ArticlePDF Available

The state of the arts in healthcare in the United States


Abstract and Figures

The arts in healthcare in the United States is a field emerged from grassroots beginnings in the mid-twentieth century. Through an overview of the field's development as well as consideration of practice, research, and educational structures, this paper summarizes the current state of the field in the United States. Practice is explored in the context of types of programs, recent field assessments, geographic prevalence of programs, funding mechanisms, and organization of the field. Research is considered in the context of evaluation, traditional research, economic studies, theoretical frameworks, and academic centers, as well as non-academic centers that support field research. The final section explores education and training standards and programs conducted by universities and non-academic organizations, and the roles of the arts and humanities in the education of health professionals.
Content may be subject to copyright.
This article was downloaded by:
[Sonke, Jill]
11 August 2009
Access details:
Access Details: [subscription number 913846505]
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK
Arts & Health
Publication details, including instructions for authors and subscription information:
The state of the arts in healthcare in the United States
Jill Sonke a; Judy Rollins b; Rusti Brandman a; John Graham-Pole c
a University of Florida Center for the Arts in Healthcare Research and Education, Gainesville, FL, USA b
Georgetown University School of Medicine, Washington, DC, USA c University of Florida Department of
Pediatrics, Gainesville, FL, USA
Online Publication Date: 01 September 2009
To cite this Article Sonke, Jill, Rollins, Judy, Brandman, Rusti and Graham-Pole, John(2009)'The state of the arts in healthcare in the
United States',Arts & Health,1:2,107 — 135
To link to this Article: DOI: 10.1080/17533010903031580
Full terms and conditions of use:
This article may be used for research, teaching and private study purposes. Any substantial or
systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or
distribution in any form to anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
The state of the arts in healthcare in the United States
Jill Sonke
*, Judy Rollins
, Rusti Brandman
and John Graham-Pole
University of Florida Center for the Arts in Healthcare Research and Education, Gainesville, FL,
Georgetown University School of Medicine, Washington, DC, USA;
University of Florida
Department of Pediatrics, Gainesville, FL, USA
(Received 12 January 2009; final version received 1 March 2009)
The arts in healthcare in the United States is a field emerged from grassroots beginnings
in the mid-twentieth century. Through an overview of the field’s development as well
as consideration of practice, research, and educational structures, this paper
summarizes the current state of the field in the United States. Practice is explored in
the context of types of programs, recent field assessments, geographic prevalence of
programs, funding mechanisms, and organization of the field. Research is considered in
the context of evaluation, traditional research, economic studies, theoretical
frameworks, and academic centers, as well as non-academic centers that support
field research. The final section explores education and training standards and programs
conducted by universities and non-academic organizations, and the roles of the arts and
humanities in the education of health professionals.
Keywords: arts in healthcare; practice; research; education; United States
This article is intended to provide an overview of the current state of the arts in healthcare
as a field in the United States, and is the second in a series of articles focusing on different
countries (Clift, et al., 2009). To contextualize current arts in healthcare practice, a brief
summary of the field’s development, including cultural and social circumstances that paved
the way, will be provided at the onset. The article will often reference frameworks for the
field that have been developed and defined by the Society for the Arts in Healthcare (SAH).
SAH, founded in 1991 and based in Washington, DC, is the largest multidisciplinary
advocacy and non-profit membership organization dedicated to advancing the arts as
integral to healthcare in the United States. SAH serves as an “umbrella” for the field at the
national level (and has members from another 14 nations), and provides resources for and
links arts in healthcare organizations and professionals around the globe.
The primary purpose of arts in healthcare is to use creative activities to lessen human
suffering and to promote health, in the broadest sense of the word. Art and art-making have
been shown to promote competence and self-efficacy; reduce boredom, anxiety and
depression, improve immune functioning; and promote coherence between the individual
and the world (Evans, 2008, 87). All healthcare practice is founded in observations or
clinical signs that are as much art as science, and that have been established and
systematized over many hundreds of years. This offering of skilled care is itself an art
form, just as much as the creation of works of beauty and form.
ISSN 1753-3015 print/ISSN 1753-3023 online
q2009 Taylor & Francis
DOI: 10.1080/17533010903031580
*Corresponding author. Email:
Arts & Health
Vol. 1, No. 2, September 2009, 107–135
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
The twentieth-century era of scientific medicine in the US witnessed immeasurable
and welcome advances. It is easy to forget that before the century that ushered in the
Flexner Report in 1910 (Beck, 2004), which created a system of formal medical education
to eliminate the prevalence of medical unorthodoxy that was still widespread in the
nineteenth century, blood-letting and purging were still common practices. However,
these huge advances in biomedical science also led to cure becoming the dominant goal,
relegating the giving of comfort and relief of suffering to strictly secondary roles. This
system of healthcare has been called a “broken model” (Gazella, 2004, p. 86), and is well
illustrated in the depersonalizing terminology of “healthcare providers and consumers”
that serves to highlight the business model of modern medical practice, perhaps especially
in the United States.
In response, over the past 50 years there has been a growing movement in the US
and elsewhere toward a more integrative healthcare model, one that addresses the
emerging dissatisfactions of both givers and receivers of care. This holistic paradigm of
healthcare recognizes the essential connection of body, mind, and spirit; it embraces
both individuals and communities; it is non-mechanistic and non-dualistic; and above all
it offers a sustainable worldview (Sperry, 1995, p. 7). There is a growing academic base
in the biological and behavioral sciences to uphold these concepts. For example,
changes in personal behavior and lifestyle have been shown in carefully designed
studies to be both highly effective and cost-effective in reducing heart disease and
cancer (Ornish, 2008, p. viii).
It is in this setting that creative activities and the arts therapies are finding their long
overdue place in modern Western healthcare. Arts-based researcher Elliot Eisner (1991)
sees the artistic use of language, or metaphor, as a precise and “central vehicle for
revealing the qualitative aspects of life” (p. 227). Anthropologist Ellen Dissanayake
(2000) recognizes art and ritual as universal human activities that are health-promoting for
both individual and community (p. 138). And art therapist Shaun McNiff (2008) sees the
researching of human experience through the arts as a way to integrate art and science in
service to others.
Development of a Field
The expressive arts therapies were first used for therapeutic intent in the US after World
War I (Serlin, 2008), and became formalized after World War II with the establishment of
the American Music Therapy Association in 1950. This was followed by the creation of
similar organizations focused on drama, dance, poetry, and the visual arts. Each of these
disciplines has defined training standards, including credentialing and monitoring, and
each shares the goals of integrating psychological, physical, and social functioning and
In the past 35 years, a more broadly based movement has emerged to introduce arts for
health within hospitals, hospices, and communities (Brandman, 2008; Deschner, 2005).
There is some overlap between these two disciplines, and expressive arts therapists and
artists in residence often work together and complement each other. The latter are careful,
however, to avoid any claim to formal diagnostic or therapeutic credentialing, but rather
seek to offer individual and communal healing in a broadly holistic sense and to create
more aesthetic environments for givers and receivers of care.
In the 1960s and 1970s, the US socio-political and cultural climate was favorable for
change. There was great dissatisfaction with a long and unpopular war in Viet Nam, and
pressure to broaden the concept of democracy to previously un-enfranchised groups
108 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
as manifest in the civil rights and women’s movements. This spirit of increased
inclusiveness was instrumental in the 1965 founding of the National Endowment for the
Arts with its mission of increased accessibility to the arts (Ivey, 2000). This in turn created
an environment that favored the development of programs such as Hospital Audiences
(HAI) and Very Special Arts.
The former, founded in 1969, responded to this spirit by bringing arts experiences to
populations in New York City that otherwise would not have had access to them, thus
mainstreaming these individuals (Hospital Audiences, 2008). The latter is now known as
VSA arts, with the VSA representing its mission: “Vision of an inclusive community;
Strength through shared resources; and Artistic expression that unites us all” (VSA Arts,
2006). VSA became affiliated with the John F. Kennedy Center for the Performing Arts in
1974. This organization is dedicated to providing and coordinating arts programs for
people with disabilities (VSA Arts, 2006). Although these organizations were not
concerned with using the arts as healing modalities per se, their existence was nevertheless
quite influential to the early development of the arts in healthcare field in general and to the
founding of the seminal hospital arts programs.
Following the creation of the above organizations, numerous arts in healthcare
programs emerged. The ensuing discussion will focus on programs that have been
particularly influential to the development of the field in some way, and a summary table
of programs relative to time of development is included. It should be noted that there are
many outstanding programs in addition to those that will be discussed.
Hospital Audiences was particularly influential to the development of what may be the
first hospital-based arts in healthcare program in the country. Two physicians at Duke
University Medical Center had experienced the impact of the arts in their own lives and
imagined that the same “healthy distractions” could be beneficial to the patients they
treated (Palmer, 2001). Following a visit with HAI in 1975, the pair implemented a
monthly performance series at Duke. By 1978, support from the National Endowment for
the Arts facilitated the establishment of the Cultural Services Program. This program was
re-named as the Health Arts Network at Duke (HAND) in 2003, and during the intervening
years the program grew to encompass regular activities in all performing, visual, and
literary arts as well as video, medical education, arts medicine and science, employee
programs, and networking (Palmer, 1991).
In 1976, several physicians and the hospital architect at the University of Iowa
Hospitals and Clinics were highly interested in developing a more humanized and
therefore healing environment. This interest led to the development of Project Art.
Initially, the program held monthly exhibits of carefully selected prints in public areas.
Other components were added later, such as a performing arts series, a traveling art cart
with framed prints and posters for customizing art in patient rooms, and art studio
workshops. Project Art also developed an impressive permanent art collection as will be
discussed (University of Iowa Healthcare, 2009a).
Another program aimed at providing an environment humanized by the presence
of art was spurred by interest from the Facilities and Interior Design departments of
the University of Michigan Health Systems. The founding of the Gifts of Art program
was established within a new hospital system in 1986 with consultation from Iowa’s
program leaders (Deschner, 2005). Like the program at Iowa, it also emphasized
exhibits and other art in the environment, continuing to focus on rotating rather than
permanent exhibits (Deschner, 2005). The program now features an outstanding art
cart program, performances, music at the bedside, and healing gardens (University of
Michigan Health System Gifts of Art Program, 2008).
Arts & Health 109
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
These three early programs were highly influential to the further development of the
field in the US through providing manuals, consultations, and contributing to the eventual
founding of the Society for the Arts in Healthcare by hosting national convocations and
symposia. These gatherings were instrumental in raising awareness of the emerging field,
of best practices, and in providing networking opportunities. In 1991, the earlier
convocations hosted by Duke, Iowa, and Michigan resulted in the establishment of the
Society for the Arts in Healthcare.
In the late 1980s, Shands Arts in Medicine (AIM) at the University of Florida began to
take shape. Like the other university hospital programs, it was spurred by individuals
within the system. Unlike the previous hospital programs discussed, this one began with
the presence of artists working directly with patients, family, and staff. A physician
interested in increasing the presence of arts and humanities in the education of future
physicians and a nurse who had experienced the healing power of participating in art
making and envisioned artists engaging patients in creative activity joined forces and,
studying earlier programs such as Iowa’s, devised the concept of the hospital artists in
residence program. AIM now operates according to a dual model that includes creating an
aesthetic environment as well as participatory art making guided by professional artists in
the visual, performing, and literary arts (Shands Arts in Medicine, 2008).
