Arts Research Case Study:
Interactive Exercise (Part 2)

 Presented by
Joseph Deacon, PhD, Associate Director, Human Development Research and Training Institute, Western Carolina Center
 Katherine Lee, EdD, Director, The Center for Creative Expression at the Riddle Institute
What is research?

What do you picture?
Someone in a white lab coat. Someone writing statistics on a chalkboard?

 How many have done research?

As you have worked with people, how many of you have altered your interactions based on observations/ perceptions of actions, thoughts (remarks), or emotions displayed by them?

If you have tried a variety of experiences/treatments, collected information regarding their effects, and have given some consideration/evaluation of the importance or usefulness of these effects, then you have done research.

The Benefits of Using Sound Methodology:
  1. Findings are accepted and respected by other professions; systematic and unbiased – objective methodology leads to confidence and trust in the accuracy and validity of what you describe or suggest from your observations.


  2. The data provides empirically obtained information for evaluating outcomes and effects. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) stresses ongoing empirical assessment.


    3. Purpose: To improve services/supports by relying on evidenced based data for decision making.

  3. Assists in therapeutic decision making.
    • Research can be person centered (meaning - individualized)
      Assists with becoming aware of when it may be most beneficial for making adjustments in a person’s experiences or therapeutic intervention.


    Evidenced Based Decision-makingleads to quality care & experiences
    • Evaluates progress towards health care goals identified by JCAHO, such as:
      - improved functional status
      - improved physiological status
      - cost effective
      - improved well-being
      - avoid adverse effects

  4. Assists with communication to team, administration, and other therapists. Extends your artistry (allows others to consider the outcome of what you have done and how to further utilize this information; thus, others may benefit from your artistry).

Methodological Issues

Three Key Factors:
1. Observable
2. Measurable
3. Presentation

Observable

 The initial step in evaluating and monitoring the outcomes of therapy is to have accurate observation and description. JCAHO stresses evidenced based decision making

Overt—explicit, specific terms
Vs.
Covert—many different interpretations of terms

translate into

Covert (I am) make observable Overt (I do)
Upset   Scream, pace, body rocking, no response to verbal interactions
Depressed   Crying, abnormal sleep pattern, feels useless, self-rating of mood, weight gain/loss
Angry   Verbal threats, hitting, cursing, screaming, property damage
Anxious   More active, nausea, changes in heart rate/BP, self-rating of tension

To understand the invisible, look very closely at the visible.

Pentimento (underlying image) – make observable
Use overt descriptions so others may see the underlying image too.

Our perceptive sensitivity or feeling is not ignored, rather, it is simply translated and brought to the surface for others to observe.
Measurable

 Some types of measures:
  • frequency (number count)
  • duration (length of time)
  • rating scale (rate 1 to 5, disagree/agree or dislike/like)
  • physiological (heart rate, BP, muscle tension)
Presentation

 Display in such a way that others may clearly see changes. Statistics may not be necessary. Graphs or charts may visually convey the beneficial significance of the experience or therapy. Figures 2,3,4,5 are examples of this.
Figure 2
Figure 3
Figure 4
Figure 5

Figure 1
Ongoing Therapeutic Outcome Cycle
First: Plan • Identify clients
• Assemble team
• Select outcomes (what to measure—data)

Second: Collect Data
• Before Treatment (baseline)
• During Treatment
• At End of Treatment
• After Treatment (follow-up)

Third: Assess Outcomes
• Organize Data
• Interpret Data
Did the experience lead to:
• Improved quality of care?
• Improved cost/benefit ratio?
• Increased knowledge?

Now…Repeat the cycle

Example 1: Applied to Conference Workshop Experience

Workshop Research Project

Plan - Include those participating in research workshop.
  • Provide creative expression experience.
  • Decide who will lead program.
  • Who will collect information/data.
  • Focus on physiological and social/emotional data.
Collect Data - Survey questions focus on social/emotional aspects and heart rate the physiological.


