Group-oriented community-based expressive arts programming for individuals with disabilities: participant satisfaction and perceptions of psychosocial impact.
Often when referring to "art", the focus is on a product that is tangible and created for the purpose of bringing pleasure to others. Less common is consideration of the impact for the artist in the process involved in creating art. "Expressive arts" (Creadick, 1985; Feder & Feder, 1981) is a term used to emphasize the processes within the many art forms; whether it be dance, drama, music, poetry, drawing, or painting. The therapeutic value inherent in art processes is a widely shared belief among writers in the arts (Kramer, 1977; Lowenfeld, 1957; Rubin, 1984). Individuals with disabilities often lack successful experiences in academics and sports due to their cognitive or physical limitations. The production of art can provide them with a sense of competence and mastery, which in turn builds self-esteem (DiCowden, 1987; Erickson, 1979; Omizo & Omizo, 1988). In addition, group art experiences can have additional benefits by providing much needed stimulation and socialization for individuals with disabilities who are isolated from peers (Canner Hume & Hiti, 1988; Clements & Clements, 1984; DiCowden, 1987).
Art is a valuable form of leisure. In an investigation of leisure satisfaction among adults with spinal cord injuries, Coyle, Lesnick-Emas, and Kinney (1994) concluded that leisure satisfaction was the most significant predictor of life satisfaction because it explained 43% of the variance in life satisfaction scores. Self-esteem and health satisfaction explained an additional 16% of the variance. The authors went on to recommend that leisure education and leisure counseling be included in rehabilitation programming in order to maximize life satisfaction achievement.
The use of expressive arts for the benefits of creating art (i.e., a process approach) has continued with individuals with disabilities despite some controversy and weaknesses in outcome documentation. Because the design of previous studies regarding the impact of art activity has frequently involved single case studies or anecdotal accounts, conclusions regarding the impact of expressive arts has been restricted (Anderson, 1983). Although single case studies (e.g., Schwarcz & Schapir, 1985; Simon, 1982) can provide valuable insights into the process of change and impact experienced by an individual who participates in expressive arts, such studies have limits for drawing broader conclusions about expressive arts as a valuable rehabilitation intervention. During the last decade, there has been improved qualitative research (Anderson, Ash & Gambach, 1982; Silver, 1989; Very Special Arts, 1993) which supports the utilization of art activity. Research on the impact of group-oriented community-based expressive arts is rather unique however.
In today's rehabilitation service climate, there are ever-increasing pressures to provide efficient, quality services and to document positive outcomes. Under these conditions, rehabilitation services which are viewed as "extras" (e.g., recreation, sports, leisure, artistic, spiritual support) are at potential risk for being eliminated or having funding and administrative support decreased. This type of action may be counter-productive when there is evidence that such aspects of life (e.g., leisure satisfaction) are critical to long-term outcomes and life satisfaction (Coyle, Lesnik-Emas, & Kinney, 1994; Crewe & Krause, 1990; Kinney & Coyle, 1992). If such services are documented as effective and the services can be provided in a cost-efficient manner (e.g., group approaches, integration into existing community-based programs), there is even more support for including the arts and leisure in present-day rehabilitation.
Where exactly can creative arts fit into rehabilitation? If the relationship between creative activity and inner well-being is to be understood, and if the creative arts are to gain acceptance in mainstream rehabilitation, art must first be viewed as a process rather than as a product. The creative and expressive properties of the process, as well as the meaning that individuals attach to participation in artistic endeavors, are also critical. As mentioned previously, recreational activity, spiritual needs, and creative activity are all too often neglected or under-valued in rehabilitation planning. Professionals in rehabilitation, education, and other human service fields acknowledge the need to re-consider traditional methods (which are frequently costly and labor intensive) and to discover new ways to enhance outcomes and the quality of life for individuals with disabilities. Numerous approaches, including providing opportunity for creative arts as a community-based group activity, are worthy of consideration. It is important for professionals to recognize that expressive arts may be a valuable resource for enhancing rehabilitation outcomes and enhancing life satisfaction for individuals with disabilities.
A valuable arts resource for rehabilitation professionals is the nationwide Very Special Arts program. Very Special Arts is an international organization and educational affiliate of the John F. Kennedy Center for the Performing Arts in Washington, D.C. (Very Special Arts Wisconsin, 1992). The U.S. Congress has designated Very Special Arts as the coordinating agency of arts programs for people with disabilities. The program is a non-profit, volunteer-based organization that provides opportunities for children and adults with disabilities to interact with peers without disabilities in a creative and enjoyable environment. The various programs take into account that individuals vary in interests and levels of ability. Programs offer group as well as individualized experiences in activities such as dance, music, drama, and visual arts. These programs are designed to allow individuals to participate at their own level of ability, and work up to their potential through personal areas of interest.