A different sort of organization influential to the development of the field was founded
in New York City in 1994. The Creative Center is an independent organization that serves
as a central hub supplying trained artists to 22 healthcare facilities in the city. One of the
program’s founders had been a social worker in a hospital bone marrow transplant unit and
therefore had witnessed the high degree of engagement exhibited by her patients with art
activities she introduced (Deschner, 2005). These experiences inspired the establishment
of the Creative Center as a community of artists, cancer patients, and survivors. (Deschner,
Having established itself as an identifiable field in the United States, the arts in
healthcare movement has taken a greater interest in networking, education, and research
and indeed the growth of the field has accelerated in both depth and breadth through
initiatives in these arenas. The number of arts programs for hospitalized patients has
increased greatly, and there has been a concurrent growth and development of arts for
recovery, rehabilitation, health maintenance, disaster relief, prevention of disease, crime
or substance abuse, for chronic conditions both physical and emotional, and for healthy
aging, to name a few related applications. Box 1 outlines the development of arts in
healthcare programs in the US from 1965 through 2009.
In 2008, the Society for the Arts in Healthcare undertook the task of creating a formalized
definition of the arts in healthcare that could provide both understanding and consistency
within and outside of the field. The task proved to be somewhat challenging due to the
highly multidisciplinary nature of the field and due to the breadth of practice in the US.
As this article was being written, the following definition was being prepared for
publication by SAH:
Arts in Healthcare is a diverse, multidisciplinary field dedicated to humanizing the healthcare
experience by connecting people with the power of the arts at key moments in their lives. This
rapidly growing field integrates the arts, including literary, performing, and visual arts and
design, into a wide variety of healthcare settings for therapeutic, educational, and recreational
110 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Box 1. Arts in healthcare developmental timeline.
1965 1975
NEA guidelines call for inclusiveness in accessibility to the arts (1965)
Hospital Audiences, New York, NY (1969)
Creative Alternatives of New York (1969)
American Art Therapy Association (1969)
VSA Arts (1974)
1976 1985
Commonwealth, Bolinas, CA (1976)
Duke University Hospital Health Arts Network (originally Cultural Services
Program), Durham, NC (1976)
University of Iowa Hospitals and Clinics Project Art, Iowa City, Iowa
(1976 78)
New Horizons, Children’s National Medical Center, Washington, D.C. (1978)
Aesthetics, Inc., San Diego, CA (1980)
Arts for People, Dallas, TX (1885)
1986 1995
University of Michigan Health Systems, Gifts of Art, Ann Arbor, MI (1986)
Big Apple Circus Clown Care, New York, NY (1986)
Arts for the Aging, Washington, DC (1988)
Caring at Columbia, New York, NY (1988)
Art for Recovery, University of California San Francisco, CA (1988)
Shands Arts in Medicine, Gainesville, FL (1990)
Society for the Arts in Healthcare, Washington (1991)
Art as a Healing Force, Bolinas, CA (1991)
Rhode Island Hospital and Hasbro Children’s Hospital Healing Arts
Program, Providence, RI (1991)
Music for All Seasons, Scotch Plains, NJ (1991)
San Diego Children’s Hospital begins art programs, San Diego, CA (1993)
Smith Farm Center for Healing and the Arts, Washington, DC (1993)
New York University establishes online Literature, Arts, and Medicine
Database (1993)
The Creative Center, New York City, NY (1994)
C. Everett Koop Institute at Dartmouth, Healing and the Arts, Hanover, NH (1995)
1996 2000
North Carolina Arts for Health, Durham, NC (1996)
Burlington City Arts partners with Fletcher Allen Hospital, Burlington,
VT (1997)
Moffitt Cancer Center Arts in Medicine, Tampa, FL (1997-8)
The Art of Elysium, Universal City, CA (1997)
Snow City Arts, Chicago, IL (1998)
University of New Mexico Hospital Arts in Medicine, Albuquerque,
NM (1999)
Center for the Arts in Healthcare Research and Education at the University
of Florida, Gainesville, FL (1999)
WellArts Institute, Portland, OR (2000)
Arts & Health 111
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
The definition reflects the Society’s and the field’s basic tenet that the arts contribute
positively to the well-being of individuals and communities. The field also operates from a
basic understanding that incorporation of the arts into healthcare can positively impact
patient health outcomes and can improve the ability of caregivers and organizations to
provide quality care. Within the field, professional artists and licensed arts therapists use
the arts as tools for addressing the psychosocial needs of patients, their family members,
and professional caregivers. Service populations are inclusive of these groups as well as
hospital visitors and whole communities. The field is oriented to addressing illness as well
as health through the arts, and engages individuals and communities both actively and
passively through arts activities, exhibits, and performances.
Types of Programming
As has been illustrated in our brief discussion of some early programs, the arts in
healthcare in America encompasses a broad array of unique programs and practices.
Although a comprehensive categorical list of arts in healthcare programs would exceed
that which this article can address, programming is generally grouped under the following
categories: (1) arts and aesthetics in the built environment; (2) bedside arts (including
individual, group, and public space activities); (3) performing arts in healthcare; (4) caring
for caregivers; (5) community arts for wellness; (6) arts therapies; and (7) the arts and
humanities in medical and other health provider education. Although there are seven
general areas of work in the field, facility-based arts in healthcare programs tend to have
one of two primary areas of focus from which they build: arts and aesthetics in the built
environment or artist-based programming. The former includes permanent collections,
rotating exhibits, interior design, healing gardens, and creative way finding. The latter
includes resident artists, volunteer artists, and visiting artists that provide bedside and
group services, as well as performing arts, in healthcare settings.
As previously noted, many arts in healthcare programs in the US began with a concern
for enhancing the physical environment of care. The modern architecture movement that
Box 1. Continued
Wake Forest University School of Medicine, Visual and Performing
Arts, Winston-Salem, NC (2000)
2001 2005
National Center for Creative Aging, Washington, DC (2001)
Arts Council of Central Louisiana Arts and Healthcare Initiative, Alexandria,
LA (2003)
Central Louisiana Arts Council teams with CAHRE, Shands AIM and the Red
Cross to offer disaster relief arts programs following Hurricane Katrina,
Alexandria, LA (2005)
Paramount Arts Center, HEARTS (Health Enriched by Arts) Program,
Ashland, KY (2005)
2006 2009
Upper Midwest Arts in Healthcare Network, Minneapolis, MN (2006)
University at Buffalo Center for the Arts, Arts in Healthcare Program,
Buffalo, NY (2008)
112 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
began in Germany between the World Wars had a significant impact on healthcare design in
the US in the twentieth century. Hospitals built between the 1940s and 1980s reflected the
clean, sterile lines and limited ornamentation of modern architecture, which also reflected
an emphasis on medical machinery and technology (Kellman, 1988). In the 1980s, the
healthcare design field and the new arts in healthcare movement began to engage art and
aesthetics as a means for transforming environments of care from sterile spaces meant to
facilitate the science of medicine to more comforting environments designed for the
comfort and well-being of people. Today, many arts in healthcare programs continue to
grow from and maintain a primary focus on the build environment of care.
Texas Children’s Hospital (TCH) in Houston, Texas, is one of the largest pediatric
healthcare systems in the US and is a flagship for creative healthcare design and for the
integration of children’s art into the experience and environment of care. The hospital’s
creative designs have won numerous awards and accolades. The hospital is committed to
using art to create a functional and aesthetically pleasing environment that supports the care,
experience, and outcomes for staff, patients, and their families (Healthcare Design, 2003).
In addition to its installations, TCH hosts an Arts in Medicine program that supports an array
of artists and arts activities. The arts at TCH provide an effective link between numerous
services, including among others, nursing, Child Life, Pastoral Care, and the Arts in Medicine.
The University of Iowa Hospitals and Clinics (UIHC) is committed to creating an
environment that promotes healing, and comforts and delights patients, visitors, and staff
through art (University of Iowa, 2009a). Since 1978, UIHC has been building its
permanent art collection as a part of its Project Art program. Project Art oversees the care
of more than 5,800 objects of art, including over 3,900 works of original art in a variety of
media, including drawing, printmaking, painting, sculpture, ceramic art, fiber art,
photography, and mixed media. The collection includes works by Iowa artists, Modern
American Masters, and Turkish Artisans, and features glass art and a World Cultures
collection. The collection is supported by gifts from patrons and artists, and purchases
supported by commissions from exhibition sales and hospital funds. UIHC also
participates in the State of Iowa’s Art in State Buildings program, which mandates that
half of 1% of the cost of major state construction projects is devoted to the acquisition and
exhibition of fine art (University of Iowa, 2009b).
The artist-based model of programming includes arts programs and services positioned
and managed within healthcare institutions as well as partnerships between healthcare
institutions and cultural organizations. Such partnerships include those with museums,
performing arts presenters, community arts agencies, arts schools and universities, and arts
in healthcare organizations such as The Creative Center in New York City. Hospital-based
Artists in Residence programs, such as those at Duke University, the UCSF Cancer Center,
Shands Hospital, and the University at Buffalo Center for the Arts, employ or contract paid
professional and volunteer artists to provide supportive creative services directly to
patients, their family members, and to professional caregivers in the healthcare setting.
These programs, and others like them, support resident artists that facilitate daily programs
and patient care, supervise volunteer artists, and work with clinical staff to address patient
needs and care plans.
The Snow City Arts Foundation in Chicago (described more fully in another article in
this issue) is an example of a unique program that maintains a focus on arts education in
healthcare. The organization was founded in 1998 and is committed to improving
comprehensive healthcare for hospitalized children by providing them with educational
outlets they lack due to their need for treatment. Serving numerous Chicago hospitals, Snow
City’s Artists in Residence provide workshops and individual sessions for hospitalized
Arts & Health 113
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
children in creative writing, music, painting, photography, and filmmaking (Snow City Arts,
2008). Snow City has developed unique relationships with Chicago area school boards to
ensure that children earn school credit for the art education they engage in while
hospitalized, and works to connect children with community arts programs after their
treatment is completed.
There are approximately 30,000 trained expressive arts therapists in the United States
(Malchiodi, 2005), and there is a considerable body of research speaking to the value of the
arts therapies in diagnostic assessment and in therapeutic rehabilitation (Feder & Feder,
1998; Malchiodi, 2005). Art therapy has evolved several theoretical approaches, including
psychoanalytical, cognitive-behavioral, and humanistic, and is used with children, adults,
families, and groups. Its parent organization is the American Art Therapy Association.
