Evidence-Based Practice in Early Childhood Music Therapy: A Decision-Making Process

As the choices for health care and intervention options increase and funding becomes more limited, practitioners working with young children with disabilities and their families need to decide which intervention options are most effective and compatible with clients' characteristics, culture, preferences, and circumstances (Buysse & Wesley, 2006). Vast quantities of literature and information of varied quality can make it challenging for music therapists, other health care professionals, and parents to identify the most suitable treatment option. To find the best available services and supports, music therapists need to ask themselves the following fundamental questions: "What works? Why does it work? For whom does it work? What might make it work even better? What else works?" (Mesibov & Shea, 2007, p. 13-14).Music therapists can learn from the field of medicine and early childhood education by looking into the definitions and criteria for treatments considered evidence-based practice (EBP) for the population they serve. The field of music therapy has not yet reached a consensus regarding a definition for EBP. Furthermore, quality Indicators for best available research evidence and levels of EBP have not been established (AMTA, June 2007). Nonetheless, Strain and Dunlap (n.d) point out that being an evidence-based practitioner is desirable, as it* maximizes beneficial outcomes for children and families by offering the best available intervention options,* responds to the accountability demands by providing data on one's position and practice,* expands one's own skills and competencies by staying current on latest developments and trends in the field,* enhances political and financial support from various stakeholders (i.e., administrators, policy makers, and funders) by providing evidence on the effectiveness of specific interventions, and* provides consumers with a rationale for the service by making sound recommendations on effective practice.Defining Evidence-Based PracticeTo understand EBP, one needs to initially look into evidence-based medicine (EBM). Evidence-based practice originated in medicine and emerged as a result of the gap often seen between research and practice. Health care professionals using evidence-based medicine agree on a patient's diagnosis, prognosis, treatment, or ways of preventing illness based on three different paths of knowledge: (1) evaluation of the best research evidence, (2) clinical expertise, and (3) patients' values (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).Currently each professional field defines EBP somewhat differently. For example, the field of psychology has defined EBP as "(...) integration of the best available research and clinical experience with the context of patient characteristics, culture, values, and preferences" (American Psychological Association, 2006, p. 273). The definition proposed by the early childhood field is "(...) a decision-making process that integrates the best available research evidence with family and professional wisdom and values" (Buysse & Wesley, 2006, p. 12). The preliminary definition drafted by the American Music Therapy Association reads "(...) the confluence of evidence from research as well as a) patient (client or student) preferences and needs, and b) clinician expertise and experience" (AMTA, June 2007, p. 1).Most professions have defined EBP as a process of finding the best available services and supports for the individual patient/client by acknowledging the three different paths of knowing presented in Figure 1 . The integration of these three components in the decision-making process creates evidencebased practice. However, a major discrepancy can be found in the criteria for "best available research evidence."Identifying the Best Available Research EvidenceConsumers often use the term EBP as a synonym for best available research evidence, empirically supported treatments, or scientifically valued practice (Snyder, 2006). …