Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music modalities, are utilized internationally to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama, and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g., increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g., enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g., creative expression, aesthetic pleasure), cognitive (e.g., stimulation of memory), and social (e.g., increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research includes stronger focus on testing of processes and mechanisms.

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

In the past decades, culture has increasingly been accepted as a dimension to be planned and managed within public policy, alongside social, economic and ecological considerations. Techniques for impact assessment of interventions on our economy, ecology and society are becoming more sophisticated, but are not yet well established within the cultural domain. This paper presents the results of a systematic literature review on applications of cultural impact assessment (CIA) internationally. Findings indicate that CIA has largely been practiced since 2002 to understand the impact of development processes on indigenous communities. While interest in CIA was also apparent in areas of public policy, particularly local government, little evidence was found of the practice actually established. A divergent understanding of CIA was found in the 'cultural' (funded arts and heritage) sector where it was understood as both impact on culture, but also impact of cultural activities. Only two developed tools for measuring cultural impact were found, one each for indigenous contexts and cities. Recommendations for strengthening CIA practice include establishing agreed definitions of culture and cultural impact, and validated tools, including measurement frameworks and indicators.

This chapter analyses theories about how social change can be effected through participation in the arts. A theory of change lens applied to the literature results in identification of three broad types of change processes: social/civic action, in which the major change strategy is influencing of public opinion and decision-making through arts activities; the community cultural development approach in which change occurs at a community level, as a result of creative social interaction between arts participants; and finally, the therapeutic paradigm, in which change is elicited in individuals through the healing process of arts used therapeutically. These approaches are examined in relation to broader theories of participation, and Vygotsky’s social development theory, resulting in a meta-theory about factors that lead to change through arts participation: the contribution of a skilled leader, the utilization and stimulation of creativity, and a collaborative process. Case studies of community music initiatives illustrate the theory.