Music therapy uses psychodynamic, behavioral, biomedical, and humanistic approaches to
help in developmental issues, emotional and behavioral problems, palliative care, and
self-actualization. The American Dance Therapy Association is the parent organization of
dance/movement therapy, which is a well-established form of psychotherapy used in
developmental, physical, and palliative settings. It uses dance and movement to try to
integrate body, mind, and spirit through action-based and spontaneous activities. Drama
therapy and psychodrama use narrative and role-play to address various psychological
issues, particularly in relation to past trauma and abuse. The National Association for
Poetry Therapy was founded in 1981, and uses poetry and other literary forms to promote
self-expression, interpersonal and coping skills, and palliative therapy. In summary, the
expressive arts therapies are finding an increasing place in all healthcare environments in
the US, and have been shown to offer psychological and physical benefits to individuals
and communities from newborns to elders with a wide spectrum of health issues.
Recent Field Assessment
In 2004 and again in 2007, SAH partnered with the Joint Commission (the national
accreditation agency for healthcare) and Americans for the Arts (a national arts advocacy
agency) to conduct surveys that examined the presence and characteristics of the arts
programs in US healthcare facilities. The surveys were developed collaboratively by the
partnering organizations and administered by the Joint Commission to accredited
healthcare institutions throughout the US. The 2004 survey, with 2,333 respondents from
unique healthcare institutions, showed that nearly half of the responding institutions
hosted arts programs, and that the greatest prevalence of art activities in these programs
was in the permanent display of art such as paintings, murals, and sculpture (73%),
followed by performances in public spaces (49%) and healing gardens (32%).
In 2007, 1,807 institutions responded to a similar survey. Although the respondent base
was slightly smaller, results suggest growth in the field with an increase from 43 to 49% of
healthcare institutions reporting arts programs (see Figure 1). As in the 2004 survey, the
vast majority of 2007 respondents represented hospitals (61%), with long-term care
facilities at 5%, and hospice and palliative care organizations following at 4%. Music,
visual arts, and crafts were shown to be the most prevalent art forms represented
(see Figure 2); and once again, the permanent display of art was the most prevalent type of
programming represented, with performances in public areas following (see Figure 3).
An analysis of the types of professionals providing services in hospitals showed that
hospitals support nearly equal numbers of artists, arts therapists, and child life specialists.
A 2008 survey of SAH members (conducted by Americans for the Arts in partnership
with the Society) yielded a different prevalence in types of programs, suggesting that
114 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
many institutions that provide artist-based programming consider themselves to be a part
of the arts in healthcare field and affiliate themselves with the Society through
membership, while many other institutions that primarily undertake environmental arts
programming do not affiliate themselves with the field (see Figure 4).
As shown in Figure 5, the 2007 survey also explored the demographics of arts in
healthcare service populations. The data demonstrated that these programs serve
extremely diverse populations. Hispanic/Latino, Black/African American, and White
populations were the largest groups served and were represented in nearly equal
proportions ranging from 18 to 19%. Sixty of the survey’s respondents reported the
number of individuals served by their arts programs annually. Collectively, those 60
programs serve 2,213,690 individuals per year, suggesting an average annual service
population of 36,895 for arts in healthcare programs.
Both surveys were interested in identifying reasons why healthcare institutions invest
in the arts. In both 2004 and 2007, benefits to patients and contributions to a healing
environment were the top reasons cited across all types of institutions (see Figure 6).
Geographic Prevalence of Programs
Although there are certainly individuals in the US who may be practicing or planning
arts in healthcare programs without any knowledge of the existence of the field, sooner
Figure 1. Percent of Healthcare Institutions with Arts Programs.
Figure 2. Distribution of Arts Disciplines in 2007.
Arts & Health 115
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Figure 3. Types of Programs in 2007.
116 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
or later they will become curious and search for similar programs. A quick search on
the Internet will reward them with myriad peers. A search on December 17, 2008, for
artsþinþhealthcare using the Google search engine yielded 12,500,000 results (Dell
Search Results for artsþinþhealthcare, 12/17/08). As of the same date, the Society for
the Arts in Healthcare had approximately 1,700 members representing at least
582 different organizations (Society for the Arts in Healthcare, 2005– 2009).
As demonstrated in the 2004 and 2007 surveys, there are far more arts in healthcare
programs and practitioners in the US than are represented by SAH members. However,
in attempting to make a reasonable geographic quantitative analysis of prevalence of
the field, the authors applied information from the Society’s membership directory to
the US Census Bureau’s designation of US regions. In Box 2, the figures in parentheses
represent the number of individual members and the number of organizations,
respectively (members/organizations), in each state.
Figure 4. Types of Activities in 2008.
Figure 5. Arts in Healthcare Service Demographics.
Arts & Health 117
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Amongst the broad regions, the Northeast has the highest membership total (498) and
the most organizations (213), followed by the South with a membership of 395 individuals
representing 117 organizations. The West comes in third in terms of individual members
(287), but tops the South in numbers of organizations at 138. The Midwest has the fewest
members (270) and organizations (114).
On an individual state basis, the top five in terms of highest numbers of members are
New York (175), California (137), Pennsylvania (100), Florida (99), and New Jersey (71),
while the same ranking in terms of organizations registered with the Society is California
(72), New York (67), Florida (47), Pennsylvania (43), and New Jersey (33). A higher
prevalence of programs in the US are based in more urban areas and larger health centers.
In the past few years, recognition of the lack of programs in rural areas has become a
concern of SAH. As a result, the Society has offered online seminars on the topic of
developing programs in rural areas and, in 2008, the State of Florida Division of Cultural
Figure 6. Why Healthcare Institutions Invest in the Arts.
Box 2. US Members/Organizations, Society for the Arts in Healthcare, December 2005 2009.
Northeast Midwest South West
New York (175/67) Illinois (58/25) Florida (99/47) California (137/72)
Pennsylvania (100/43) Minnesota (47/17) Maryland (45/22) Oregon (48/13)
Ohio (43/16) Virginia (44/13) Washington (26/14)
Massachusetts (95/44) Michigan (30/12) Texas (33/11) Colorado (22/13)
Missouri (26/16) North Carolina (31/9) Arizona (19/7)
New Jersey (71/33) Wisconsin (20/10) Kentucky (29/13) Utah (9/6)
Connecticut (15/8) Indiana (17/8) Tennessee (25/9) Montana (9/3)
Maine (14/5) Nebraska (11/6) District of Columbia Nevada (9/3)
Rhode Island (11/4) South Dakota (8/5) (23/10) New Mexico (7/3)
Vermont (9/3) Iowa (7/4) Georgia (16/4) Alaska (7/2)
New Hampshire (8/6) North Dakota (3/1) South Carolina (15/8) Hawaii (2/1)
Kansas (0/0) Louisiana (11/5) Idaho (1/1)
Alabama (11/5) Wyoming (0/0)
Oklahoma (6/2)
Mississippi (5/1)
Arkansas (4/2)
Delaware (1/0)
West Virginia (1/0)
118 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Affairs dedicated funding to the development of a model for the development of arts in
healthcare programs in rural hospitals.
Funding Mechanisms
The 2004 and 2007 surveys administered by the Joint Commission in partnership with the
SAH and Americans for the Arts explored mechanisms of fiscal support for arts programs in
American healthcare institutions (see Figure 7). Surveyed US institutions were asked to
report on how their arts programs are funded and managed. In 2004, 40% of organizations
cited their organization’s operating budget as a source of funding for arts programs, while
in 2007 that percentage rose to 56%. This growth in internal funding marks a significant
increase in the support of arts programs by healthcare organizations. It also
signals increased stability for programming and an increase in the extent to which
healthcare institutions value the arts. Additionally, support from foundation and
endowments funds rose to match that of volunteer organization support. An increase in
the number of paid arts administrators was also indicated, signaling growth in the
professionalism of arts in healthcare programs.
In addition to funding mechanisms identified through the surveys, some institutions in
the US have developed very innovative methods for supporting arts programming. The Gifts
of Arts program at the University of Michigan Health System supports its programs through
revenue from numerous sources, including the sale of art in its galleries and from vending
machine revenue. Some programs also undertake product sales (such as greeting cards
featuring patient artworks) and fundraising events. It should be noted that, in the US, there
are no current proposals for direct billing or third-party reimbursements for the services of
healthcare-based artists in residence. There is, as is demonstrated in the recent survey data, a
clear trend toward arts services being supported by organizational budgets.
Organizing the Field
SAH is the most significant organizing entity for the field in the US (see Box 3). Although
the Society is based in the American capital, its vision is to be an international resource
uniting the arts and healthcare. As a convening organization, SAH hosts an annual
international conference and periodic symposia throughout the US. The Society works to
advocate for the arts in healthcare at the national level through active engagement and
Figure 7. How Programs are Funded.
Arts & Health 119
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
partnership with the National Endowment for the Arts, Americans for the Arts, the Joint
Commission, and numerous other national organizations and agencies as well as the
national legislative system. In addition, it provides an extensive array of supportive and
professional development services to the field, including a comprehensive website, grant
opportunities for members, organization of special interest groups, and its CREATE
Services, which encompasses consulting services, grants and awards, educational
programs, technical assistance, member networks, and exhibits all designed to aid in
professional and organizational development.
Defining Value: Research
The arts in healthcare movement in the US has grown considerably and rapidly over the
past several decades and with it, an increase in the call to measure results. “Measuring” is
occurring on two levels: evaluation and what is often referred to as traditional or basic
research. Technically, evaluation is a form of research, and confusion often arises between
the two because processes such as data collection activities (e.g. conducting surveys or
interviews) may look the same. However, in the traditional sense, researchers cite some
differences based on purpose, particularly the intended use of the findings.
With the exception of creative arts therapies research, program and project evaluation has
progressed at a faster pace than basic research activities. In the early years of the arts in
healthcare movement, it seemed to be enough for program personnel to justify their
existence by simply describing their observations and perhaps offering a quote or two from
satisfied and enthusiastic participants. Today, more formal program or project evaluation
is becoming the norm (Camic, 2008).
Summative or Outcomes Evaluation
Many of the US programs have supporting documentation, evaluations, surveys, and
patient and staff satisfaction data that form a large body of evidence on the practice and
success of these programs. For example, some programs use outcome studies measuring
patient satisfaction as a means to evaluating the effectiveness of using the arts in
healthcare settings; however, a handful of programs have conducted rigorous evaluations
that have gleaned much more information (see Box 4).
Box 3. The Society for the Arts in Healthcare.
The Society for the Arts in Healthcare achieves its mission to advance the arts as
integral to healthcare by:
Demonstrating the valuable roles the arts can play in enhancing the healing
Advocating for the integration of the arts into the environment and delivery of
care within healthcare facilities.
Assisting in the professional development and management of arts
programming for healthcare populations.
Providing resources and education to healthcare and arts professionals.
Encouraging and supporting research and investigation into the beneficial
effects of the arts in healthcare.
120 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Formative or Process Evaluation
An essential aim of evaluation is to provide information to improve future practice.
Although stakeholders may at times seem interested only in outcomes, program leaders
have found that learning how these outcomes come about is a critical element in project
improvement. A number of United States arts and health researchers (e.g. Graham-Pole &
Lander, 2009; Lander & Graham-Pole, 2006; Rollins, 2007) are turning to Appreciative
Inquiry (AI), an empowering method for understanding and improving an organization’s
programs, processes, products, policies, and systems (Preskill & Catsambas, 2006). For an
example, see Box 5.