Even though human service professionals acknowledge that leisure contributes to self-growth and self-development (e.g., Bammel and Burrus-Bammel, 1982; Coyle, Lesnick-Emas, & Kinney, 1994), the impact of leisure and creative arts activities on change (or perceived change) in self-esteem, behavior and social activity are less well understood. One of the purposes of this study was to examine the relationship between psychosocial functioning ratings and participation in a group-oriented community-based art program for individuals with disabilities. More specifically, the study examined whether the frequency of participation (i.e., once a year vs. at least monthly) or the length of participation (i.e., less than two years vs. three or more years) related to perceived changes in psychosocial functioning. The second major component of the study was to take a more in-depth look at the impact of community-based art programming on the lives of individuals with disabilities through a structured interview.
This pilot study targeted individuals who had been ongoing participants in Very Special Arts programming for a period of one year or more. Support for and permission to proceed with the study was obtained from the state Very Special Arts (VSA) office of a midwestern state. The intent of the study was to obtain a sample of individuals with varied disabilities from both rural and urban communities. The six local coordinators in the Very Special Arts districts throughout the state identified individuals who met the study criteria and elicited the cooperation of VSA program teachers to distribute the questionnaires. Therefore, questionnaire distribution occurred at the local level and VSA participant identities were protected. Participants for the follow-up interviews were selected from individuals who identified themselves on the questionnaire and indicated a willingness to be interviewed.
The questionnaire, developed by the authors, included demographic, art programming participation, and psychosocial functioning items. On the series of 15 statements about psychosocial functioning, respondents were asked to rate "the changes you have noticed since your involvement with VSA." The statements were selected by the authors to address three main areas of psychosocial change - social interactions, behavior, and self-esteem/self-concept. Sample statements are: I am willing to help others when needed; I feel like an important member of my peer group; I am proud of my accomplishments. The questionnaire focus on "I" and "my" statements, along with cover letter emphasis on self-perceptions, emphasized the authors intent to gather information regarding self-perceptions rather than perceptions of others.
Change was scaled and rated on a Likert-type scale with the following categories: significant positive change, positive changes, intermediate changes, no changes, negative changes. (Since the level of measurement of this scaling was deemed ordinal rather than interval, data analysis procedures were selected conservatively as appropriate for ordinal measurement.) Respondents were also asked to indicate in which of three areas (i.e., social interactions, behavior, self-esteem/self-concept) they had noticed the most and least significant changes. Additional written comments were encouraged by leaving extra space by each rating item and by asking for other comments (e.g., recommendations for increasing the effectiveness of VSA programs).
The follow-up interviews were semi-structured with a list of eight questions which were related to questionnaire items but allowed for increased depth of responses (e.g., Overall, what do you feel was the programs' most significant impact?). Participants were asked to describe their program involvement, social interactions, self-concept, views of others regarding their involvement with the VSA program. The interviewer (one of the study authors) uniformly asked the series of general questions but also raised follow-up questions specific to the responses given. Participants were provided freedom to tell their experiences in an uninterrupted and spontaneous manner. The interviews were recorded on audiotape for ease of transcription and interpretation (with the consent of the interview participant or guardian and the understanding that tapes would be destroyed following analysis).
Design and procedure
Questionnaires were distributed by VSA district coordinators, either directly or through program teachers, to individuals meeting the minimum criteria for the study (i.e., ongoing participation in VSA programs for one year or more). Orientation to the study was provided via in-person presentations, phone contacts, and explanatory materials. The opportunity to ask questions or express concerns was offered through a contact person at the state VSA office or via inquiry to either author. An accurate estimate of VSA participants who met the eligibility requirements for this study was not available from the state VSA office. In addition, since the VSA districts vary in size and level of participation varies from year-around to seasonal, it was not possible for the authors to accurately estimate the number of individuals who met the study eligibility criteria.
Participants were volunteers who returned questionnaires (some of whom also consented in writing to a follow-up interview). The completed questionnaire forms were returned via stamped self-addressed envelope to the state VSA office to the attention of one of the authors. Since the design assured confidentiality by having VSA staff distribute questionnaires rather than the authors, information regarding the number of questionnaires actually distributed is not available and a return rate could not be calculated. The follow-up interviews were conducted in the homes of participants with VSA participants and a parent/guardian (as appropriate) present.
