How we talk about what we do: The need for precise and accurate terminology in our field

by Laura McFarland | Apr 16, 2021 | The Latest in Equine Assisted Therapy and Learning

In December 2020, The Journal of Alternative and Complementary Medicine published an article entitled, “Optimal Terminology for Services in the United States That Incorporate Horses to Benefit People: A Consensus Document.”

We at the Natural Lifemanship Institute very much appreciate the authors’ timely work and its importance to our field, to your businesses, and most importantly to the clients you serve. They attempt to address a significant need in the field through a process of inquiry and consensus.

Seriously y’all this is a big deal – leaders (and competitors) in our field came together in a TWO YEAR process of discussion, exploration, research, and collaboration, because, like you, they care about our field, our businesses, and our clients.

We were glad to see that this article has been circulating on social media a bit, but we also realize that it’s an academic article and it’s long!  Since we think it’s super important that you read this article and discuss it with us, I wrote up this lovely summary for you!  I kinda geek out on these kinds of things, so it was truly a pleasure.  🙂

The purpose of this blog is to provide a concise summary of the article and its recommendations with the hopes of promoting ongoing dialogue amongst our members and others who partner with horses to help people. We want to hear from you! Please join us on Facebook and tell us what you think!

As stakeholders ourselves we have been engaging in lots of internal dialogue about the recommendations and will be publishing an official response in the coming weeks. Our discussions with you will inform our decisions.

If you are interested in being notified when we have posted our response, you may request to be notified, here.

Article Citation

Wood, W., Alm, K., Benjamin, J., Thomas, L., Anderson, D., Pohl, L., & Kane, M. (2021). Optimal terminology for services in the United States that incorporate horses to benefit people: a consensus document. The Journal of Alternative and Complementary Medicine, 27(1), 88-95.

Click here to download the article.

Article Summary

Optimal Terminology for Services in the United States that Incorporate Horses to Benefit People: A Consensus Document (Wood et al., 2021)

The Consensus Process in a Nutshell

A working group of representatives from national organizations in the field of equine-assisted services participated in a 2-year process for the purpose of recommending terminology to be used and to be discontinued in the field.

The grant-funded project was motivated by the recognition that unclear and imprecise use of terminology in the rapidly expanding and diverse field of services incorporating horses to help humans is problematic and potentially damaging. Ambiguous terminology creates confusion and inadequate protection for consumers, obstacles to reimbursement and research, and misinformed policies and practices.

The six-step collaborative process started with an exhaustive search of sites, databases, and literature to identify the most commonly used terms in the field. The authors listed 12 distinct types of equine-assisted services represented under 3 broad categories of therapy, learning, and horsemanship. Next, they developed and disseminated a survey asking stakeholders in the field to rate the relative usefulness of each term. A 2 ½ day professionally facilitated summit was then convened, bringing in additional stakeholders, to discuss the results and to produce a draft of recommendations. The draft underwent review and revision by summit members as well as additional stakeholders to produce the final recommendations that are shared in the article.

The categories themselves, a description of the types of services within each category, and the expertise and credentials required of service providers are summarized in the Nuts & Bolts section below.

The Authors’ Recommendations in a Nutshell

1. Equine-assisted Services is the optimal unifying term when referring to two or more services. It is too imprecise to be used to describe one program or distinct type of service.
2. Therapy services (5 distinct types include: counseling, occupational therapy, physical therapy, psychotherapy, and speech-language pathology) should use therapy-first language (e.g., physical therapy using equine movement, psychotherapy incorporating horses, occupational therapy in equine environments). Reasons for emphasizing therapy-first language are outlined in the Nuts & Bolts section below.
3. Equine-assisted learning (3 types of non-therapy services): Equine-assisted learning in education, equine assisted learning in organizations, and equine-assisted learning in personal development.
4. Horsemanship (4 types of non-therapy services): Adaptive equestrian sport, adaptive riding or therapeutic riding, driving, and interactive vaulting.
5. Discontinue the use of problematic terminology, including: equine therapy, equine-assisted activities and therapies, equine-assisted therapy, equestrian therapy, hippotherapist, hippotherapy clinic or program, horse therapy, horseback riding therapy, and therapy riding.

