and celebration is one teens will return to.
Several students reach toward faith at their lowest points — not as performance, but desperate and honest. Alongside that runs a strong moral current: a refusal to pass suffering on, a commitment to lead, a desire to leave something better. This is not a theme that was taught to them.
| IOP Clinical Goal | Research-Supported Mechanism in RC's Program | Source |
|---|---|---|
| Engagement & Retention | Hip hop's cultural resonance dramatically reduces initial resistance and increases session attendance | Finding 1 |
| Emotional Regulation | Music therapy interventions show consistent beneficial effects on emotional and motivational outcomes in SUD populations | Finding 3 |
| Trauma & Depression Processing | The full creative pipeline (write, record, perform) produces statistically significant reductions in stress and depression; hip hop-specific systematic reviews confirm consistent reductions in internalizing symptoms | Finding 2 |
| Identity & Self-Concept | Writing, recording, and performing one's own story builds self-concept through authorship. BRL clinical staff consistently document improvements in self-esteem, self-efficacy, and sense of "voice" as central outcomes | Programs in Practice; Finding 2 |
| Treatment Motivation & Readiness | Music-based group formats produce significantly higher change readiness than verbal group therapy alone — consistent across the SUD literature and documented in a randomized adult detox study | Finding 3; Silverman 2011 |
| Relapse Prevention | Coping skill development, reduced isolation, and prosocial bonding through group music all reduce relapse risk | Findings 1 & 3 |
| Future Orientation & Hope | Student lyrics consistently demonstrate future-oriented thinking — a key protective factor in recovery | Qualitative Analysis |
Facilitator Model
Refresh Collective facilitators are creative arts educators and program specialists — they are not licensed counselors or clinical therapists, and we want to be transparent about that distinction. What they bring is deep relational experience with youth, consistent trauma-informed care professional development, and a strong ethic of clinical deference. In every setting where we have operated — including residential treatment facilities, school-based recovery support programs, and rehabilitation settings — we have worked hand-in-hand with the licensed counselors and therapists on site. Our facilitators do not conduct therapy; they create the conditions in which young people feel safe enough to do therapeutic work alongside the clinicians who are already present.
Safety & Disclosure Protocol
All Refresh Collective facilitators are trained in mandatory reporting requirements. Any disclosure of harm — to self or others — is handled in accordance with applicable law and immediately escalated to the appropriate clinical contacts or authorities on site. In a clinical setting such as an IOP program, our facilitators defer to and coordinate directly with the supervising clinical staff. We do not operate independently of the clinical team; we are an extension of it.
Start the Conversation
If what you've read here raises the question of what this could look like inside your program, we'd like to have that conversation. Refresh Collective has spent fifteen years developing and refining this work with youth in recovery — we're ready to bring it to a clinical partner.