The interview data (on audiotape) was analyzed using a constant comparative method (Glaser & Straus, 1967) and conformed to procedures of analyzing qualitative data (Bogdan & Taylor, 1975). Each response was assigned a category on an index card (e.g., categorized as self-confidence). Other participants who made statements regarding self-confidence would be noted in the same category. A total of 27 categories were identified. After the data was reviewed several times and no new separate categories emerged, general themes were obtained by combining similar categories. For example, the general theme of "changes in self-concept" emerged from combining "self-confidence," "self-esteem," "pride," and "sense of accomplishment."
Completed questionnaires were received for thirty four individuals with disabilities (M age = 19.8; SD = 10.2) who had participated in a community-based art program (Very Special Arts: VSA) for a period of at least one year. Sixty-one percent (n=20) of the questionnaires were completed with the assistance of a parent/legal guardian and 39% (13) were completed by the VSA participant (missing information for one questionnaire). The person who filled out the questionnaire was significantly related to the age of the VSA participant (e.g., younger than 18) [Chi square with continuity correction (1, N=33) = 9.95 p=.002, lambda with age dependent = .53]. The continuity correction reflects an adjustment to the chi square statistic for a table with two rows and two columns to improve the estimate of the observed significance level (i.e., a more conservative estimate for testing hypothesis of independence of the variables). "Lambda with age dependent" measures how much the error rate regarding association decreases when the additional information regarding age is considered.
The primary functional limitations experienced by study participants were cognitive limitations (29%) or multiple limitations (50%). Seventy-one percent (n=24) of the sample indicated that they attended school and 76% (n=26) indicated they were active in paid or volunteer employment. School was the source of information regarding VSA community art programs for 68% (n=23) of the sample. Forty-seven percent of the participants (n=16) had been involved with some aspect of VSA programming for three or more years.
There are a variety of expressive arts opportunities within the Very Special Arts program and some individuals were involved in more than one activity. Fifty percent (n=17) of the total sample participated in the Artist in Residence program; 38% (n=13) in the marching band; 15% (n=5) in the New Visions Dance/Movement program; and 35% (n=12) participated in other special activities (e.g., art festival, Broadway Show Tune rehearsal and performance). Social and group activity were predominant characteristics of the community-based art programming for participants in this study.
Perceptions of psychosocial impact from questionnaires
The initial study objective was to determine if psychosocial changes occurred relative to involvement with a community-based art program for individuals with disabilities. Change in a positive direction (i.e., "intermediate," "positive" and "significant positive change") was noted by the majority of respondents (range 59% to 91%) to all fifteen psychosocial functioning items (See Table 1). Two items which relate to self-esteem (i.e., pride in personal accomplishments and enjoyment in showing others what has been learned) were endorsed as a change in a positive direction by 91% (n=30) and 82% (n=27) of the participants respectively.
Two of the questionnaire choices for areas in which the "most significant changes" were noted since initiating involvement [TABULAR DATA FOR TABLE 1 OMITTED] in community-based art programming were related to self-esteem [self-esteem and social/self-esteem]. At least one of these two items was selected by 50% of respondents (n=16). Social change was noted as the most significant change for 15% of respondents (n=5) and behavioral change was noted for 24% (n=8). Only one completed questionnaire noted "no areas" of most significant change while "all areas" was selected on two questionnaires.
Because individuals who participated in this study varied not only in age but also in who completed the questionnaire (i.e., VSA participants or their parents/legal guardians), a series of chi-square analyses were conducted to determine if the perceptions of psychosocial change differed based on either age or who assisted in completion of the form. Ratings of psychosocial functioning were regrouped into two categories: those with no change or negative change and those with change in a positive direction (i.e., intermediate, positive, and significant positive change responses). For purposes of this analysis, age was recoded into two groups: under age 18 and 18 or over. No statistically significant differences in perceptions of change were noted based on either age of the VSA participant or on who filled out the questionnaire responses. (See Table 2.)
To examine whether perceived psychosocial changes were affected by the frequency or duration of participation in expressive art activities, another series of chi-square analyses were conducted. Response choices for the frequency of participation question were regrouped into two categories: "at least monthly" (i.e., daily, weekly, monthly responses) and "annually." The number of years of VSA participation were recoded into two categories: "two years or less" and "3 or more years."
As indicated in Table 3, the relationship between frequency of participation and "I am willing to help others when they need it" was found to be statistically significant, [chi square with continuity correction [(1, N = 33) = 5.96, p = .015; lambda with frequency dependent = .36]. The Fisher's exact test (two-tailed) also revealed statistical significance (p = .008). [The Fisher's exact test evaluates the same hypothesis as the chi-square test and is suitable for tables having two rows and two columns with small expected frequencies (any cell less than 5)]. No statistically significant relationships were found between frequency of participation and the other psychosocial variables.