NUTS & BOLTS of the Article 

WHAT

The article describes the structure and outcomes of a two-year consensus-building process. The purpose of this process was to create a set of recommendations for terminology used when referring to services (within the U.S.) that incorporate equines to benefit people. Recommendations included both the adoption of optimal terminology and the discontinuation of terminology the working group found to be problematic.

WHO

The process was undertaken by a working group (the authors, listed below) comprised of representatives of several relevant national organizations:

1. Wendy Wood, PhD, Departments of Animal Sciences and Occupational Therapy , Temple Grandin Center, Colorado State University, Fort Collins, CO, USA
2. Kathy Alm, BA, Professional Association of Therapeutic Horsemanship International (PATH, Intl.), Denver, CO, USA
3. Joann Benjamin, PT, American Hippotherapy Association, Inc., (AHA, Inc.), Denver, CO, USA
4. Lynn Thomas, LCSW, Equine Assisted Growth and Learning Association (EAGALA), Spanish Fork, UT, USA
5. Debbie Anderson, AS, Strides to Success, Plainfield, IN, USA
6. Lissa Pohl, MA, University of Kentucky, Lexington, KY, USA and Equine Experiential Education Association (E3A), Reno, NV, USA (Click here to watch a Horse Sense webinar with Lissa Pohl as she discusses this article)
   
7. Michele Kane, MA, Major, USMC (Ret.), My Heroes, LLC, Fort Collins, CO, USA

WHY

In the past 30 years, human services incorporating horses have greatly expanded and diversified. As a result, terminology for naming and describing these services has become increasingly unclear and imprecise. The current state of imprecise terminology in our field generates serious problems for stakeholders (including consumers, service providers, funders, researchers, advocates, and regulatory agents). When terminology is vague or misleading, it contributes to confusion, inadequate consumer protection, obstacles to reimbursement, barriers to research, and misinformed policies and practices, among other adverse effects.

HOW

The consensus-building process was initiated in 2018 and spanned two years. The process consisted of 6 steps:

1. PATH obtained funding from the Bob Woodruff Foundation to support the consensus building process, and convened a working group of five leaders (authors Wood, Alm, Benjamin, Thomas, and Kane)
2. The working group designed and disseminated a survey that asked stakeholders to rate the relative usefulness of the most commonly used terms. The first round of consensus occurred at this step, and consisted of the following sub steps:
   1. Before developing the survey, the team had to identify and agree on the most commonly used terms in the field. To do this, they conducted an extensive and systematic search of websites, databases and literature, including books and peer-reviewed journal articles. They used over 45 search criteria related to equine- and animal-assisted services and interventions. Nine databases were searched, returning 158 books and peer-reviewed journal articles. This literature was then examined to identify the terms that were used. The terms were entered into an Excel database for the purpose of comparing and contrasting their frequencies of use. The team divided the work and ultimately reached consensus on the most commonly used terms.
   2. Once a list of commonly used terms had been compiled, the working group collaborated with experts in survey research to design, develop and approve the final survey.
   3. The survey was distributed through:
      1. AHA, Inc.
      2. E3A
      3. EAGALA
      4. Equus Foundation
      5. PATH Intl.
      6. Directly to ~500 recipients of services, parents, or caregivers

A total of ~16,156 surveys were distributed with a return of 1,745 (or 10.8%) useable surveys, which made up the dataset.

Survey design, research questions, analysis, and key findings are not included in the article but may be obtained.

3. A professionally facilitated 2 ½ day terminology summit was held. The attendees (called the summit group) included the members of the working group plus 10 individuals chosen for their extensive experiences and perspectives, representing: AHA, Inc., Bob Woodruff Foundation, Certification Board for Equine Interaction Professionals (CBEIP), EAGALA, E3A, PATH, Intnl, and the U.S. Department of Veterans Affairs. The summit group produced an initial framework of recommendations.
4. The working group developed a first draft of recommendations. Summit attendees approved the draft as suitable for further review by leaders and board members of the represented organizations.
5. The working group considered all received reviews and finalized their terminology recommendations.
6. The working group submitted final recommendations to other summit attendees for approval or disapproval, as well as to the Boards of Directors of eight relevant national organizations, who were asked to approve or disapprove the recommendations that were relevant to them. These organizations included:
   1. AHA, Inc.
   2. American Horse Council (AHC)
   3. Certified Horsemanship Association (CHA)
   4. CBEIP
   5. EAGALA
   6. E3A
   7. Horses and Humans Research Foundation (HHRF)
   8. PATH, Intl.

