Summary of the impact

Researchers in the Music for Health Research Centre have collectively made a significant contribution to research in music therapy in the public sector, impacting upon national policy. Specifically, researchers have worked with the Department of Health (DOH), the National Health Service (NHS) and The Cochrane Library. The Centre's research has raised the national profile of music therapy significantly by ensuring professional recognition of the benefit of such therapy and through the increasing levels of deployment in health services as an accepted method of treatment. Working collectively within specific areas, research has led to: the development of new music therapy treatment approaches and assessment tools for children on the autistic spectrum; the instigation of new music therapy approaches in adult mental health, impacting on the NHS through the expansion of music therapy services; and the influencing of government policies through using research outcomes to contribute to changes in policy.

Underpinning research

Our music therapy research can be broadly grouped into four areas, each with a distinctive focus in its outcomes.

Treatment:

Oldfield, at Anglia Ruskin University since 1994 and a Professor of Music Therapy since 2012, has undertaken research, in collaboration with Odell-Miller (at Anglia Ruskin University since 1994, and Professor of Music Therapy since 2008), and Wigram, (Professor of Music Therapy at Anglia Ruskin University 2005-2011), in the field of music therapy for children on the autistic spectrum. A Music Therapy Charity funded research project (2000-4) supervised by Odell-Miller led to the development of a new approach for children with autistic spectrum disorder and their families: Interactive Music Therapy (Oldfield 2006a). Oldfield analysed 222 half-hour videotapes of music therapy sessions with ten families with pre-school children with autistic spectrum disorder in minute detail. She identified eight aspects that characterise this approach: the motivational aspect of music making; structure; the balance between following and initiating; basic exchanges; control; movement; playfulness and drama; and involving parents or primary carers.

Assessment:

Oldfield, with Odell-Miller, also researched and developed a new Music Therapy Diagnostic Assessment tool (MTDA). Thirty children suspected of having autistic spectrum disorder participated in MTDAs and also the commonly used Autism Diagnostic Observation Schedule tests (ADOS). The two tests were scored and compared, and the children and the testers were interviewed. Results showed 72% agreement between diagnostic categories, indicating that the MTDA was providing similar information to the recognised and established diagnostic tool. Results also showed significant differences in scores of individual questions, indicating that the MTDA could serve a useful and distinctive purpose in helping the psychiatric team to diagnose children with autism, specifically through the application of `play-based' interactive musical techniques (Oldfield 2006b).

Approach and service delivery

In the adult mental health field Odell-Miller, in consultation with Wigram, carried out a randomised controlled trial across all the arts therapies in a mental health trust, with 42 participants. (Odell-Miller, Hughes and Westacott, 2006). This demonstrated: a) the need for a more interactive approach with disturbed patients, both in arts psychotherapies and music therapy; b) the benefits of the artistic interactive relationship with people suffering from depression, schizophrenia and bi-polar disorder; and c) the design of the semi-structured interview, which was trialled in collaboration with Addenbrooke's NHS Trust, and which was later adopted by Nottingham Healthcare Trust. The research traced the development of patients' mental states alongside arts therapies processes, charting whether arts therapies changed these. Important outcomes included: an acknowledgement that the rapport between the arts therapist and patient is crucial; a realisation that the use of art forms helps patients feel understood through the therapist's artistic and verbal reflection; confirmation that therapists' views about the therapy and benefits to patients coincided with the patients' own views about this in all cases.

Public Policy and Treatment Efficacy

Wigram was a leading contributor to the first Cochrane Review for schizophrenia (Gold et al, 2005), which systematically reviewed current research from across the world. The review concluded that music therapy for people with schizophrenia reduces negative symptoms of schizophrenia and that active improvised music making is effective in this respect (corroborated by Odell-Miller's (2013) research linking technique to diagnosis). These effects were shown to be sustained at six months follow-up. This has led to the inclusion of music therapy treatment in the National Institute for Clinical Excellence's (NIHR) guidelines.