Significant relationships were found between the duration of participation (i.e., number of years) and the following psychosocial variables: "My ability to effectively communicate with others" [chi square with continuity correction (1, N = 33) = 4.61, p = .032; lambda with years dependent = .33]; and "I enjoy showing others new things that I have learned" [chi square with continuity correction (1, N = 33) = 4.08, p = .044; lambda with years dependent = .20]. No statistically significant relationships were found between the number of years of VSA participation and the other psychosocial variables.
The second objective of this study was to qualitatively examine the cumulative data on the individuals'/family's perception of emotional, social, and behavioral growth since involvement in this community arts program. [A sub-sample of 10 individuals (ages 11-59, 5 male and 5 female) from the original sample (selected because they identified themselves and expressed willingness to be interviewed) were interviewed in their homes.]
Social interactions. Of the ten participants interviewed, nine (90%) attributed positive changes in social interactions to involvement in a VSA program. For these individuals, the art program provided them with an opportunity to meet new people, develop friendships, and enhance their social skills. In addition, four individuals discussed social isolation as a factor in their lives and the need for programs, like Very Special Arts, that provide social opportunities for peer interactions.
Table 2 The Relationship Between Respondent (self or parent/guardian) or Participant Age and Perceived Changes in Psychosocial Functioning Attributed to Participation in a Group-oriented. Community-based Art Program Chi-Squares with Continuity Correction Psychosocial change Respondent Age Value Signif Value Signif Interaction with peers 0.00 1.000 0.00 1.000 Willing to ask for help 0.00 1.000 0.07 0.786 Willing to help others 0.29 0.588 0.50 0.481 Willing to share 0.00 0.971 0.10 0.748 Ability to communicate 0.03 0.866 2.21 0.137 Wait for directions 0.02 0.900 0.00 1.000 Sit quietly and listen 0.00 1.000 0.01 0.947 Express thoughts/feelings 0.00 1.000 0.03 0.867 Feel important with peers 0.00 0.971 0.68 0.409 Confidence meeting new people 0.08 0.782 0.00 1.000 Describe accomplishments 1.46 0.226 0.07 0.794 Show what has been learned 0.00 1.000 0.49 0.484 Proud of accomplishments 0.00 1.000 0.03 0.868 Seen as more capable 0.29 0.588 0.50 0.481 Seen as more independent 0.29 0.588 2.31 0.128 Continuity correction for two by two table; DF=1; No items statistically significant at [less than] .05
[TABULAR DATA FOR TABLE 3 OMITTED]
Self-esteem. The individuals who were interviewed confirmed positive changes in self-esteem as a result of their arts experiences (80%, n=8). These individuals discussed pride in their artworks/performances as well as increased self-confidence as a result of their newly-discovered talents. 40% (n=4) of these people attributed involvement in additional activities outside of VSA to the confidence they gained through their arts experiences. For example, one 39-year-old woman with multiple sclerosis discovered her artistic ability while trying to cope emotionally with her physical limitations. The confidence she gained through the process of creating and selling her art led to a desire to pursue these talents further by enrolling in fine arts classes at a local college.
Unexpected themes. The authors hypothesized that the process of participating in group-oriented expressive arts activities would positively influence socialization and self-esteem. Therefore, structured interview questions focused on these issues. However, two additional and unexpected themes emerged during the interview process. Fifty percent (n=5) of the individuals interviewed talked about their arts experience as an activity which enhanced learning. For example, a mother related that her 16-year-old son with autism developed mathematic skills through the process of counting musical notes on a sheet of music. A 28-year-old man with cerebral palsy described art activity as having an even more basic educational value: "(art activity)...teaches people to work towards something...to have a goal." Personal expression was another valuable benefit attributed to group-oriented expressive arts activity. One parent commented that in contrast to the many "rules" in school and society which restrict individuals from self expression, VSA participation opened up some unique opportunities. For example, once her son was allowed the freedom to really move with the music he was playing, he opened up in other ways (e.g., socially).
New opportunities for success. Throughout the interviews, both individuals with disabilities and family members reiterated that individuals with disabilities receive numerous reminders (e.g., by schools and other agencies) of all the things they cannot do. Sixty percent (n=6) of the individuals stated that community-based art programming was one of the only opportunities for positive and supportive experiences. Adult participants in particular commented that opportunities in the arts are otherwise lacking for adults. One 59-year-old woman, who described herself as developmentally disabled, stated that until someone approached her to become involved in VSA Showtunes, she did not realize her talent in singing. (This woman spent the majority of the interview talking of her joy in music and voluntarily sang a few songs of her upcoming performance.)