Workshop Survey

Super Hero Name ______________________

Heart Rate _____________

1. On a scale of 1 to 10, with 1 being “not stressful” to 10 being “extremely stressful”, please rate your current level of stress __________

Please circle the number below the words which best reflect how much you agree with each statement.
 
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
2. I feel energetic
1
2
3
4
5
3. I am feeling alert
1
2
3
4
5
4. I feel
1
2
3
4
5
5. I feel emotionally used up
1
2
3
4
5
6. I feel lonely
1
2
3
4
5
7. I am feeling happy
1
2
3
4
5
8. I want to interact with others
1
2
3
4
5


Discussion with regards to research purposes:
  • The use of a Super Hero name for identification purposes was to highlight the importance of confidentiality of all information collected. Names may be used with approval from the individual or perhaps numbers may be used.
  • The survey was distributed before (pretreatment) and after (post treatment)
  • Physiological (heart rate) and social/emotional measures were collected from the survey.
  • Information was compared on a group basis and also individual basis. This allowed us to discuss results in terms of general effects as well as show the use of research designs in assisting with evaluation of therapeutic effects for individual clients.


Assess Outcomes - Participants completed survey before and after workshop experience. Compare the before (pre) experience ratings and measures to the after (post).

Overall evaluation
  • Did it effect the group in general?
  • Did it have a greater effect on some participants than others?
  • Did it not effect some participants?
  • What was different about those it did not effect?
  • What might be added to experience to reach these people?
(Start Cycle again: Plan adjustments in experience/therapy)

Example 2: Applied to Examining the Effects of Art Experiences on Staff Burnout

Art Experience/Therapy Effects on Staff Burnout

 Plan - Staff are experiencing burnout. Will monitor the effects of both improved benefits (insurance, educational experiences, increased salary), then monitor the effects of the addition of easily accessible art experiences in the work setting.

Collect Data - Will assess through the use of a self-rating scale of mood. Scale will assess the affective symptoms associated with burnout. Other possibilities for assessment include:
  • Work-Related Symptoms (tardiness, poor performance, risk-taking, absenteeism)
  • Physical Symptoms (fatigue, sleep difficulties, illness)


    • Assess Outcomes - Figure 3 displays possible changes across time in self-ratings as people experience improved benefits and then art experiences

    Evaluate and Discuss Outcomes - In this example, the improved benefits had some positive effects. However, the art experiences appeared to have additional positive effects and seemed necessary for the most positive moods.

    Figures are found in the additional attachments
    Figure 2
    Figure 3
    Figure 4
    Figure 5

    References

    Julliard, K. (1998). Outcomes Research in Health Care: Implications for Art Therapy. Art Therapy Journal of the American Art Therapy Association, Vol. 15, No. 1, 13-21.

    Beck, S. L. (1991). The Therapeutic Use of Music for Cancer-Related Pain. Oncology Nurses Forum, Vol. 18, No. 8, 1327-1336.

    Von Rossberg-Gempton, I. E., et. Al. (1999). Creative Dance: Potentiality for Enhancing Social Functioning in Frail Seniors and Young Children. The Arts in Psychotherapy, Vol. 26, No. 5 313-327.

    Bailey L. M. (1986). Music Therapy in Pain Management. Journal of Pain and Symptom Management, Vol. 1, No. 1, 25-28.

    Lazarus-Leff, B. (1998). Art Therapy and the Aesthetic Environment as Agents for Change: A Phenomenological Investigation. Art Therapy Journal of the American Art Therapy Association. Vol. 15, No. 2, 120-126.

    Mathey, M. (2001). Health Effect of Improved Meal Ambiance in a Dutch Nursing Home: A 1-Year Intervention Study. Preventative Medicine, Vol. 32, 416-423.

    Maslach, Christina, (1996). Maslach Burnout Inventory Manual. Third Edtion, Consulting Psychologists Press.

    Internet Mental Health Resources:
    http://library.adelaide.edu.au/guide/med/mentalhealth/scales.html


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