References to the research

Details of the impact

The Music for Health Research Centre has made an impact upon the local, national and international understanding, recognition of and implementation of music therapy as an effective treatment tool. For example, Wigram was a leading contributor to the first Cochrane Review for schizophrenia (Gold et al, 2005), which led to the inclusion of music therapy in the National Institute for Clinical Excellence (NICE) guidelines; Wigram Oldfield and Odell-Miller have demonstrated the success of music therapy in relation to autism; and Odell-Miller is a member of national advisory boards, influencing public knowledge, and policy-making. Further detail about this impact is:

Assessment and treatment
Professor Wigram, Oldfield (and Sandford, Chair of the then Association for Professional Music Therapists) jointly reviewed the music therapy literature related to autistic spectrum disorder in order to provide evidence of efficacy for the CAMHS (Child and Adolescent Mental Health Service) NHS teams. Oldfield was consulted owing to her research and clinical experience with children with autism described in section 2 above. As a result of this work music therapy was given `two ticks' (2009 onwards) for `Treatments and Therapies for Autism Spectrum Disorders Currently Under Scientific Evaluation by Research Autism', which meant that it was seen as an effective means of treatment for this client group (5g).

Approach and service delivery
Odell-Miller, as invited advisory professor, has enabled a university alliance to be set up between Anglia Ruskin University and Central and Northwest London Healthcare (5c), which now has a large arts therapies profile in NHS training, impacting on service delivery and changing treatment approaches.

Professors Odell-Miller, Fachner (Professor of Music Health and the Brain appointed at Anglia Ruskin University, January 2013), Wigram and Oldfield regularly advise clinicians on research that impacts on healthcare facilities, thus changing directions and policies of service delivery. Examples of this are:

• Oldfield's involvement in the Northern Ireland Music Therapy Centre's Lottery Fund research with children and adolescents, which has an impact on increasing the profile, understanding and positive outcomes of music therapy in this field.
• Fachner is reported as an expert in neuro-scientific research in the THES and this has already had an impact on raising the profile of music therapy and neuroscience.
• Odell-Miller was research advisor to a clinical NHS trial, the first of its kind for people with Post Traumatic Stress Disorder, which was reported in 2012 (5i). The work impacted on a service that has not had music therapy before, showing music therapy to be beneficial for people with PTSD.
• Impact on the local community of increased engagement with music therapy is demonstrated through the new state-of-the-art Jerome Booth Music Therapy Centre, made possible through private donations from members of the public, amounting to over £1.5M. The new centre has a purpose-built clinic and training centre and has already enabled local schools and health care providers wider access to music therapy, thus changing lives of people.
• The impact of the design of new assessment tools in adult mental health is demonstrated by Nottingham Healthcare and specifically Rampton Special Hospital adapting and trialling Odell-Miller's assessment tool developed in Odell-Miller et al's 2006 study.

Public Policy and Treatment Efficacy
The impact from the first Cochrane Review on schizophrenia (2005) has far-reaching effects. Evidence for this is found within the NICE guidelines (2009) that now recommend music therapy as a beneficial treatment for people with schizophrenia, alongside other arts therapies, emphasising the benefits of non-verbal treatments. Original research evidence came from the music therapy research studies listed in the Cochrane Review, and systematically reviewed by Wigram and colleagues. The NICE Guidelines state: `The review found consistent evidence that arts therapies are effective in reducing negative symptoms when compared to any other control. Further, they recommend: (8.3.8.1) `... offering arts therapies to all people with schizophrenia, particularly for the alleviation of negative symptoms. (5d)

Odell-Miller has been involved in the dissemination of these and other research results at national and international levels, through her work as an elected member of the Professional Advisory Board for Allied Health Professions to the Department of Health (recently to Health Education England), and to the National Clinical Academic Careers Development Group for Nursing, Midwives and Allied Health Professionals. The latter group has instigated a new clinical pathway for clinicians to begin research early in their NHS careers through the new Clinical Academic Internship Programme. Here, Odell-Miller has worked to ensure that the `smaller' professions, such as arts therapists, are included (5b) and she is now listed in their terms of reference as a member with `special expertise'. Odell-Miller also spoke on Radio 3's Music Matters programme about music therapy research and new developments in 2011. (5e)