Perceptions of others. The last part of the interviews focused on the perception of others towards the individual who became involved in a VSA program. All ten (100%) of the individuals interviewed believed their involvement positively influenced the way others view them. This was expressed in the recognition they received from friends and family members. Program participation also helped parents look for integrated activities for their child. As one mother of an eleven-year-son with autism and speech processing difficulties stated, "Sometimes when you're just getting used to having a child that's special, you don't always say 'Oh, he's just a regular kid'...and this kind of experience (VSA Festival) where you get to see him be 'just a regular kid', is very rewarding...and so you continue to look for these types of things for your child." In addition, VSA expanded the types of activities families would have ordinarily participated in: "You wouldn't think of (pursuing) things that the family does not participate in on a regular basis...and sometimes your child doesn't fit into (what you do participate in)...parents need opportunities like this to explore these things."
This preliminary data supports the intuitive logic that the process of participation in group-oriented community-based expressive art programming is associated with perceived improvements in psychosocial functioning. As hypothesized, positive psychosocial changes were perceived by the majority of expressive art program participants. Frequency of participation was statistically significantly related to a measure of social interaction (i.e., willingness to help others when they needed it). The duration (i.e., number of years) of participation was statistically significantly related to effective communication and enjoyment in sharing what had been learned from participation.
Analysis of structured interviews revealed that many individuals with disabilities lack opportunities to interact with peers on a social level. This was particularly true of adult participants who were out of school and lacked resources to identify programs that suited their needs and interests. Once these individuals were given opportunities for peer interactions, their social network expanded and even led to more interactions and involvement in other activities outside of Very Special Arts. Self-esteem improvement was attributed to VSA involvement by the majority of participants. Participants gained recognition for their accomplishments from friends and family members which also contributed to their self-esteem. In addition, VSA programs gave parents an opportunity to discover other interests their child may have as well as a chance to see their child be successful at something they really enjoy. Some concern was expressed regarding the visibility of programs such as VSA. In fact, a desire to learn more about expressive arts programs was one of the reasons which was given for agreeing to participate in a structured interview.
Several limitations of this study should be noted. The number of questionnaires returned was smaller than anticipated. Since the authors did not have direct control over distribution of the questionnaires (for reasons of confidentiality), follow-up to try to increase the number of responses was limited to encouraging local coordinators to participate. The substantial reliance on volunteers which is present in a free program such as VSA also complicated efforts at maximizing data collection. The responses received however include individuals from VSA programs functioning statewide rather than being limited to only one group or program in a specific location. Although the age ranges within the sample were diverse (i.e., both children and adults) and questionnaire responses were filled in by either arts program participants or a parent/legal guardian, no statistically significant differences on ratings of psychosocial change perceptions were noted based on either age or who filled in the questionnaire. While the authors acknowledge that responses regarding perceived changes could be influenced by a person helping to complete the questionnaire, the wording of questionnaire items (i.e., "I", "my") emphasized self-perceptions of the individual who participated in VSA programming. Interviews with a sub-sample of study participants provided a method to corroborate questionnaire responses. The interviews substantiated questionnaire information and allowed for more intense, expanded responses.
The data collected for this study was based on an author-developed self-report list of psychosocial functioning variables to which respondents were asked to note changes since participating in expressive arts programming. Therefore, the results have been described as "perceived changes" rather than "measured change" (e.g., actual change in behavior assessed by observation). The authors also acknowledge that although the results discuss "change", the study was not a pre-post design. Instead, the authors have obtained data regarding perceptions of the impact of program participation. This method is in essence a measure of satisfaction with services received. Although respondents were asked specifically to rate change since involvement with VSA programming, other factors which might have occurred since VSA involvement (e.g., changes in employment) could not be controlled for statistically.
In conclusion, there is evidence to suggest that participation in group-oriented community-based expressive arts programming for individuals with disabilities is related to perceived enhancement of social and communication skills. Expressive art activity in this study focused on group-oriented community-based activities and the process of creating art rather than on individual pursuits of self-expression resulting in a product. Therefore, group participation in expressive arts activities is one of the unique characteristics of this preliminary study. The authors recommend that future research regarding expressive arts and leisure consider not only the creative, self-actualizing aspects of creative endeavors in the arts and music, but also the socialization aspects of expressive art activity. Rehabilitation professionals are urged to consider the potential combined benefit of creative activity and socialization opportunities which are possible within group-oriented community-based expressive arts programming.
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|Publication:||The Journal of Rehabilitation|
|Date:||Jul 1, 1996|
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