Horses have always had an emotional pull to them and those who love them usually end up with horses and animals being a center piece to their life, but horses in therapy? Now that is something new to add to all the other modalities of treatment out there. Over the last ten years this experiential modality - specifically, EAGALA- has become a proven and effective treatment modality with a variety of populations, and more and more programs are adding this amenity to their facilities.

It has been my pleasure to have developed several equine amenity/therapeutic programs for behavioral health treatment programs. Equestrian site and equine therapy program planning is a unique skill set, and when combined with behavioral health issues, it raises the complexity of execution tenfold.

First, the bad news. Equestrian amenities do not usually make money to cover expenses. The good news is the ROI comes from expanded depth of clinical programming, the multi-faceted lessons and genuine change that the horses will facilitate in your clients, to the relaxation of clients, parents and employees when they are on site. Finally having a stable or barn makes your facility much more inviting and beautiful with horses and animals grazing in the fields.

For non-horsey people there is a pretty big learning curve that goes with taking on this type of project. First and foremost, the issue of safety has to be addressed. Having an experiential amenity, whether it is a ropes course or an equine facility, increases your liability insurance and risk management tenfold. You can have increased worker's comp claims from staff, to different types of property and horse insurances. The bottom line is, if owners are not comfortable assuming additional risk, then experiential elements are not a good fit for the program.

Having an equine facility feasibility study completed is the next step. Looking at the proposed site - is there existing land or buildings or will land be purchased? A feasibility study is individualized for each program and determines if planning facility renovations or new site development will occur. A proper and thorough study should include land use-geographic considerations, state laws, sustainability projections, market comparables (if for profit), waste management solutions, fencing, projected budget line items and other important components. It can include assessments of animals in place and risk management.

Any equestrian therapeutic program should have an Operations Manual. An Operations Manual has items such as barn rules, what to do in case of multiple types of emergencies, ongoing facility evaluations (I like quarterly and annually), equine health and medications, quarantine, nutrition, feeding, job descriptions, incident reports and other topics. I have written a 60 page manual and adapted it to the programs that I have developed. The policies have passed CARF and JACHO audits.

Behavioral Health programs must include the HR department. Clinicians should be certified that will be facilitating the sessions. The EAGALA model uses a team for safety reasons (one person for the horses and one for the clients), and for capturing all the rich clinical information that presents itself in a session. There are the black and white aspects of program development that have to be written and implemented such as specialized job descriptions, protocols/ policies to be approved and adapted, to staff training.

Staff training is a huge piece. Training has to occur for everyone to be comfortable with expectations and their roles when on site, not every staff can be around horses, some may have fears, some may be allergic, some may have control issues and not have the temperament to be suitable for working with animals. I have incorporated the equine facility into orientation at some programs, or have facilitated half day seminars to educate staff and run through scenarios. If you are going to have a dedicated person, either a staff or seasoned equine person as a Program Coordinator or Manager, what types of documentation, tracking, spreadsheets etc do you need or want? How does a therapist do this kind of clinical note? If you have an online charting system, a new group note and individual note will have to be developed in addition to adding goals to the Treatment Plan/ Treatment plan review menus.

Next, we have to look at the clients. This is a topic of great interest to me, and as a Clinician, Clinical Director, and Administrator, I have had to continually look at through different lenses when working with a program and an equine facility. Some questions that have to be thought through include- What kind of population are you working with? Will you have any exclusionary criteria for your population? How soon once you have a new admission can someone come to the stables? Do they need to be cleared by your Medical Director, be 1:1 with staff? For how long? Do you provide them with a Horsey 101 book upon admission? Do you tour the facility with potential admissions? How will you motivate the clients who don't care for horses to come to participate? How do you handle the issue of clients (if over 18) wanting to smoke, listen to IPods or other types of electronics that can affect safety at the stable? How do you incorporate equine into your treatment plan? What kind of activities should we do?

Horse handlers must have experience. There is a saying, green horses and green riders…are a disaster. When you then add in mental illness issues, it can get dangerous quickly. If a horse steps on someone, a toe or ankle can break, tears will flow, if a horse kicks, someone could get a broken bone, if someone falls off a horse if you have a riding program, they could sustain a head injury and die. I cannot stress how important it is for horse handlers to be trained and have solid prior experience. For example, having a local person who worked at a trail riding business may not be able to proactively see a situation with a client and a horse in a field, or manage a situation in the barn isleway where a horse that has become scared and trying to get away while a client is going off on a manic episode / having an outburst/ displaying agitated, aggressive behaviors. Crisis intervention and reducing tension at the stables with animals that are instanteously flight or fright, with mentally ill people is a whole other level of fun for staff.

I have left the most important piece to consider last - the horses. Horses are horses yes, but horses are like people. Age, size, breed, temperament, history and many other factors all go into building a program. Like dogs, certain breeds have certain characteristics. Do you want a mini or a draft? Do you want retired performance horses or other types of horses? How you incorporate a horse into the herd or therapy mix if you have other horses. There are sound (healthy) horses, and horses that have health problems/athletic injuries that need maintenance, and are not sound, might not pass a vet check for riding, but are fantastic when relating to people on the ground. One of the best horses I have ever saw had one eye and was a huge draft mare and could not pull a carriage anymore, but was fantastic. Another was a retired police horse. I have seen a mini horse with an attitude larger than any horse stand their ground and teach all humans lessons every time they were in session.

Where you get the types of horses is another long conversation and can be embarked upon once the program needs are determined. The good news is that there are many horses that need homes that are good, solid citizens and take care of people, so don't think you have to spend a great deal of money. In this economy horses are being given away at an alarming rate because people cannot afford to keep them and take care of them, but you have to have the experience to know what you are getting. I do not recommend using young horses in programs until they are at least four years of age and have started classically trained ground work. Young horses cannot handle the emotions of the residents, and it's not fair to put them to work so young. Although they are cute to have around, they also require more labor hours to feed and supervise, because like young children, they are into everything, curious about the world and can often get hurt.

I hope that this article has given you some items to reflect on as you consider an equestrian amenity. I personally have witnessed and helped facilitate genuine change in children, adolescents, the military (vets who are reintegrating), victims of domestic violence, the thought disordered and trauma, to name a few populations who all have used this modality. Please feel free to contact me to discuss any, or all of these topics.

Kristi Seymour, MA, LPC, MBA can be reached at Kallista2@aol.com or 435-817-0812.