Odell-Miller was involved in developing the competencies for the Health Professions Council (Standards of Practice and Standards of Education and Training), and in researching and articulating differences between artists and arts therapies, and specifically advising on the Nuffield Review (Nuffield 2004, 5h, which has had recent impact (Odell-Miller 2013). More recently she had an advisory role in researching into the current and future workforce planning for Arts Therapies for the Centre for Workforce Intelligence (CfWI 2012), contributing to the writing of their report, Education commissioning risks summary for Arts Therapies Report (WRO ECRS 2012). (5b, 5c). Finally, writing about Odell-Miller, Oldfield and Wigram, senior members of the profession endorse this case study in corroboration letters (5j).The following quotation sums up the impact `these three key pioneers of music therapy and music therapy research, assessment, policy formation and practice have been key to the development of the discipline of music therapy and their work has had far reaching impact on a broad area of clinical practice benefitting both clients and practitioners within the UK and Internationally.

Sources to corroborate the impact

a) Oldfield's work with the Croft Child and Family Unit is in The Cambridge and Peterborough Foundation Trust is described on their web site, where the impact of her research is demonstrated: www.thecroftchildandfamilyunit.nhs.uk/default.asp?id=69

b) This Association of UK University Hospitals web site shows the impact of the work and Odell-Miller's contribution as a listed expert invited member: www.aukuh.org.uk/index.php/affiliate-groups/nmahps

c) Arts psychotherapies research based practice: This document lists the work of the International Centre for Arts Psychotherapies Training, for which Odell-Miller is an advisor. It is a new initiative within the NHS, which is impacting internationally and nationally on clinical work:
www.cnwl.nhs.uk/wp-content/uploads/2012/12/ICAPT_Training_20132.pdf

d) NICE guidelines for schizophrenia which make reference to the impact of the Cochrane Review (Gold, Dahl and Wigram 2005): www.nice.org.uk/nicemedia/pdf/CG82FullGuideline.pdf

e) Radio 3 Music Matters programme (4 June, 2011). Odell-Miller interviewed — over 2 million listeners: www.bbc.co.uk/programmes/b011pks0

f) Odell-Miller, H., (2009). Arts therapies evaluation and evidence: what counts? Paper at the joint conference, Evaluation in arts therapies best practice' organised by The Scottish Arts Therapies organisations, the Scottish Health Department and Queen Margaret's University. This is further evidence of UK impact on an audience of 200:
http://eresearch.qmu.ac.uk/2056/1/eResearch_2056.pdf

g) This is the website for Research Autism showing the impact of the review, and subsequent policy change, carried out by Sandford, Oldfield and Wigram:
www.researchautism/interventionlist.ikml).

h) The Nuffield Foundation (2004) Creative Arts and Humanities in Healthcare: Swallows to other continents, a strategic paper. London: The Nuffield Trust for research and policy studies in health services. Odell-Miller was a major contributor and her research is also sited on p. 29. in this policy document to advise government and this paper has led to impact as stated above and to Odell-Miller (2013) section 3 above, linking arts therapies and arts for health.

i) Odell-Miller clinically supervised this trial, published as: Carr, C., d'Ardenne, P., Sloboda, A., Scott, C., Wang, D., and Priebe, S. (2012) `Group Music Therapy for Patients with Persistent Post-Traumatic Stress Disorder — An Exploratory Randomized Controlled Trial with Mixed Methods Evaluation' in Psychology and Psychotherapy: Research and Practice, 85: pp. 179-202. doi: 10.1111/j.2044-8341.2011.02026.x

j) Two letters Nov 2013 corroborating this case study: i) From the former CEO of Nordoff Robbins London (the current chair of the Training and Education Committee for BAMT). ii) From the Chair of The British Association of Music Therapy, (BAMT).