Lander and Graham-Pole (2006) have applied AI and its teaching application,
Appreciative Pedagogy (AP) to palliate care research, education, and clinical practice.
With the theory that research into the experiences between patients and their caregivers
may improve communication, they have begun a systematic multicultural AI study based
on professional caregivers’ and students’ stories of loss.
Box 4. Evaluation of The Creative Center, New York, NY (KCI Research &
Evaluation, 2002).
In 2002, KCI Research and Evaluation conducted a year-long quantitative/qualitative
study of training and other program processes that took place in 2000/2001 in the
Hospital Artist-in-Residence (AIR) Program of The Creative Center in New York City.
The intent was to use the evaluation results to guide training of the AIRs as well as the
creation of the Training Program.
Sample. A total of 60 patients and 56 staff members from 5 of the 7 hospitals the
Creative Center serves.
Instruments. The evaluator, in consultation with the Executive Director and the
Coordinator of the AIR Program, with input from the artists, developed the criteria by
which patient satisfaction and patient outcomes were to be measured and provided the
basis for the development of the questionnaires. Two surveys were developed: a
26-item patient questionnaire and a 16-item staff questionnaire. Although the
instruments were designed to be self-administered, in many cases an interviewer would
need to assist the patient with completing the form.
Data collection and analysis. Questionnaires were disturbed or administered by four
carefully selected and well-trained interviewers. One interviewer was bilingual
Spanish English. The quantitative data were analyzed using the SPSS statistical
analysis software package; qualitative data were analyzed by the evaluator manually.
Results. Data from both patients and staff showed that The Creative Center’s major
objective of relieving patient feelings of boredom, anxiety, loneliness, and sadness was
achieved, with only 6 10% of respondents reporting these feelings after the artistic
experience, contrasted with 18 33% who reported them previously. Additionally, the
number of respondents who reported feeling “cheerful” doubled from 22% to 46%.
A secondary, but important, benefit was noted: making the caregiver’s job easier.
“A significant number of staff interviewed said that the patient was more willing to talk
about treatment options and/or responded better to treatment after the artist’s visit”
(KCI Research & Evaluation, 2002, 16). For the complete report, see www.thecrea
Arts & Health 121
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Basic Research
Much basic research in arts and healthcare in the United States has been qualitative.
Methods that convey information about patient, staff, and family responses to their
experiences and the healthcare environment are especially useful to healthcare
institutions because it is difficult to measure quantitatively emotions such as loneliness,
fear, joy, and relief (National Endowment for the Arts [NEA], 2003). Qualitative methods
Box 5. Appreciative Inquiry with Arts for the Aging, Bethesda, MD (Rollins, 2007).
Arts for the Aging (AFTA) provides free artistic outreach services to older adults in
more than 50 senior day care centers and nursing homes. Staff were eager to engage in
a participatory evaluation process to enable them to learn more about their
organization, to develop new evaluation tools to capture relevant data for current and
future programming and projects, and to further incorporate evaluation into everyday
activities. Incorporating Phase 1: Inquire of Appreciative Inquiry into their annual
artist/instructors’ meeting was a first step in the evaluation plan.
Sample. Twenty artists representing a variety of artistic disciplines music, creative
writing, visual arts, storytelling, dance.
Instrument and process. Each artist was asked to choose a partner and was given an
interview guide. The guide included three sets of core questions tailored to the specific
inquiry about their peak experiences, values, and wishes. Artists had 15 minutes to
interview their partner, and then reversed roles. After the 30-minute interview segment,
everyone reported out on his or her partner to the larger group. The evaluator analyzed
the data manually.
Results. Regarding characteristics that resulted in their greatest experiences, four
themes emerged: (1) Paying attention (45%), (2) Being open and flexible (50%), (3)
Being creative and innovative (30%), and (4) Pulling from all that they are (95%).
About the senior participants artists revealed two themes: (1) Being present with many
gifts, and (2) Being a teacher/role model. Concerning what they valued most about
AFTA and its programs, 55% pointed out that the organization truly honors age in a
society that does not, 50% mentioned personally feeling respected and valued, 15%
expressed appreciation for AFTA’s openness to innovation and new ideas, and 25%
were grateful for the practical support AFTA provides.
Three wishes that could make more exceptional experiences possible included more
collaboration/cooperation with the centers (45%), more financial resources that would
allow for more sessions, additional art supplies and musical instruments, further
development of their skills (50%), collaboration with other artist/instructors (25%), and
programming requests (40%) such as more intergenerational programming, expanding
program services to other geographic areas, or expanding their roles by training senior
center staff.
Results of the AI process provided AFTA with data about the characteristics to look for
when selecting new artists for their program, information about some issues to address
with the centers to which they provide services, and elements to consider for new
programming. Artists seemed empowered from engaging in the AI process and actively
participated in the development and implementation of the evaluation instruments and
data collection activities that followed.
122 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
are becoming more accepted in arts in healthcare research, particularly when
accompanying quantitative methods. Lander & Graham-Pole (2006) point out that
although qualitative research may seem to be an “orphan field” of evidence-based
medicine, “the bedside practice of every physician is founded in observation clinical
signs that have been gathered over several hundred years and systematically recorded
for every medial student’s classroom” (p. 13).
American and European researchers have found that qualitative methods can provide a
richness and depth in data that often is not captured using quantitative methods (Camic,
Rhodes, & Yardley, 2003). For example, researchers exploring the impact of an art
program on an inpatient oncology unit used semi-structured interviews with seven patients
and seven nurses who cared for these patients following participation in an established art
program (Ferszt, Massotti, Williams, & Miller, 2000). Findings revealed benefits such as
improved patient coping with pain, improved nurse-patient communication, and improved
attitude toward hospitalization.
However, because efficacy of any treatment or procedure in a healthcare setting is
generally proven by scientific methods and quantitative research, a limited amount of
this type of research, e.g. controlled investigation with a strict protocol and clearly
defined measures, is taking place in arts and healthcare research in the US. Findings
from quantitative research would likely capture more attention from hospital and other
healthcare institutions’ decision-makers and thus help practitioners garner more
credibility and support (NEA, 2003). The NEA (2003) offers three reasons for the lack
of controlled arts and healthcare research: (1) it is expensive and requires expertise in
research techniques and methodologies; (2) research studies are highly competitive for
support in institutions that are already experiencing budget cuts and tight resources; and
(3) medical and administrative staff members disagree as to the value of conducting
arts and healthcare research with the same models used in traditional healthcare
research (p. 11).
Nevertheless, controlled arts and healthcare research is being carried out in the United
States. One of the first studies with a control group was Gene Cohen’s two-year multisite
national study on the impact of professionally conducted community-based cultural
programs on the general health, mental health, and social activities of persons age 65 years
and older (Cohen, 2006). See Box 6 for an example of a short-term intervention study by
Noice and Noice (2004).
Box 6. Experimental Design with Control Groups.
A Short-Term Intervention to Enhance Cognitive and Affective Functioning in Older
Adults (Noice & Noice, 2004)
This study investigated the benefits of a short-term intervention for older adults that
targeted cognitive functioning and quality of life issues important for independent
Method. Participants (124 community-dwelling persons aged 60 –86 years) took part
in one of three study conditions: theater arts (primary intervention), visual arts (non-
content-specific comparison group), and no-treatment controls.
Results. After 4 weeks of instruction, those given theater training made significantly
greater gains than did no-treatment controls on both cognitive and psychological well-
being measures. A comparison of theater and visual arts training showed fewer benefits
in fewer areas for visual arts.
Arts & Health 123
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Economic Studies
In our current economic crisis, the healthcare dollar is increasingly dear. Although initially
arts in healthcare research focused only on outcomes for patients, families, and staff, today
savvy researchers are translating their findings into economic terms. For example, Cohen
(2009) compared medication use and doctor visits between individuals who participated
in a chorale group and the control group in his Creativity & Aging Study. He calculated an
annual savings of $172.91 per year per participant. Although this may not seem like a large
sum, if one considers the current and projected numbers of people in the aging population,
participation in creative activities can add up to big savings for Medicare, other insurers,
and individuals.
Other researchers are exploring the economic benefits of their findings on healthcare
staff. For example, Parrish Medical Center in Titusville, Florida, opened a new hospital in
2002. Two years later, a survey of 734 staff members found that the majority believe the
design features access to natural light, improved airflow, separation of public/patient
transport areas, and “homelike” patient room design positively affect the quality of their
worklife and help them provide care more effectively. As a result, staff turnover is now at
13% per year, compared to 20% annually in the old facility (Center for Health Design, n.d.).
Staff turnover, particularly nurse turnover, is a huge issue for hospitals. One study
found that the cost of registered nurse turnover ranges between $62,100 and $67,100 per
nurse (Jones, 2005). Alongside nurse retention is the issue of the nursing shortage, which is
slated to persist through the next two decades, with demand growing at 2 –3% per year
(Buerhaus, Staiger, & Auerbach, 2009). Increasingly, hospitals and other health care
organizations are developing and implementing strategies to retain the valuable nurses
they hire (Christmas, 2008). Thus, arts in healthcare research that highlights economic
benefits will likely play a larger role in the growth of the field in years to come. Conserving
nursing resources is another economic issue. Walworth (2005) conducted a comparative
analysis that examined the cost-effectiveness of music therapy as a procedural support in
the pediatric healthcare setting that resulted in findings with implications that addressed
this issue. See Box 7 for details.
Theoretical Frameworks
In a recent article in this journal, Cohen argued that sometimes the evidence or outcomes
demonstrating success is not enough for results to be taken seriously: “If there is not an
understanding of the underlying mechanism to explain why the results happened, then no
matter how robust the findings of the research, they could be dismissed”(Cohen, 2009, p.48).
As arts in healthcare research activities become more sophisticated, investigators are
paying more attention to theory. For example, Cohen’s Creativity & Aging Study (2006)
builds upon two major bodies of gerontological research theory: (1) Sense of Control, and
(2) Social Engagement.
Other studies are applying theories of psychoneuroimmunolopy (PNI), a
transdisciplinary scientific field concerned with interactions among behavior, the immune
system, and the nervous system (Solomon, 1996). For example, Walsh, Radcliffe, Castillo,
Kumar, and Broschard (2007) tested the effects of an artmaking session on reducing
anxiety and stress among family caregivers of patients with cancer using a saliva sample
from each participant to measure salivary cortisol, which indicates stress levels, and asked
them to complete the Beck Anxiety Inventory (BAI). A two-hour artmaking session
followed pre-testing. Post-tests included a repeat BAI and a second saliva sample. Anxiety
was significantly reduced after the artmaking session.
124 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Perhaps one of the most highly developed theoretical bases in the US is that employed
by designers of healthcare environments. The field of environmental psychology, the study
of transactions between individuals and their physical settings (Gifford, 1987), involves
issues such as control, privacy and social interaction, personal space, territoriality, and
comfort and safety (Shepley, 2005). Although most design professionals are not trained as
environmental psychologists, increasingly more are applying theories from the field to
their healthcare work. For example, the Press-Competence model (Lawton & Nahemow,
1973) is frequently considered when developing healthcare environments. This theory
suggests that the more compromised patients are with regard to their physical or emotional
health, the more susceptible they may be to negative aspects of the physical environment.
