Outcome-Focused Dance Movement Therapy Assessment Enhanced by iPad App MARA

Healthcare and human services are increasingly required to demonstrate effectiveness and efficiency of their programs, with assessment and evaluation processes more regularly part of activity cycles. New approaches to service delivery, such as the National Disability Insurance Scheme (NDIS) scheme in Australia, require outcome-focused reporting that is responsive to the perspectives of clients. Eco-systematic approaches to service delivery and assessment consider the client as part of an interconnected web of stakeholders who all have responsibility for and contribute to their development and progress. These imperatives provide challenges for modalities for which there are not well-established assessment approaches. Dance movement therapists face particular difficulties in this respect, as they have few assessment tools that are practical for regular use. Existing dance movement therapy (DMT) assessment approaches largely do not yet prioritize input from clients. This article addresses these challenges in reporting a trial of iPad app MARA (Movement Assessment and Reporting App) developed for assessment in DMT. MARA is applied in a program for adults with intellectual disability (ID) over 16 weeks. Assessment data is gathered utilizing the app's features: two researcher-therapists undertake quantitative scoring that MARA aggregates into graphs, substantiated by qualitative note-taking, photos, and videos; and clients provide feedback about their progress stimulated by viewing photos and videos. A sample graph generated by MARA and supporting notes and a report drawn from data are provided. Responses to reports from program stakeholders (12 participants, 12 families, 11 center staff) gathered through interviews and focus groups are discussed, and researcher–therapists' reflections are detailed. The benefits of using MARA reported by researcher–therapists include strengthened capacity to focus on participant outcomes, assess efficiently, plan and make decisions for the program, and communicate participants' progress to stakeholders. Family members perceive reports drawn from data gathered in MARA to be useful in enabling better understanding of the DMT program and participant outcomes and potentially to support NDIS service planning. Managers perceive the potential value of data in these reports for quality control and resource decisions, while other staff confirm the therapists' perspective that reports offer the possibility of improved communication and collaboration between center staff.


Appendix 2: Sample questionnaire for clients' parents/carers
Research project: Assessment for dance movement therapy across contexts and cultures: advancing trials of an iPad app QUESTIONNAIRE FOR CLIENTS AND PARENTS/CARERS 1.How easy or difficult was it for you to understand the assessment information in this report about your family member's progress in the therapeutic dance program?
☐ really easy ☐ quite easy ☐ difficult If you found it difficult to understand, was it that: ☐ too much information was provided ☐ not enough information was provided ☐ the terminology used was unfamiliar to me ☐ other -please explain…………………………………………………… 3. Did the assessment information provide you with any new information or insight about the dance movement therapy program or client/s' progress?

Data usefulness
• How could/does data generated through this process inform your work?
• What insights might be generated that are new and not obtainable through other assessment processes? • What is your perspective about the usefulness and relevance of the data generated for other stakeholders including clients, families/carers and other professionals?  This report is provided to support communication between our participants, their families and support staff to enrich participants' experience in the program. It includes information about the dance movement therapy program and its relationship to participants' NDIS and PCP goals. The final section offers the dance movement therapist's input about Angela's participation, and her own comments.

About the program
The dance movement therapy (DMT) program at Bayley House fosters the use of dance to address therapeutic goals meaningful to participants. It encourages enjoyment of all bodies' abilities to move and express through dance. The dance group aims to offers an accepting and safe space for participants to express themselves creatively and to support each other. It encourages self-awareness and ownership of each person's contributions and development. The program is informed by dance movement therapy and neuroscientific research which support the potential for dance and movement to enhance physical and mental health, emotional regulation, cognitive functioning and social skills.

