THE DEVELOPMENT OF A RESEARCH TEMPLATE TO ASSIST MUSIC THERAPY CLINICIANS IN EVIDENCE-BASED PRACTICE BY Copyright 2009 Robin C. Edwards MMT, Southern Methodist University, 2001 MM, Southern Methodist University, 2001 BMT, Phillips University, 1998 Submitted to the graduate degree program in Music Education and Music Therapy and the Faculty of the Graduate School of the University of Kansas in partial fulfillment of the requirements for the degree of Doctor of Philosophy of Music Education (Music Therapy) ____________________________________ Chairperson Committee Members: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Date Defended: April 10, 2009 The dissertation committee for Robin Edwards certifies that this is the approved version of the following dissertation: THE DEVELOPMENT OF A RESEARCH TEMPLATE TO ASSIST MUSIC THERAPY CLINICIANS IN EVIDENCE-BASED PRACTICE Committee: ___________________________________ Chairperson ____________________________________ ____________________________________ ____________________________________ ____________________________________ Date Approved: April 23, 2009 ii Abstract One of the most prevalent trends in healthcare today is the movement toward evidence-based practice. Evidence-based practice requires that health care providers base their treatment decisions not only on their own professional experiences and their client‟s needs and values, but also on current quality research outcomes. The American Music Therapy Association has been promoting evidence-based practice among its clinicians through a research initiative created to encourage the use of scholarly research within the profession. The purpose of this study was to develop a research template to assist music therapy clinicians in accessing clinically relevant information from an individual research study and evaluating the quality of that study to participate in evidence-based practice. Development of the research template occurred in three steps. First, the researcher consulted current literature on the topic of evidence- based practice and research to determine content and design of the template. Next, a focus group of five individuals known for their clinical and research expertise in music therapy examined the template and provided suggestions for improvement, as well as validity for the need for such a template in the profession. Finally, a sample group of music therapists completed an Initial Questionnaire (N=14), the research template on an assigned article and two participant-selected articles (n=12), and a Follow-Up Questionnaire (n=11). Thirty templates were completed across five different research articles. Responses on the questionnaires and iii completed research templates were analyzed to determine clarity of the individual items and the overall function of the template and were used to make necessary modifications to the template itself. Results indicate that the designed research template is useful for clinicians consulting the research literature to inform their clinical practice decisions and to determine the level of quality of a study. Implications for the role of the template in educational and continuing music therapy education settings to promote evidence-based practice in the field of music therapy are discussed. iv Acknowledgements It is during the arduous phases of life that I am most aware of and grateful for the assurance that “I can do all things through Christ who strengthens me” (Philippians 4:13, NKJV). So, to God be the Glory for His presence and support throughout my graduate school journey and successful completion of the Ph.D! A heartfelt thank you to those I connected with at KU: Dr. Colwell - you were my earliest music therapy mentor and the one who first suggested the possibility of graduate school. It is fitting that you have seen me through my dissertation and doctorate as my advisor once again. Thank you for your priceless suggestions and comments on my research and for the sacrifices you made to get me finished on time! Dr. Alicia Clair, Dr. Jane Wegner, Dr. Debra Hedden, and Dr. Steven Hedden - Thank you for serving on my dissertation committee and for the time and energy you put forth in reading my dissertation and providing vital comments and suggestions. Blythe… Dr. …LaGasse - for the hours we spent on the phone talking through research ideas and determining those pesky deadlines and formatting requirements. We finally made it! Your friendship and support are a blessing to me and I look forward to future conferences and dal dinners! Sarah Studebaker, Betsey King, and Sheri Clark - you made my transition back into graduate school not only endurable, but fun! I fondly remember our many pizza and coffee study nights! Sarah, I learned so much about musicianship and improvisation from you… you remain the most talented musician I know. To all who provided invaluable comments on the template as a focus group member - Thank you! Your assistance and validation of this project provided me with the fuel to move forward in this study with confidence! And to all who read through research and completed the template as a participant in this study - I could not have done this without you. v All my love and deepest appreciation to my family and friends: David - your love and commitment to seeing this through to its completion were demonstrated in so many ways… lunches, dinners, dishes, laundry, prayers… and, of course, the many suggestions you provided as my „first editor.