Today, many hospitals throughout America feature both abstract and realistic artwork.
The use of abstract art is frequently substantiated by various color theories
Box 7. Procedural-Support Music Therapy in the Healthcare Setting:
A Cost-Effectiveness Analysis.
This study examined the effectiveness of music therapy in eliminating the need for
sedation and reducing distress in pediatric patients receiving inpatient and outpatient
non-invasive procedures and determined the cost-effectiveness of music therapy as
procedural support.
Sample and procedure. Over a one-year period, all music therapy-assisted pediatric
echocardiograms (ECG) (n¼92, ages 6 months to 7 years), computerized tomography
(CT) (n¼57, ages 1 month to 9 years), and other procedures, such as IV insertions
(n¼17, ages 18 months to 11 years) at a general medical hospital were evaluated to
determine the success rate of completing each procedure without the need for sedation.
Live music therapy techniques that provided distraction were used for the children
undergoing echocardiograms and other procedures, while techniques that induced
sleep were used for the children undergoing CT scans.
Data analysis. Interventions were considered successful if the behaviors elicited by a
patient did not interfere with the procedure and if the procedure was completed without
Results. There was a 100% success rate of eliminating the need for sedation for
pediatric patients receiving ECGs, an 80.7% success rate for pediatric CT scan
completion without sedation, and a 94.1% success rate for all other procedures.
Economic benefits. When interventions were successful, no registered nurses were
required to be present to assist. Cost analysis on the ECG patients alone for the 92
patients was $76.15 per patient, totaling $7,005.80. This cost is based on the following
The RN was not required to assist, eliminating $55 per procedure.
The sedation cost of $9.45 per dose was eliminated.
The sonographer time was reduced from 1 hour to 20 minutes, decreasing the
cost of the sonographer from $23.00 to $5.75 per procedure.
The cost of the music therapist averaged $5.55 per procedure.
The year-long project resulted in 184 RN-hours saved for other duties, and with an
average of 20 minutes per procedure, the equipment and staff could be scheduled for
three times as many procedures as previously, and space in recovery rooms was
Arts & Health 125
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
(Tofle, Schwartz, Yoon, & Max-Royale, 2004). Appleton’s prospect/refuge theory (1975),
although not entirely substantiated, is often used to explain certain individuals’ preference
for nature scenes in artwork and gardens in healthcare settings. The theory states that taste
in art is an acquired preference for particular methods of satisfying two inborn desires
opportunity (prospect) and safety (refuge), circumstances believed to be optimal for
Box 8. The United States Academic Centers for Arts and Healthcare Research.
Center for the Arts in Healthcare Research and Education (CAHRE)
The University of Florida’s CAHRE, Gainesville, FL, is committed to advancing
research, education, and practice in the arts in healthcare, locally and globally.
Regarding research, Co-Directors and committee members conduct research projects
that study the effects of the arts in healthcare on individual, collective, and institutional
levels. CAHRE encourages research and scholarship in the field by providing a
framework and other support for studies by individual researchers as well as effecting
its own projects. Research goals include expansion of the current body of research in
the field, development of appropriate measurement tools, and the facilitation of related
research throughout the nation.
The Arts and Quality of Life Research Center
The Arts and Quality of Life Research Center, Boyer College of Music and Dance,
Temple University, Philadelphia, PA, promotes research, training, and innovative
programs that demonstrate the unique role of the arts in making a difference in people’s
lives. To this end, the Center focuses on exploring uses of various creative arts to
enhance human functioning, developmentally, intellectually, psychologically, socially,
physically, aesthetically, and spiritually.
The Art/Global Health Center at UCLA
Located at the University of California Los Angeles, The Art/Global Health Center is
committed to supporting and developing scholarship focused at the nexus of art and
health; to fostering interdisciplinary interaction among artists, public health workers,
and medical professionals, at UCLA and beyond; to creating new opportunities for
engaged scholarship; and to reuniting the consideration of art and health around the
globe. These objectives are currently pursued through the Center’s major initiative
The Center on Aging, Health & Humanities
The Center on Aging, Health & Humanities at the George Washington University in
Washington, DC, establishes programs focused on understanding, studying, and
promoting creativity that accompanies aging. The Center coordinates a major research
program focused on creativity and aging and houses the Creativity Discovery Corps, a
new program targeting the creative efforts of three groups: creative older persons
themselves; programs that creatively foster the release of human potential in older
individuals; and volunteers who are creative in their efforts to promote both the
visibility of talented older persons and the best practices of programs that help older
persons to be creative.
126 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
human survival and reproduction in the savannah. The theory proposes that humans
respond to such things as art subconsciously and that individuals attracted to such
circumstances would have stood a better chance of survival by choosing to spend time in
such places. Thus, the theory implies, art that puts the viewer in between prospect-
dominant and refuge-dominant areas will be most appealing.
Academic Centers
As research in the field of arts in healthcare has progressed, some universities have made a
commitment to research in this field by developing centers devoted to this research topic.
A sampling of such academic programs in the US is offered in Box 8.
Non-Academic Organizations That Promote Arts in Healthcare Research
A growing number of non-academic organizations promote arts in healthcare research. In
addition to the Society for the Arts in Healthcare described earlier, other active
organizations are described in Box 9.
Education and Training
In the climate of the twenty-first century, continued growth and development in the arts in
healthcare has spurred the development of education and training programs. While degree
programs have not yet developed, numerous institutions in the US, including academic
institutions and non-academic organizations, are addressing education and training for
field practitioners and for organizers.
Professional Standards and Credentials
As has been noted, the arts in healthcare encompasses a wide array of practices. These
practices are facilitated by an equal array of professionals, including:
.professional artists,
.community artists,
.arts educators,
.arts administrators,
.healthcare administrators,
.physicians, nurses, and other health professionals,
.medical and other researchers,
.arts therapists, expressive arts therapists, and occupational therapists,
.child life specialists,
.artists, architects, and designers,
.psychiatrists, psychologists, mental health counselors, and social workers.
Arts in healthcare services are also commonly delivered by volunteers, including
artists, community crafts people and performers, medical students, and students of the arts.
While formalized credentials or licensing have not yet been established for practitioners in
the field, general standards for practitioners do exist. In 2005, the Arts in Healthcare
Advocates, a group made up of the directors of long-standing US programs, gathered to
develop a white paper entitled Arts in Healthcare Programs and Practitioners: Sampling
the Spectrum in the US and Canada that describes a sampling of programs, including
structures and staffing (Deschner, 2005). The work of the Advocates led to some common
consideration of hiring standards for artists, which are reflected in the guidelines set in
Arts & Health 127
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Box 9. A Sampling of Non-Academic Organizations Promoting Arts and
Healthcare Research.
Center for Health Design
The Center for Health Design (CHD), Pleasant Hill, CA, is a non-profit organization
that supports, develops, and disseminates information and research that demonstrate
how supportive environmental design enhances health and well-being. Since 1988,
CHD’s focus has been on healthcare facilities. CHD offers technical support, a
healthcare design action kit, research reports (including Ulrich and colleagues’ (2004)
report of the role of the physical environment in the hospital of the twenty-first
century), a journal of healthcare design, a booklist, a directory of products, and a list
of exemplary facilities in the United States. Of special interest is the Pebble
Project research project that provides examples of healthcare organizations whose
facility design has made a difference in the quality of care and financial performance.
National Endowment for the Arts
The National Endowment for the Arts (NEA), Washington, DC, is a public agency
dedicated to supporting excellence in the arts, both new and established; bringing the arts
to all Americans; and providing leadership in arts education. Established by Congress in
1965 as an independent agency of the federal government, the Endowment is the nation’s
largest annual funder of the arts, bringing great art to all 50 states, including rural areas,
inner cities, and military bases. NEA has arts in healthcare as one of their leadership
initiatives. In addition to resources on their website, the organization has held
symposiums on the topic and recently hosted an arts in healthcare research roundtable,
the second in a series of meetings the Office of Research & Analysis is convening to
bring together arts and culture researchers to discuss trends and issues facing the field.
National Association of Children’s Hospitals and Related Institutions
The National Association of Children’s Hospitals and Related Institutions (NACHRI),
Alexandria, VA, is an organization of children’s hospitals with 218 members in the US,
Canada, Australia, UK, Italy, China, Mexico, and Puerto Rico. Children’s hospitals
work to ensure the health of all children through clinical care, research, training, and
advocacy. The organization recently released a new publication, Evidence for
Innovation: Transforming Children’s Health Through the Physical Environment
(2008). This report, developed in partnership with the Center for Health Design,
presents a scientific review of 320 articles in the literature and the business case for
evidence-based design.
Society for the Arts in Healthcare
In addition to offering research resources on the website that include a link to the
CAHRE research database, the Society, based in Washington, DC, has an active
Research Committee, a Research Special Interest Group, a consulting service
(SAHCS), webinars, the American Art Resources and Society for the Arts in
Healthcare Research Grant, and a research award for completed published research.
Research and evaluation also are promoted through the rigorous requirements of the
Blair Sadler Award, which is presented annually at the Society’s spring conference.
128 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
place by Shands Arts in Medicine, a program that employs 14 professional artists in
residence. Through anecdotal experience, the authors believe that these guidelines may be
generally representative of the field at large. Shands requires artists in residence have a
minimum of a bachelor’s degree in a related field or demonstrated equivalent professional
artistic experience outside the educational setting. Artists must complete a related training
program and demonstrate an understanding of the complexities of the clinical setting, or
have at least one year of previous professional experience working in a healthcare setting.
New artists are also required to complete the Shands Arts in Medicine mentoring program.
Program-based Training Models
There are myriad trainings and certifications in specific practices closely related to arts in
healthcare practice, such as the Clown Care training of the Big Apple Circus (Children’s
Hospital Boston, 2009), the International Harp Therapy Training Program (IHTTP) (n.d.),
and Anna Halprin’s long-standing training programs at the Tamalpa Institute (Halprin,
2000, 15). The Creative Center in New York has developed a long-standing National
Training Program (The Creative Center, n.d.) for hospital artists in residence. The program
provides professional training to artists focused on work with cancer patients in medical
centers, clinics, and hospitals. The one-week program includes seminars, workshops, and
open studios led by artists, physicians, nurses, and psychologists from New York
educational and medical centers; and features internships at major medical centers.
Most hospital arts programs provide structured individual mentorship to new artists in
residence and develop their own training programs and materials. For example, Duke’s
program created a Hospital Arts Handbook, and The Creative Center published and sells a
guide entitled Artists-in-residence: The Creative Center’s approach to arts in healthcare
(Herbert, Waggoner, Deschner, & Glazer, 2006). A number of established programs,
including the University of Iowa and Shands Arts in Medicine, offer structured site visits
for consultation to guide new programs in establishing training mechanisms.
Professional development in the field is undertaken by the Society for the Arts in
Healthcare, the National Center for Creative Aging (NCCA), the North Carolina Arts for
Health, andthe various arts therapies associations. In addition to the professional development
services described earlier, the Society for the Arts in Healthcare has an extensive ToolBox of
resources on their website for program development, management, and expansion (Society
for the Arts in Healthcare, 2005–2009). The North Carolina Arts for Health network
implemented a training institute in 2003 and has revised the format for 2008 that is aimed at
renewing creative energyfor arts in healthcare practitioners and providing insightsinto the use
of the arts within the healthcare system and the state of the eld in North Carolina.