Dance movement therapy sessions: what happens?
Each session comprises routine elements to support learning and personal development and to provide predictability and a sense of safety, including: 1. A greeting that incorporates symbolic movement and talk linked to participants' experiences or feelings for the day. 2. A warm up which isolates body parts and involves participants contributing a movement to the group. 3. Creative movement experiences to support objectives such as development of a wider range of movement dynamics, or social attunement skills. 4. Cool downs and stretches focussed on body awareness and integration, breath awareness and self-regulation. 5. Relaxation, experiencing stillness and rest to close the session.
Music is important part in the dance experience and is chosen to reflect the interests of the participants and to expose them to new genres and styles. Props are used to extend movement experiences and to support participants to recognise and connect with movement dynamics and conceptual themes. Music, props and variations in dance activities are designed to stimulate participants' interest and stretch cognitive and physical capabilities.

The relationship between dance and other areas of life
It is the intention of this dance program that the physical, expressive, emotional and cognitive gains participants may attain can transfer into other areas of their lives. For example, the ability to negotiate space more skilfully may enhance independence in daily life; while the ability to relax and release through practiced breath and stretching may provide tools for emotional self-regulation.

NDIS Outcomes, PCP Goals and Dance movement therapy objectives NDIS Outcomes
NDIS outcomes relevant to this program are: Independence, Social Inclusion, Health and Wellbeing.
The DMT program supports progress towards those outcomes through: -Independence: daily living skills are supported through increased physical health, strength and coordination -Social inclusion: development of social skills through shared dance experiences in a safe and supportive group setting. -Health and Wellbeing: physical and mental health are addressed through activities developing physical fitness and strength, and the ability to self-regulate through breath and movement work.

PCP goals
Angela's PCP Goals relevant to this program are: To build confidence and the ability to speak out.
The DMT program supports Angela's development of confidence and ability to speak out through strong emphasis on development of social skills and positive connections with others. By honouring both verbal and non-verbal communication, this program provides Angela with a range of communication tools to achieve positive connection and communication with others.
In dance movement therapy, Angela will have many opportunities to: -share news and greet others with verbal and movement-based communication; -work on creative movement activities in pairs and teams; -express herself creatively in a safe and supportive environment alongside her peers.

Dance movement therapy program objectives
-Fitness and Coordination: Increasing integration of body parts through varied movement experiences.
-Connection and Communication with others: Developing social attunement to others through shared dance and movement experiences For more information: If you would like to learn more about the dance movement therapy program, please feel free to contact Tessa Hens (on email xxx or after the session), who can provide readings and website links for further information.

Assessment: Dance movement therapist's observations Objective 1. Fitness and coordination, increasing integration of body parts through varied movement experiences:
Angela's confidence to participate in group routines and to experiment with new movement experiences is slowly growing as she settles into the group. She has a preference for light, small movements using her hands, arms and core. This term we have been experimenting with integrating body parts to move in and through space. For example, the group used a range of props to create their own dance obstacle courses which they moved through to different styles of music. Angela was able to demonstrate rhythmic walking, using high and low level movements and jumping (see film attached). She has also become more confident in sharing movement during our group greeting of improvised movement, and has demonstrated bi-lateral patterning with a strong dynamic using hand punches At the end of each session, cool down movements include a spinal roll (graduated forward roll through the spine), core twists, breath work and stretching. Initially Angela preferred to just dip her head and upper body forward. With gentle guidance through touch and mirrored modelling, Angela has achieved a deeper and more fluid forward fold, demonstrating the ability to extend her movements and integrate body parts more fully with support.

Objective 2. Connection and communication with others, developing social attunement to others through shared dance and movement experiences:
Angela is a quieter member of our group but has demonstrated the ability to take turns, listen to others, and offer her own news during group greeting, and contribute movement ideas to group warm ups. Her voice volume and confidence when interacting has begun to grow in the second half of this series of sessions. She has benefited from the support of her closer friends in the group who have helped her to settle into group routines with guidance and encouragement.
During partner and small group work, Angela demonstrates warm and sensitive connections with others using eye contact and gesture to check in with her peers. She has also worked in small teams effectively by offering ideas and listening to others to generate movement ideas and shapes. Angela has demonstrated an emerging ability to mirror movement with peers she feels comfortable with and with staff members. Angela is always calm and friendly in her interactions and her smiles indicate enjoyment of working in a supportive group setting.