‟ Thank you for encouraging me to “keep up the good work” when I wanted to quit. You are my one true love and best friend! My beloved gift from God. Mom and Dad - you have loved, encouraged, and supported me through so many adventures. You saw the value in music therapy at the very beginning and encouraged me to work hard to develop my skills to the fullest. Thanks for supporting me in this endeavor and for helping with the editing process! God truly gifted me with the best parents in the world! Michelle, Tim, Paul, Megan, Rachael, John, Judah, and Samuel - My biggest (and littlest) prayer warriors and fans! You are constant reminders of what „really matters‟ in this life. Mom Pam, Stephen, Angelina, and Philip - Thank you for your encouragement and your prayers! I am so blessed to call you my family. Aunt Jeri - I‟ve so enjoyed spending time with you during my time in Kansas. Thank you for encouraging me through this process and talking me through the defense! Aunt Bev - your prayers are invaluable. Thank you for sharing in the excitement of these milestones! Jill Dupras - for the past 24 years you have been, and for many more to come you will be my “Bestest Friend in the Whole Wide World!” Amy Henry - thank you for the many conversations over the past four years in which you helped to scrape my ego off the floor and encouraged me to get back in the game! Alli, Gracie, and Doe - your words and notes of encouragement during this time were so precious to me. Thank you for being such incredible friends! My Cornerstone Church Family - You have surely earned an honorary degree for the times you listened to my „first run‟ through a presentation! Thank you for your love, support, and constant prayers… You are the Body of Christ! And To My First Baptist El Paso Church Family - Thank you for praying for me throughout this journey! vi Table of Contents Page Abstract iii Acknowledgements v Table of Contents vii Chapter 1: Introduction 1 Chapter 2: Review of Literature 7 The Origin & Development of Evidence-Based Medicine 7 Evidence-Based Research in Medicine 11 Evidence-Based Practice as it Relates to Evidence-Based Medicine 14 Evidence-Based Research & Practice in Music Therapy 17 Evidence-Based Research & Practice in Speech-Language Pathology 26 Conclusion 32 Research Questions 35 Chapter 3: Method 38 Materials 38 Participants 50 Procedure 52 Data Collection 53 vii Chapter 4: Results 56 Focus Group Responses 56 Sample Group of Music Therapists 63 Completed Research Templates 72 Final Modifications to the Research Template 98 Chapter 5: Discussion 101 Future Applications for the Research Template 101 Limitations of this Study 104 Music Therapy Research Literature 107 Conclusion 108 References 110 Appendix A: Statement of Consent – Focus Group 120 Appendix B: Statement of Consent – Sample Group of Music Therapists 122 Appendix C: Initial Questionnaire 124 Appendix D: Follow-Up Questionnaire 129 Appendix E: Research Template Completed by Sample Group of MTs 130 Appendix F: Final Research Template 135 viii Chapter 1 Introduction One of the most unique features of music therapy is that it is beneficial in the treatment of most areas of human functioning. In fact, music therapy is often referred to as an “umbrella” therapy because of its ability to target multiple domains. Specifically, a music therapist may develop cognitive, communication, social, physical/motor, sensory, behavior, and/or emotional treatment goals for children and adults with special needs. The broad focus of treatment for a variety of needs makes music therapy attractive to many who are interested in becoming trained in the profession, as well as to those who seek treatment. This extensive nature of the discipline, however, can make research-informed practice both time consuming and tedious, as it requires the clinician to examine current research literature and implement related findings into treatment considerations. This same task becomes even more overwhelming for clinicians who provide treatment to multiple individuals with differing diagnoses and needs. To inform one‟s practice through current research, now referred to as “evidence-based practice,” a clinician must make a concerted effort to obtain and evaluate research literature and then to translate related research findings into treatment interventions. Although a topic of much debate among music therapists, research based practice is essential if the profession is to gain and maintain credibility within the healthcare setting. In fact, it is necessary simply to fulfill the 1 claim made in the definition of music therapy established by the American Music Therapy Association (AMTA) in 2005. This definition states, “Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” (AMTA, n.d.). The use of the term “evidence-based” within this definition reflects the values and goals of the medical community over the past 20 years. The profession of music therapy is not alone in touting the term “evidence-based” as a description of the care provided by its practitioners. In their 2005 article, Steinberg and Luce substantiated the common use of this term in stating, “If you are doing almost anything related to health care today, being „evidence-based‟ is de rigueur. Even when it is not obligatory to do so, claiming to be „evidence-based‟ conveys a measure of credibility nowadays that is valuable to have” (p. 80). Indeed, as health care consumers now have unlimited access to information via the internet, and as insurance companies and other third party payers restrict services deemed as reimbursable, it is necessary to establish through current research that the treatment provided is the most effective and efficient available. The concept of evidence-based practice developed out of the movement toward establishing evidence-based medicine. Thus, to gain a full understanding of evidence-based practice (EBP), an awareness of the etiology and an 2