University-based Training and Curricula
As professionalism increases in healthcare-based arts programs, so does the demand for
academic training and credentialing. Employers and practitioners alike are looking for
more in-depth training and documentation of that training. Although, as noted above, there
are no accredited degrees offered currently in the US in the arts in healthcare, several
universities have developed curricula and certificate programs. These programs will be
described as distinct from arts and humanities curricula in medical schools, which will be
discussed in the next section.
University courses in arts in healthcare topics range from special offerings to stable
components of ongoing curricula. The earliest coursework was developed at the
Arts & Health 129
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
University of Florida in the College of Fine Arts by the Center for the Arts in Healthcare
(CAHRE). In 1996, CAHRE developed the Dance in Medicine course, which has since
expanded into a 12-credit certificate program (CAHRE, Courses, n.d.). CAHRE currently
offers at least 11 arts in healthcare courses per academic year in four colleges at UF (see
Box 10), including opportunities for overseas study (CAHRE, Study Abroad, n.d.).
CAHRE’s new Arts in Healthcare Certificate, a 12-credit program, is designed to be
earned by UF and non-UF students as well as professionals.
Since 2001, CAHRE has offered the Arts in Healthcare Summer Intensive, a three-
week comprehensive training program for arts in healthcare practitioners, administrators,
and healthcare providers. The program covers both theory and practice, including guided
clinical experience with Shands Arts in Medicine. Students may elect to an emphasis on
clinical practice, administration, or a combination of both (CAHRE, Summer Intensives,
n.d.) and can earn academic or continuing education credits. In 2007, CAHRE partnered
with the University at Buffalo Center for the Arts to develop a new annual summer
intensive training program at UB, which in 2009 will expand to include an advanced
clinical practice track for professionals.
Montgomery College in Silver Spring, MD, offers a course entitled “Artists in
Hospitals, designed to introduce artists to work in healthcare settings. The course includes
supervised hospital visits and is taught by Dr. Judy Rollins who also teaches “Arts for
Children in Hospitals” for medical students at Georgetown University (Society for the Artsin
Healthcare, 2005– 2009). Georgetown University School of Medicine is currently in the
process of planning the development of a Center for the Arts and Humanism in Medicine.
Arts in Medicine I at the University of New Mexico is a service learning course dealing
with the ways creativity and the arts impact healing and are used in the arts in healthcare
field. It includes informational sessions, arts workshops, and clinical projects based in the
UNM hospitals, Psychiatric Center, Cancer Research and Treatment Center. Students may
receive credit through the appropriate arts discipline and the service learning is
individually contracted (University of New Mexico, n.d.).
The Arts in the Education of Health Professionals
Modern evidence-based medicine has evolved an increasingly specialized focus, with the
narrowly defined outcomes and interpretations of clinical trials as its gold standard. This
has its origin in the United States in the publication of the Flexner Report in 1910
(Beck, 2004), describe earlier. No one today would question the dramatic advances in
Box 10. Arts in Healthcare Courses Offered by the University of Florida.
Introduction to the Arts in Healthcare
Arts in Healthcare Clinical Practice
Dance in Medicine
Dance Clinical Practice
Writing and Healing: Process and Practice
Music and Health
Spirituality and Creativity in Healthcare
Reflective Writing
Culture, Health, and the Arts: Sub-Saharan Africa and the US
The Arts and Healing in Europe and North Africa (Study Abroad)
Arts in Healthcare Service Learning in the Gambia (Study Abroad)
130 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
medical science and practice that ushered in this era of high-tech medicine. But in seeking
to eliminate scientific unorthodoxy and bias, medical science also came to largely discount
the vast store of “subjective” psycho-socio-spiritual experience that is the essential story
of human suffering and healing. The modern medical student spends several years learning
that everyone’s physiology and pathology is essentially the same, only to find out very
early in practice that we are all in fact quite different (Platt, 1965). It is in failing to account
for this individual uniqueness that evidence-based medicine has fallen short. And it is in
the incorporation of the arts and humanities into medical and nursing education that the
system asserts an intention to return a more holistic view to the practice.
As more subjective, patient-centered approaches have evolved at the bedside and in the
clinic, so too has humanism found an important place in medical education. Training
programs in the medical humanities and narrative medicine have become ubiquitous in the
US, the UK, and elsewhere (Charon et al., 1995; Coles, 1979; Greenhalgh & Hurwitz,
2004; Hunter, 1991; Jones, 1997; Kleinman, 1988). Pioneered in the 1970s and 1980s,
these programs have since infiltrated mainstream US medical education, although they
remain elective in most curricula, and are also becoming more prevalent in nursing
Medical humanities is a broadly inclusive term that incorporates the fields of
humanities (literature, ethics, philosophy, and religion), the social sciences (anthropology,
psychology, and sociology), and art (music, theater, and the visual arts). Because they
reflect every aspect of our world, the medical humanities are ideally suited to help in
interpreting our whole subjective experience of illness, suffering, and healing. This is
reflected in the extraordinary outpouring of all forms of arts representation concerned with
human health and illness, particularly in the fields of literature and the dramatic arts, both
for professional and lay audiences/readership. “On Doctoring, an anthology of medical
literature first published nearly 20 years ago, included more than 100 contributions from
over 70 writers, from the Bible until the modern day (Reynolds & Stone, 1991). This genre
of writing by and about doctors and other health professionals continues to burgeon. Many
medical professional journals now include sections devoted to poetry, patient stories, and
personal vignettes and reflections on the subjective and narrative aspects of illness.
Arts programs have developed within the medical schools of numerous major research
universities, including Harvard Medical School’s nine-week course in partnership with the
Museum of Fine Arts, Boston; Yale School of Medicine’s partnership with the Yale Center
for British Art; a new “mini-elective” course offered by the University of Pittsburgh
School of Medicine with the Carnegie Museum of Art and Andy Warhol Museum; Tufts
University School of Medicine’s partnership with the School of the Museum of Fine Arts;
and the Frick Collection program with the Weill Medical College of Cornell University.
Courses are offered at these and other universities, including Tulane University, Stanford
University, Emory University, the University of Florida, the University of Connecticut,
Columbia University, and the University of California, San Francisco, to name a few.
Medical schools that have incorporated visual art programs into their curriculum have
proven the value of such educational approaches through research. A study by Joel Katz
and Shahram Khoshbin from the Departments of Medicine and Neurology at Harvard-
affiliated Brigham and Women’s Hospital is published in the Journal of General Internal
Medicine (July, 2008), and an earlier study by Yale Medical School’s Irwin Braverman,
M.D., professor of dermatology, former student Jacqueline Dolev, M.D., and Linda
Friedlander, curator of education, Yale Center for British Art is detailed in Journal of the
American Medical Association (September 5, 2001). Katz and Khoshbin found that
students receiving the training were likely to make more observations than those in the
Arts & Health 131
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
control group, and showed stronger visual acumen through greater accuracy, complexity,
and sophistication in what they observed. Braverman, Dolev and Friedlander found that
students who received the training improved their detection of details by 10%, while
control groups showed no improvement in detection of details.
Final Reflections and Recommendations
The arts in healthcare has emerged as a significant field and as a recognized component of
the healthcare systems in the United States over the past half century. Although
advancements in professional practice, research, education, and organization of the field at
the national and international levels are significant, coordinated efforts are required for
continued growth and for stability of the field. To maintain its growth trajectory,
particularly in light of the current widespread budget cuts in healthcare, the field must
undertake coordinated efforts in developing a body of research that documents and
articulates the impact and value of the arts for patients, caregivers, healthcare systems, and
communities. This body of research must appeal to the broad spectrum of healthcare
professionals, including administrators and policy makers, and address the business case
for the arts in healthcare. As our aging populations grow and our economy changes, the
costs associated with healthcare become central and critical issues. Arts in Healthcare
studies should address cost-effectiveness and return on investment as well as the impact of
the arts on the health and well-being of individuals and communities. Only as the body of
research grows to include economic evidence of the value of the arts in healthcare will
development of the field benefit not only from individual and organization efforts, but
from policy-related achievements as well.
Appleton, J. (1975). The experience of landscape. London: John Wiley.
Beck, A. (2004). The Flexner Report and the standardization of American medical education.
Journal of the American Medical Association,291, 2139 2140.
Brandman, R. (2008). The development of the contemporary international arts in healthcare field.
In J. Sonke-Henderson, R. Brandman, I. Serlin, & J. Graham-Pole (Eds.), Whole person
healthcare: Volume 3: The arts & health (pp. 43 65). Westport, CT: Praeger.
Buerhaus, P.I., Staiger, D.O., & Auerbach, D.I. (2009). The future of the nursing workforce in the
United States, data, trends and implications. Boston: Jones and Bartlett.
Camic, P.M. (2008). Playing in the mud: Health psychology, the arts and creative approaches to
health care. Journal of Health Psychology,13, 287 298.
Camic, P., Rhodes, J., & Yardley, L. (Eds.). (2003). Qualitative research methodology in
psychology: Expanding perspectives in methodology and design. Washington, DC: American
Psychological Association.
Center for the Arts in Healthcare Research and Education, Certificates. Retrieved December 22,
2008, from
Center for the Arts in Healthcare Research and Education. Courses. Retrieved December 22, 2008,
Center for the Arts in Healthcare Research and Education. Summer intensives. Retrieved December
12, 2008, from
Center for Health Design (n.d.). Pebble Project data summary. Retrieved December 17, 2008, from
Charon, R., Banks, J.T., Connelly, J.E., Hawkins, A.H., Hunter, K.M., Jones, Montello, M., et al.
(1995). Literature and medicine. Annals of Internal Medicine.122, 599 606.
Children’s Hospital Boston. (2009). Big Apple Circus Clown Care Program. Retrieved on January 4,
2009, from
Christmas, K. (2008). How work environment impact retention. Nursing Economics,26(5),
132 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Clift, S., Camic, P.M., Chapman, B., Clayton, G., Daykin, N., Eades, G., et al. (2009). The state of
arts and health in England. Arts and Health: An International Journal for Research, Policy and
Practice,1, 635.
Cohen, G. (2006). The creativity and aging study: The impact of professionally conducted cultural
programs on older adults. Retrieved December 17, 2008, from
Cohen, G. (2009). New theories and research findings on the positive influence of music and art on
health with ageing. Arts and Health: An International Journal for Research, Policy, and
Practice,1(1), 4862.
Coles, R. (1979). Medical ethics and living a life. New England Journal of Medicine,301, 444 –446.
Dell Search Results. Retrieved December 17, 2008, from¼
Deschner, J.W. (2005). Arts in healthcare programs and practitioners. Sampling the spectrum in US
and Canada. White paper 1. New York: Center Colloquium Group. Retrieved January 20, 2009,
Dissanayake, E. (2000). Art and intimacy: How the arts began. Seattle: University of Washington
Eisner, E. (1991). The enlightened eye: Qualitative inquiry and the enhancement of educational
practices. New York: Macmillan.
