Data-based Decision Making in Music Therapy
作者Eric. G. Waldon
The work of all music therapists involves the collection, synthesis, and analysis of data to meet clinical aims of consumers. Differences exist, however, in how music therapists conceptualize data and the ways in which data are used to make treatment decisions. The purpose of this article is to present a data-based decision making (DBDM) model in music therapy and illustrate its application in early childhood education.
Sometimes referred to as data-driven decision making, DBDM has seen widespread use within education as a means of improving educational outcomes (Sagebrush, 2004). In many schools, these data-driven approaches have been implemented to address accountability regulations specified in No Child Left Behind (NCLB) Act of 2001 Pub.L.No.107-110,§115, Stat. 1425 (2002) and as part of the reauthorization of the Individuals With Disabilities Education Improvement Act (IDEIA), 20 U.S.C.§ 1400 (2004). More specifically, DBDM has been used to improve the provision of special education services in districts adopting a Response to Intervention (RTI) approach. In RTI, data are collected on all students to inform educational programming prior to special education referral (Greenwood, Bradfield, Kaminski兰新诚 , Linas, Carta, & Nylander, 2011). Consequently, based on a student’s response to “pre-referral” interventions, educational specialists can determine whether a child requires an intensive (i.e., more restrictive) versus a general educational program. However, beyond accountability and student identification, some schools have found that DBDM promotes home-school involvement, improves curriculum, enhances teaching, and assists educators when communicating bestpractices (Sagebrush, 2004).
有时也叫数据推动做出决定。DBDM在教育领域使用广泛，以便提高教学效果。(Sagebrush, 2004)。在许多学校，这些数据推动的方式用于落实2001年《一个孩子不落下法案》（No Child Left Behind (NCLB)） 中的问责条款，与部分《残疾人教育提高法案》的内容。更具体的，部分地区已经通过治疗干预回馈计划（Response to Intervention (RTI) )童振军。RTI计划收集学生数据，采取了这些方案的区域，DBDM被用于提高特殊教育服务。基于学生对转学前干预的翻译，教育专家能够决定孩子是应该接受大众化的教育项目，还是管理严格的项目。但是，除了问责与学生情况，有些学校还发现DMDM可以提高家庭与学习间的互动，改善课程，提高教学水平，推动教育者相互交流有效教学方式(Sagebrush夏河叶航 , 2004)。
While specific models differ, all appear to agree that DBDM is systematic, ongoing, and collaborative.According to Marsh, Pane, and Hamilton (2006), datadriven approaches involve “teachers, principals, and administrators systematically collecting and analyzing various types of data, including input, process, outcome and satisfaction data, to guide a range of decisions to help improve the success of students and schools” (p. 1). In their work for the San Bernardino Unified School District (California), Johns and Patrick (2013) describe DBDM as “an ongoing process of analyzing and evaluating information to inform important education decisions and actions.”
The Heartland Area Education Agency (Heartland AEA, 2007) uses a model based on four data-driven practices: 1) Reviewing; 2) Observing; 3) Interviewing; and 4) Testing. The R.I.O.T. model is particularly advantageous because it encourages multi-method data collection across the decision making process. This approach provides different perspectives on problem-solving, multiple sources of evidence to support decisions, and an examination of convergent and divergent patterns (in educational performance or behavior), which guide intervention planning. A summary of the R.I.O.T. model follows.
Heartland地区教育咨询（Heartland AEA, 2007) 运用四种“基于数据”技法建造了一个模型，主要分四步：1.回顾；2.观察；3.访问；4.测试。R.I.O.T模式优势在于它在决策过程中鼓励通过多种方式收集数据，并研究各模式的异同（教育表现或行为方面）。这些模式是设计治疗干预方案的知道。一下是R.I.OT模式的总结：
(R) Reviewing refers to examining pertinent records, artifacts, archival data, and work samples. In early childhood educational settings, cumulative files, Individualized Family Service Plans (IFSP), Individualized Education Plans (IEP),赵欣培
grade books, attendance records, and medical records may play an important role in determining strengths and needs. Reviewing also involves examining the relevant literature for best-practices with certain populations.
（R)回顾指的是研究相关记录，模型，档案数据，工作样品。在儿童早期教育中，日渐积累的记录，个体家庭服务计划（Individualized Family Service Plans (IFSP)），个体教育计划（IEP)，评级数，出勤记录，医疗记录，都在确定项目的长处和需求方面起到重要作用。回顾也包括查阅相关文件，确定与该个体工作时最好的方法。
(I) Interviewingencompasses direct data collection methods whereby information is obtained, formally or informally, from clients, parents, teachers, educational specialists, and medical professionals. Beyond the value of gathering historical information, interviews are inherently helpful to DBDM because informants’ views of the problem and perceptions of improvement can be used to guide treatment.
