An Investigation of the Effectiveness of Arts Therapies Interventions on Measures of Quality of Life and Wellbeing: A Pilot Randomized Controlled Study in Primary Schools

Abstract

BackgroundOver the last decades there has been a change in the way schooling is perceived recognizing that children’s learning is closely linked to children’s health. Children spend most of their time at school, which is often the place where problems are identified and interventions are offered, not only for treatment but also prevention. Embedding arts therapies into the educational system may help address children’s emerging needs and have a positive impact on their wellbeing.MethodsA pilot cross-over randomized controlled design was employed to investigate the effectiveness of an arts therapies intervention on a series of child- and teacher-reported outcome measures, specifically, health related quality of life (assessed using a HRQOL scale; EQ-5D-Y), wellbeing and life functioning (assessed using the child outcome rating scale; CORS), emotional and behavioral difficulties (assessed using the strengths and difficulties questionnaire; SDQ), as well as duration of sleep (assessed using Fitbits). Sample size calculations for future large-scale studies were also performed, and the sustained impact of the intervention was evaluated at 3, 6, and 12 months follow-up. The pluralistic theoretical and therapeutic framework of this intervention was informed by a systematic review on school-based arts therapies interventions and is presented in detail in the study protocol. Participants were 62 children with mild emotional and behavioral difficulties.ResultsImprovements in HRQOL and CORS were greater in those engaged in the arts therapies intervention than the control groups and were maintained at the follow-up stages. Significant improvements were only found for duration of sleep (P = 0.002) and SDQ (P = 0.008). Minimal clinically important differences (MCIDs) as defined in the published protocol were found for CORS, SDQ and duration of sleep, but not HRQOL.DiscussionFindings indicate that the arts therapies interventions were having a clinically significant effect on life functioning, duration of sleep, emotional and behavioral difficulties. Findings also indicate a small effect size for health related quality of life, suggesting the intervention was having a small positive effect on this outcome measure. The study indicates that all outcome measures assessed here would be suitable for inclusion in a larger randomized controlled study utilizing these arts therapies interventions, and that a sample size of 225 participants would be required if these outcome measures were used.

Qualitative and Arts-Based Evidence from Children Participating in a Pilot Randomised Controlled Study of School-Based Arts Therapies

“…This pilot was developed based on two systematic reviews [ 40 , 41 ] which synthesized previous interventions that had been successfully implemented and assessed by children themselves, and it was informed by other evidence-based arts therapies protocols [ 42 , 58 , 59 ]. The therapeutic protocol and intervention were evaluated by children, arts therapists and the research team [ 20 ] and is expected to inform the development of future interventions in school-based arts therapies. The detailed description of the therapeutic protocol and its principles is expected to make this intervention replicable in future studies.…”

“…Data collection took place before, during and after the arts therapies in the same room as the sessions were conducted but were separate from the sessions themselves. In this paper, only the qualitative and arts-based methods will be presented, as the quantitative methods has been published separately [ 20 ].…”

“…For example, 7000 children are being excluded from schools annually in the UK (equivalent to 35 children/day), while 1300 of these exclusions come from primary schools [ 19 ]. These exclusions could have been avoided with prevention and timely interventions at the early stages of children’s education [ 20 ]. In contrast, it is estimated that more than 70% of children lack supportive services at a sufficiently early age [ 21 ], 30% of referrals are turned away and waiting lists can take up to a year [ 19 ].…”

“…The protocol was published before the beginning of the study [ 28 ]. Furthermore, the first research question (a) was addressed in a separate publication which presented the quantitative evidence of this study [ 20 ]. The current article aims to address the second research question (b), presenting the qualitative and arts-based evidence from the children who participated in the arts therapies.…”

Artmaking in Elementary School Art Therapy: Associations with Pre-Treatment Behavioral Problems and Therapy Outcomes

“…Child art therapy provides a protected space for self-expression, self-inquiry, and dealing with distress through artmaking in a safe relationship [ 1 ]. Studies present evidence regarding the beneficial value of art for mental well-being in children [ 2 , 3 ]. Clinicians and art therapy theorists posit an association between the mental and emotional state of the artmaker, and the experience of artmaking in therapy, e.g., [ 4 ].…”