Evans, J.E. (2008). The science of creativity and health. In J. Sonke-Henderson, R. Brandman,
I. Serlin, & J. Graham-Pole (Eds.), Whole person healthcare: Volume 3: The arts & health
(pp. 87105). Westport, CT: Praeger.
Feder, E., & Feder, B. (1998). The art and science of evaluation in the art therapies: How do you
know what’s working? Springfield, IL: Thomas.
Ferszt, G., Massotti, E., Williams, J., & Miller, J. (2000). The impact of an art program on an in
patient oncology unit. Illness, Crisis, & Loss,8(2), 189 199.
Gazella, K. (2004). Mark Hyman, MD. Practicing medicine for the future. Alternative Therapies.
10(4), 8389.
Graham-Pole, J., & Lander, D. (2009). Metaphors of loss and transition. Arts & Health: An
International Journal for Research, Policy and Practice,1(1), 74 88.
Greenhalgh, T., & Hurwitz, B. (2004). Narrative based medicine: Dialogue and discourse in clinical
practice (4th Impression). London: BMJ Books.
Gifford, R. (1987). Environmental psychology: Principles and practice. Boston: Allyn & Bacon.
Halprin, A. (2000). Dance as a healing art. Mendocino, CA: LifeRhythm.
National Center for Creative Aging. (2008). Home page. Retrieved December 22, 2008, from http://
Healthcare Design. (2005). Texas Children’s Hospital HOUSTON, TX. Retrieved on January 3,
2009, from¼9B6FFC446FF7
Herbert, G., Waggoner, J., Deschner, J., & Glazer, R. (2006). Artists-in-residence: The Creative
Center’s approach to arts in healthcare. New York: The Creative Center, Inc.
Hospital Audiences, Inc. (2008). Mission statement. Retrieved on December 4, 2008, from http://
Hunter, K.M. (1991). Doctors’ stories: The narrative structure of medical knowledge. Princeton, NJ:
Princeton University Press.
International Harp Therapy Training Program. (n.d.). Why is the International Harp Therapy
Training Program unique? Retrieved on December 18, 2009, from
Ivey, B. (2000). Foreward. In B. Koostra (Ed.), National Endowment for the Arts 1965 –2000: A brief
chronology of federal support for the arts (p. 5). Washington, DC: NEA.
Jones, A.H. (1997). Literature and medicine: Narrative ethics. Lancet,349, 12431246.
Jones, C. (2005). The costs of nurse turnover, part 2: Application of the nursing turnover cost
calculation methodology. Journal of Nursing Administration,35(1), 4149.
Arts & Health 133
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
KCI Research and Evaluation. (2002). Satisfaction and outcomes assessment hospital artist-in-
residence program of The Creative Center arts for people with cancer. Accessed April 28, 2005
Kellman, N. (1988). History of healthcare environments. First Symposium on Healthcare Design.
Carlsbad, CA. In S. Marberry (Ed.) (1995), Innovations in healthcare design (pp. 38 48).
New York: Van Nostrand Reinhold.
Kleinman, A. (1988). The illness narratives: Suffering, healing, and the human condition. New York:
Basic Books.
Lander, D., & Graham-Pole, J. (2006). The appreciative pedagogy of palliative care: Arts-based or
evidence-based? Journal for Learning through the Arts: A Research Journal on Arts Integration
in Schools and Communities,2(1), article 15. Retrieved December 17, 2008, from http:// .
Lawton, M., & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer & M. Lawton
(Eds.), The psychology of adult development and aging (pp. 619 674). Washington, DC:
American Psychological Association.
Malchiodi, C. (2005). Expressive therapies. New York: The Guilford Press.
McNiff, S. (2008). Art-based research. In J.G Knowles & A.L. Cole (Eds.), Handbook of the arts in
qualitative research (pp. 2940). Thousand Oaks, CA: Sage.
National Association of Children’s Hospitals and Related Institutions. (2008). Evidence for
innovation: Transforming children’s health through the physical environment. Alexandria, VA:
National Endowment for the Arts and Society for the Arts in Healthcare. (2003). The arts in
healthcare movement in the United States. Washington, DC: Author. Retrieved January 6, 2009,
Noice, H., & Noice, T. (2004). A short-term intervention to enhance cognitive and affective
functioning in older adults. Journal of Aging and Health,16(4), 562 585.
Ornish, D. (2008). Foreword. In J. Sonke-Henderson, R. Brandman, I. Serlin, & J. Graham-Pole
(Eds.), Whole person healthcare: Volume 3: The arts & health (pp. vii x). Westport, CT:
Palmer, J. (2001). An introduction to the arts-for-health movement, or how the arts sneaked in on the
medical model. Community Arts Network Reading Room. Retrieved March 30, 2006, from http://
Palmer, J., & Florence, N. (1991). The hospital arts handbook. Durham, NC: Duke University
Medical Center.
Platt, R. (1965). Thoughts on teaching medicine. British Medical Journal,2, 551 552.
Preskill, H., & Catsambas, T. (2006). Reframing evaluation through appreciative inquiry. Thousand
Oaks, CA: Sage Publications.
Reynolds, R., & Stone, J. (1991). On doctoring. New York: Simon & Shuster.
Rollins, J. (2007). Arts for the Aging Appreciative Inquiry session report. Washington, DC: Rollins &
Serlin, I. (2008). Theory and practices of art therapies: Whole person integrative approaches to
healthcare. In J. Sonke-Henderson, R. Brandman, I. Serlin, & J. Graham-Pole (Eds.). Whole
person healthcare: Volume 3: The arts & health (pp. 107 120). Westport, CT: Praeger.
Shands Arts in Medicine. (2008). Home. Retrieved March 30, 2006, from
Shepley, M. (2008). The health-care environment. In J. Rollins, R. Bolig, & C. Mahan (Eds.),
Meeting children’s psychosocial needs across the health-care continuum (pp. 313 349).
Austin, TX: ProEd.
Snow City Arts. (2008). Home. Retrieved on December 15, 2008 from http://www.snowcityarts.
Society for the Arts in Healthcare. (2005 2008). Membership directory. Retrieved December 15
17, 2008, from
Society for the Arts in Healthcare. (20052008). Retrieved December 22, 2008, from http://www.¼%09180.
Society for the Arts in Healthcare. (20052008). About, Person. Retrieved December 20, 2008, from¼5331.
Solomon, G. (1996). Understanding psychoneuroimmunology (PNI) and its applications for
healthcare. Journal of Healthcare Design.8, 7983.
134 J. Sonke et al.
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
Sperry, R.W. (1995). The riddle of consciousness and the changing scientific worldview. Journal of
Humanistic Psychology,35(2), 7 34.
Tamalpa Institute. (2006). About. Retrieved December 20, 2008, from
The Creative Center. History. Retrieved December 20, 2008, from
The Creative Center. (n.d.). National programs. Retrieved January 4, 2009, from http://thecreative
Tofle, R., Schwarz, B., Yoon, S., & Max-Royale, A. (2004). Color in health care environments:
A critical review of the literature. San Francisco, CA: Coalition of Health.
Ulrich, R., Quan, X., Zimring, C., Joseph, A., & Choudhary, R. (2004). The role of the physical
environment in the hospital of the 21st century: A once-in-a-lifetime opportunity. Concord, CA:
The Center for Health Design. Retrieved April 5, 2007, from
University of Iowa Healthcare. (2009). Project art. Retrieved January 16, 2009, from http://www.
University of Iowa Healthcare. (2009). Permanent collection. Retrieved January 16, 2009, from
University of Michigan Health System Gifts of Art Program. Home. Retrieved November 20, 2008,
University of New Mexico. (n.d.). Arts in medicine. Retrieved December 20, 2008, from http://
VSA Arts. (20032006). Home. Retrieved on December 2, 2008 from http://www.vsartsalabama.
Walsh, S.M., Radcliffe, R.S., Castillo, L.C., Kumar, A.M., & Broschard, D.M. (2007). A pilot study
to test the effects of art-making classes for family caregivers of patients with cancer. Oncology
Nursing Forum,34(1), E9E16.
Walworth, D. (2005). Procedural-support music therapy in the healthcare setting: A cost-
effectiveness analysis. Journal of Pediatric Nursing,20(4), 276284.
Arts & Health 135
Downloaded By: [Sonke, Jill] At: 18:56 11 August 2009
... Characterization of SA training SA as an emerging interdisciplinary field has been integrated into both arts and social educational practices worldwide (22)(23)(24). Increasing numbers of social work curricula include courses in the arts, and in 2008 the first M.A. specialization in the arts in social work was launched at Ben Gurion University of the Negev. Similarly, art schools include SA courses and projects in their training programs; for example, at the Bezalel Academy of Arts and Design, the University of Haifa's School of the Arts, and the Musrara School for Art and Society. ...
... Because the emerging field of SA studies has not been sufficiently researched it is important to define the characteristics of SA training programs as a distinct field of study since it has grown out of multiple training directions that include creative arts therapies, social work and the fine arts (visual and theater) (24,79,80). The significance of this study lies in characterizing the aims, scope (breadth and depth), and needs in SA training, thus creating an integrative theoretical and methodological model that will be useful to SA teachers, researchers, and practitioners. ...
Full-text available
Introduction Mounting empirical evidence underscores the health benefits of the arts, as recently reported in a scoping review by the World Health Organization. The creative arts in particular are acknowledged to be a public health resource that can be beneficial for well-being and health. Within this broad context, and as a subfield of participatory arts, the term social arts (SA) specifically refers to an art made by socially engaged professionals (e.g., artists, creative arts therapists, social workers, etc.) with non-professionals who determine together the content and the final art product (in theater, visual arts, music, literature, etc.) with the aim to produce meaningful social changes. SA can enhance individual, community, and public health in times of sociopolitical instability and is an active field in Israel. However, SA is still an under-investigated field of study worldwide that is hard to characterize, typify, or evaluate. This paper presents a research protocol designed to examine a tripartite empirically-based model of SA that will cover a wide range of SA training programs, implementations, and impacts. The findings will help refine the definition of SA and inform practitioners, trainers, and researchers, as well as funding bodies and policymakers, on the content and impact of SA projects in Israel and beyond. Methods and analysis This 3-stage mixed methods study will be based on the collection of primary qualitative and arts-based data and secondary, complementary, quantitative data. Triangulation and member checking procedures will be conducted to strengthen the trustworthiness of the findings obtained from different stakeholders. Discussion Growing interest in the contribution of arts to individual and public health underscores the importance of creating an empirically grounded model for SA. The study was approved by the university ethics committee and is supported by the Israel Science Foundation. All participants will sign an informed consent form and will be guaranteed confidentiality and anonymity. Data collection will be conducted in the next 2 years (2022 to 2024). After data analysis, the findings will be disseminated via publications and conferences.
... The subjects of these studies are mostly groups of older adults attending arts programmes offered by the facility they live in or receiving arts therapy with medical doctors' recommendations. Medical research that collects data from older adult patients through participation in arts activities or research that attempts to achieve therapeutic effects through arts activities is an emerging field of creative ageing research (Cohen et al., 2006;Greaves and Farbus, 2006;Sonke et al., 2009;Lowry, 2017). ...