(O) Observing involves directly examining client behaviors across settings, times of the day, and inthe presence of different people. Observations may include descriptions of the environment (e.g., classroom, home) and involve both formal (e.g., time sampling or functional assessment) and informal (e.g., narrative description of a client engaged in play) methods. In addition to providing information about behavior and the influence of environmental factors, observations may be conducted by parents and teachers (informal observations) as a means of gauging a client’s response to interventions; this may provide evidence for transfer of learning in settings not routinely accessed by interventionists.
Relevance of DBTM to music Therapy
Some may be reluctant to adopt an approach which is rooted around the word “data.” As one of its earliest proponents in music therapy, Hanser (1987) acknowledges this hesitation and explains that a data-based model is a “set of procedures for accurate assessment, efficient planning, and objective evaluation in music therapy” (p. 17). Furthermore, she explains that the approach assists the music therapist by identifying the effectiveness of particular interventions and increases client awareness of progress towards goals. In a later edition of the text, Hanser (1999) described how she applied a data-based sensibility to caring for her newborn daughter. By using this approach, she explained:
有些人一听到与“数据”这个词有关的方法，就避之不及。音乐治疗领域，Hanser是最早支持这种方法的人豪门囚情 ，他看出这一领域对数据的不喜，并解释说“数据模型是音乐治疗准确评估，有效设计，与客观评判的前提。”（p.17)。另外，她还解释说这种方法容易发现某种干预手段是否有效，也让来访者对治疗进程更加清晰。Hanser 在这篇论文的修改版中还描述了数据如何赋予她敏感性，让她更好的照顾新生的女儿。以下是她的描述：
By learning her routine, I was not only in better control of our interaction, but I became more confident and relaxed as a mother. I devoted more of my energy to our play, getting to know her through singing, talking, touching, moving and loving her every moment (p. 28).
Applying this same sensibility to a clinical music therapy situation, freed from uncertainty through a data-based structure, therapists can devote more time to building the therapeutic relationship, listening and responding more actively to client needs, and engaging clients musically. Ultimately, implementing treatment in this manner may lead to consistency of intervention and growing the body of evidence-based practice in music therapy.
A DBDM Model in Music Therapy
A modified version of John and Patrick’s (2013) definition is used here to define DBDM in music therapy: “Data-based decision making in music therapy involves an ongoing process of collecting, analyzing, and evaluating information to inform important decisions and actions across treatment” (Waldon, 2013). The aim of this reimagined definition is to broaden the applicability of the model beyond educational settings and encourage intentional treatment decision-making using multiple sources of evidence.
本篇论文中，我改编了John 和 Patrick （2013)的定义，来说明什么是音乐治疗中的DBDM：音乐治疗中基于数据的决策模型指的是不断对信息进行收集，分析，评估，以便治疗过程中在信息完全充分的情况下做出重要决定(Waldon, 2013)。之所以改写原来的定义，是为了突出基于数据的决策范围应用之广，绝不仅限于教育；也希望鼓励更多治疗师在治疗中有意使用多种渠道收集信息，做出决定。
In particular, the proposed DBDM model in music therapy (see Figure 1) is built on three characteristics described in the educational literature: (a) multi-method data collection (b) ongoing data collection, and (c) cyclical decision making. First, Heartland AEA’s multi-method approach (R.I.O.T.) is deployed across all stages of music therapy treatment. Furthermore, the American Music Therapy Association’s (2012) Standards of Clinical Practice is used to define the various treatment stages:
下面给出的音乐治疗中的DBDM模式是基于教育学文献中描述的三个特征：(a)多渠道收集数据；(b) 不断收集数据；(c) 临床决策。首先，Heartland AEA的多渠道方式 (R.I.O.T.) 在音乐治疗各个阶段均有应用。另外，本文美国音乐治疗协会（2012） 临床做法标准来界定治疗中各个阶段。
Secondly, data collection, analysis, and decision-making are ongoing and, therefore occur over the entire course of treatment. DBDM activities are not confined to a fixed point during treatment. This means, for example, that specific data-based activities such as observing and interviewing may occur at both the Assessment (to ascertain strengths and needs) and Implementation (to monitor client responses) stages. This assures that multiple sources of evidence are being used to guide treatment decisions.
Finally, as suggested by Mandinach, Honey, and Light (2006), the process of DBDM is cyclical. This means that data-based procedures at one treatment stage are used to justify advancement to subsequent stages (as represented by descending, rectilinear arrows in Figure 1).
最后，正如Mandinach, Honey 和 Light (2006)提出的，DBDM是一个循环过程蜀山金须奴。也就是说治疗某阶段基于数据的流程能够用来指导下一阶段的进行。
Likewise, data collected and analyzed at later stages may justify returningto an earlier stage (as represented by ascending, curvilinear dashed arrows in Figure 1).