... For example, there are studies of an amateur senior orchestra (MacRitchie and Garrido, 2019), musical tastes (Harrison and Ryan, 2010), textual and craft activities (Kenning, 2015), old-age fandom (Harrington, 2018), arts museum experiences (Thongnopnua, 2015) and a museum volunteer programme . The studies of arts programmes in senior centres with therapeutic purposes and arts programmes designed for dementia prevention and treatment (Greaves and Farbus, 2006;Sonke et al., 2009;Lowry, 2017;Dewey and Sonke, 2019;Robertson and McCall, 2020;Hendriks et al., 2021;Hughes et al., in press) also fall under this category. Recently, discussions surrounding the need for a professional group specialising in these programmes (Throsby and Zednik, 2011;Dewey and Sonke, 2019;Robertson and McCall, 2020) have also begun. ...
Full-text available
How to promote wellbeing in old age is an issue that is drawing increasing attention as populations age in societies around the world. This study explores arts participation in later life and creative ageing through artistic engagement. We focus on potential participants who have had little prior experience with the arts, examining their journey through artistic activities, and the broader benefits to society of a creatively engaged population. We applied an action research methodology by designing two phases of arts workshops, one focused on hands-on creation activities and the other on appreciation of professional artists' works. This approach yielded the following findings. First, facilitation is key to initiating and sustaining artistic engagement among older adults, in part by helping them adapt to a changing society. Second, potential participants should be centred in discussions on creative initiatives. In particular, still active pre-seniors have much to offer in developing creative ageing initiatives. Third, arts participation for creative ageing goes far beyond the individual; it promotes community wellbeing and contributes to creating social value. Finally, we make an actionable suggestion that ‘facilitation for arts participation’ be developed as a specialised professional field.
... 12,13 Participation in music, such as singing, has been linked with positive psychoneuroimmunological effects. 10,11,13 In recent publications such as the World Health Organization's Intersectoral Action: The Arts, Health and Well-being 14 and the State of the Field reports in the United States, England, Australia, and Canada, [15][16][17][18] authors describe arts in health broadly across patient populations, however, the evidence is frequently drawn from creative arts therapies' literature, thereby missing an opportunity to articulate the role and scope of practice of artists working in healthcare settings. Distinguishing artists working in healthcare from creative arts therapists, such as a music therapist or art therapist, is useful in order to acknowledge the differences in formal education, training, and credentialing as well as the distinct aims, outcomes, and strengths of engagement with each (see Table 1 for definitions of artists and creative arts therapists used for this review). ...
... Primary themes reported in these studies built upon existing evidence in the field of arts in health. [10][11][12][13][14][15][16][17][18] It was well documented in arts in health literature that arts engagement promotes meaning-making, discovery, reflection, and expression yielding a sense of well-being, self-discovery, and connection with others. This knowledge was reinforced by the studies on the arts in palliative care included in this review. ...
Background Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care. Aim To systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice. Design A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes. Data sources PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed. Results Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with (1) a sense of well-being, (2) a newly discovered, or re-framed, sense of self, (3) connection with others, and (4) challenges associated with practice. Conclusion Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists’ engagement in palliative care including: (1) consistency in methods and reporting; (2) inclusion of wider perspectives; and (3) key considerations for adapting the arts by health condition and art form.
... Primary themes reported in these studies built upon existing evidence in the field of arts in health. [10][11][12][13][14][15][16][17][18] It was well documented in arts in health literature that arts engagement promotes meaning-making, discovery, reflection, and expression yielding a sense of well-being, self-discovery, and connection with others. This knowledge was reinforced by the studies on the arts in palliative care included in this review. ...
... This knowledge was reinforced by the studies on the arts in palliative care included in this review. [10,[14][15][16][17][18] Arts engagement offered opportunities for patients to examine and embody the question "what gives your life meaning?", thereby enhancing wellbeing and connection among patients, family members and care providers. ...
Full-text available
Background: Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care. Aim: to systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice Design: A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes. Data sources: PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed. Results: Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with 1) a sense of well-being, 2) a newly discovered, or re-framed, sense of self, 3) connection with others, and 4) challenges associated with practice. Conclusion: Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists’ engagement in palliative care including: 1) consistency in methods and reporting; 2) inclusion of wider perspectives; and 3) key considerations for adapting the arts by health condition and art form.
... The use of artistic media to support health and well-being is growing around the world (Clift et al., 2009;Sonke et al., 2009;Wreford, 2010;Cox et al., 2010;Laitinen et al., 2020). The dynamic field of "arts and health" integrates the domains of healthcare, social impact and cultural life through artistic practice and experience in many forms, ranging from creating and appreciating the arts as a form of therapy to actively using the arts as a platform for health communication and promotion. ...
Full-text available
Background: This article examines the state of the field of arts and health in Singapore and identifies the drivers that have shaped its development to date, adding new insights from Asia to the growing international literature in this area. Methods: Various methods, including an online survey and in-depth focus groups were used. Results: We find that the field in Singapore is rapidly growing, with a proliferation of activities across the arts and culture, healthcare, and social care sectors in recent decades fostered by various policy developments, increased funding and new peer-to-peer networking. Nevertheless, several issues persist, including inconsistent understanding and conceptualisation of the field as a whole across multiple stakeholders, limited research capacity and training platforms, and lack of professional recognition. Conclusions: We provide recommendations for further action, including developing arts and health literacy and research capacity, investing in efforts to bridge education and practice, and focusing on formalising and elevating professional standards.
... To date, music, the most-researched medium of art and healing (Sonke et al., 2009;Stuckey & Noble, 2010), has been found to improve blood pressure (do Amaral et al., 2016); improve sleep quality (Feng et al., 2018); decrease activity in the hypothalamus-pituitary-adrenal axis, the body's central response system to stress (Koelsch et al., 2011); activate parts of the brain that play a role in descending inhibition of pain, such as opioid-rich midbrain nuclei (Brown et al., 2004;Koelsch et al., 2011); reduce anxiety and pain (Stuckey & Noble, 2010); reduce depressive symptoms (Zhao et al., 2016); and elicit social bonding (Tarr et al., 2014). The biopsychosocial model organizes these outcomes into multiple pathways through which music might influence pain, SUD, and OUD (see Figure 1). ...
In October 2017, the U.S. Department of Health & Human Services declared the opioid crisis a national public health emergency and prioritized identifying effective, evidence-based strategies for pain management and the prevention and treatment of substance use disorder (SUD). Increasingly, the arts have become more widely established and accepted as health-promoting practices in the United States and around the world. As the U.S. health care system moves toward greater integration of physical and behavioral health, arts-based interventions should be considered among potential complementary approaches for managing pain and preventing and treating SUD. We conducted an integrative literature review to summarize and synthesize the evidence on the role of the arts in the management of pain and in the prevention and treatment of SUD, including opioid use disorder. The available evidence suggests that music interventions may reduce participants’ pain, reduce the amount of pain medication they take, improve their SUD treatment readiness and motivation, and reduce craving. Few studies examined art forms other than music, limiting the ability to draw conclusions for those art forms. Given the critical need to identify effective strategies for managing pain and preventing and treating SUD, future research on arts-based interventions should examine maintenance of pain management and SUD treatment benefits over time and outcomes related to SUD prevention.
... Themes such as arts engagement promoting a sense of well-being, an enhanced sense of self, and connection with others to uniquely facilitate meaning-making, discovery, re ection, and expression are well documented in the broader literature. [10,[14][15][16][17][18] Hence, it could be argued that arts engagement addresses primary aims of palliative care such as to offer opportunities for patients to review and embody the question "what gives your life meaning?" and to provide social support for patients and family members. ...
Full-text available
Background Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement, facilitated by artists, promotes a sense of well-being and connection with others. However, much of the evidence is drawn from the use of the arts in broad health contexts or from creative arts therapies’ literature. This review aimed to systematically identify and synthesize existing evidence in order to reveal key knowledge gaps and to inform future research and practice. Methods An integrative review of the literature was conducted using a pre-defined, comprehensive search strategy. Databases searched included: PubMed inclusive of MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase. Search terms included variations on visual arts, literary arts, and performing arts; service users or patients; and palliative care or end-of-life care. The quality and rigor of articles were scored using Hawker and colleagues’ tool designed to systematically appraise disparate studies. Synthesis was conducted using a constant comparison method as outlined in the integrative review framework. Results Eight reviewed studies explored literary, performing, and visual arts engagement in residential hospice, day hospice, and hospitals in England, the United States, France, and Canada. Seven of eight studies used qualitative methods and one study engaged in mixed methods. Patient perspectives were most commonly represented followed by health care professionals and family members. Creative writing, music, and visual art were predominant modalities whilst dance and theatre were underrepresented. Themes identified across studies associated arts engagement with 1) a sense of well-being, 2) a newly discovered, or re-framed, sense of self, 3) connection with others, 4) challenges associated with practice. Conclusion This review synthesized current evidence and key knowledge gaps regarding artists' facilitation of arts engagement in palliative and end-of-life (EOL) care. It serves as a starting point in the consideration of next steps in standardizing professional practice and preparation for artists working in palliative and EOL care settings specifically. Recommendations for future research include exploring the value of collaboration between artists and palliative care teams when engaging with individuals living with life-limiting illness.
This article traces the history of arts and health in South Australia, using an interview-based methodology to detail how grassroots practice developed into formal arts and health policy. The project interviewed 47 arts and health stakeholders, including former state government ministers, artists and health professionals. South Australia has a long history of arts and health work. However, interviewees describe a lack of momentum for the field since the endorsement of the 2013 National Arts and Health Framework, largely because it did not contain binding commitments which left the field vulnerable to changes associated with political leadership. South Australia thus represents both a case study of how grassroots support can maximize political interest in arts and health to create formal policy as well as a warning on the challenges that occur when this interest wanes.
Background: The field of arts and health has been growing rapidly in the Republic of Korea (ROK) as a means to solve social problems with the development of arts and health government programs to prevent mental disorders and improve quality of life. This study addresses the history, policy and funding scale, practices, and challenges of the arts and health in the ROK and provides a global overview of different countries to guide development procedures and communicate directions to relevant stakeholders. Methods: Data were collected using various methods, including policy reports, grey literature, peer-reviewed articles, and open data provided by Statistics Korea. Results: Progress has been made in identifying specific opportunities for the arts to address mental health concerns in the Korean society. Specialty and digital arts are emerging as new professional practices in the arts and health fields. Conclusions: Establishing new government agencies is the next challenge toward identifying and reaching a consensus among relevant stakeholders for the future development of arts and health in the ROK.
Although there is a growing body of literature describing the benefits of creative arts in health care, research in this area is limited. This article describes an exploratory qualitative research study that examines the potential benefits of an arts program on an inpatient oncology unit located in a major medical center in New England. Semistructured interviews of seven patients and seven nurses who cared for these patients were conducted following participation in an established arts program. Benefits included improved patient coping with pain, improved nurse-patient communication, and improved attitude toward hospitalization.