Moreover, when decisions to either advance or return to stages of treatment are based on multiple sources of evidence, overall decision-making power is strengthened thereby increasing probability of a successful outcome. To further illustrate the use of the approach, the following questions and guidelines are presented to highlight the ways in which DBDM may be applied to early childhood music therapy:
另外，关于推进还是退回治疗某一阶段的决定是基于多种来源的数据。这也加强了治疗师全局决策能力龙魂剑圣 ，提高治疗成功的可能性.下列问题与指导突出了儿童早期音乐治疗中如何运用DBDMM 。下面将进一步说明这种方法的运用。
1.Review: What information is present within the written referral? To what extent have referral criteria been met (see Hanser, 1999, for example referral criteria)? What research evidence is available which supports the use of music therapy to address the referral problem(s)?
2.Interview: What information can be obtained directly from the referring provider or parent? Identify data that may be absent from the original referral which are important in making a referral acceptance decision.
3.Observe: Can the prospective client be observed prior to accepting the case? Informal observations (in the school cafeteria, playground, or during free time)may be appropriate and warranted prior to referral acceptance.
4.Test: What test scores or measurements (e.g. cognitive or adaptive behavior estimates) are available that may influence the referral decision?
1.Review: What records are available and pertinent to the identification of strengths and needs? What work samples (homework or artwork) are available for examination? What does the literature recommend with regard to assessment for this population不破真广?
2.Interview: Who should be interviewed? Can an interview with the client be conducted to directly assess communication, cognitive, motor, and affective functioning?
3.Observe: What types of systematic or descriptive observational techniques will yield the most relevant data? What are the most clinically relevant environments in which to observe the client?
4.Test: What cognitive, behavioral, academic, developmental, or curriculum-based data are available? Are additional test data pending? What music therapy measures (e.g., IMTAP by Baxter, Berghofer, MacEwan, Peters, & Roberts, 2007) may be relevant?
1.Review: In formulating a treatment plan, what does the clinical and research literature reference as best practice (e.g., Humpal & Colwell, 2006)? What current educational and/or clinical goals and objectives are listed (e.g., from IFSPs or IEPs)?Determine whether music therapy is an appropriate method of addressing these needs.
2.Interview: What are the parents’ and client’s thoughts about the proposed plan? To what extent are consultation and/or collaboration with other allied professionals warranted?
3.Observe: What observations are available which support the treatment plan? Does the intervention (timing, length, and intensity) fit the client’s environment? If others will be responsible for administering a component of the treatment, are they capable of carrying out that responsibility?
4.Test:Can baseline data be collected before implementation? Could archival data be used as a proxy for baseline measurement? In the latter case, the use of routine developmental screening tools, curriculum-based measures, and records (disciplinary or academic) may be useful.
1.回顾：制定治疗计划时，根据临床记录和研究文献南山寺 ，哪些是最好的做法（比如 Humpal & Colwell，2006）？有哪些现行的教育与临床对象和目标（可以从IFSPs 或 IEPs中查找）？找出哪些音乐治疗方式能最好的呼应这种需求。
1.Review: What permanent products or records will be kept to monitor progress? Is there a component of treatment that requires parents or teachers to monitor progress by keeping a record or log?
2.Interview: Aside from clients, parents, or teachers王晴川 , who else may be able to provide pertinent progress monitoring information? What interview information may suggest a need to reformulate the treatment plan or approach?
3.Observe: While providing direct services, what client observations might prompt: (a) a modification of treatment; (b) a reformulation of goals/objectives; or (c) other changes in treatment? If third-party observers (other professionals, parents, or teachers) are involved in collecting progress-monitoring data, what training is needed?
4.Test: What specific measures (i.e., behavior counts, inventories, or developmental tools) are being used to monitor progress? Are data being collected consistently? Do these measures occur naturally in the client’s educational or home environment? When possible, use measures that fit the ecology of the client’s environment. In other words, avoid developing a new system of measurement when an appropriate system already exists.
3.观察：除了提供直接服务，来访者观察还能促进（a) 治疗方案调整；(b) 重新制定目的目标；（c)治疗方案有无其它变化？如果第三方观察者（其它治疗师，父母长孙无垢，老师）参与收集进程检测数据，他们需要什么样的训练。
1.Review: What evidence suggests that termination is appropriate? What instructions or follow-up materials will be included as part of an after-care or follow-up plan?
2.Interview: What are the client’s, parents’, or teacher’s views about termination? to what extent have treatment expectations been met?
3.Observe: What observations are relevant to either discontinuing treatment or changing the level of service? If generalization was a goal, to what extent was that met?
4.Test: What quantitative data are available supporting the discontinuation or change in treatment?
The model presented is one way in which DBDM can be applied in music therapy. While the example above illustrated its application in early childhood education, the DBDM paradigm has wider application across populations and settings in music therapy. The strengths of the approach come from the use of multiple data collection methods, ongoing data-based strategies across treatment stages, and using data to drive all treatment decisions. Ultimately, the objective of DBDM is to improve outcomes for clients while elevating the standard of care in music therapy.