RESULTS

As a result of the 6-step consensus-building process, outlined above, the working group identified and organized 12 types of distinct types of services (see below) and produced the recommendations that follow.

12 distinct types of equine-assisted services were identified under 3 broad categories:

Recommended Terminology

1. Recommended optimal unifying term: Equine-assisted Services (EAS)
   1. Refers to multiple services in which professionals incorporate horses/equines to benefit people. Each distinct service constitutes a type of EAS; but the inclusive term, EAS, alone does not suffice as a description for a particular service when it is marketed to consumers.
2. Therapy
   1. Licensed therapy professionals may incorporate horses in each of the five distinct therapies listed in the table above.
   2. These professionals work within the scope of their practice and particular discipline.
   3. Best practice dictates that they obtain specialized training focused on incorporating interactions with horses, equine movement, or the equine environment into the individualized plans of care of those receiving therapy.
   4. These professionals incorporate horses within treatments or interventions to help address individualized goals, and improve overall function, health, and wellness.
   5. They may or may not work with equine professionals or other assistants for risk management and other purposes.
   6. Therapy-first language is recommended to refer to any one of the types of therapies identified. The terminology must precisely identify the exact therapy (e.g., physical therapy, psychotherapy). Equine related descriptors can then be added. Examples:
      1. Physical therapy using equine movement
      2. Psychotherapy incorporating horses
      3. Occupational therapy in an equine environment
   7. Rationale for using therapy-first language:
      1. Emphasizes licensed therapy professionals who determine how best to implement particular therapies while also acknowledging the potential of the horse to enhance therapeutic outcomes.
      2. After completing discipline-specific evaluations, the therapists develop treatment plans for achieving goals and specify tools, strategies or interventions, which may include how best to incorporate the horse.
      3. Therapy-first language reflects the fact that licensed therapy professionals have many options available to them, the incorporation of the horse being one of them.
      4. Non-specific terms are problematic (see #5 below)
3. Learning
   1. Specially trained or certified professionals may incorporate horses in 3 distinct types of nontherapy services:
      1. Equine-assisted learning in education
         1. Focuses on academic skills, character development, and life skills such as problem-solving and critical thinking.
         2. Professionals providing services have expertise related to learning theory and teaching methodology.
         3. Work is with schools and school systems to help integrate educational strategies that support individual education plans and academic remediation.
      2. Equine-assisted learning in organizations
         1. Assists members of organizations build effective teams and leadership, and improve work dynamics and performance.
         2. Professionals providing services have expertise related to organizational theory, team building, strategic planning, or leadership development.
         3. Various approaches or strategies, such as executive coaching, team-building, or group retreats, may be integrated to address the needs of clients.
      3. Equine-assisted learning in personal development
         1. Assists individuals and groups in discovering new ways to face life challenges and opportunities by developing skills in effective problem-solving, decision-making, critical and creative thinking, and communication.
         2. Professionals providing services have expertise in facilitation, coaching, and teaching. They clearly understand how their services differ from psychotherapy and counseling.
         3. Various approaches or strategies, including personal coaching, and wellness-related activities, may be integrated to address the needs of clients.
4. Horsemanship
   1. 1. Equine professionals may offer four distinct non-therapy services that are adapted from traditional equine disciplines of horseback riding, driving, and vaulting, to serve clients with diverse needs.
      2. Equine professionals providing these services have specialized training or certifications to provide these services to individuals and groups with diverse needs. They require competencies in adapting equipment, the equine environment, and teaching techniques to match the abilities and needs of participants. They develop lesson plans that may involve riding, driving, vaulting, or ground-based activities to help participants attain individualized horsemanship skills and allow for the naturally healthful benefits of riding and other horsemanship activities to occur.
      3. The four distinct non-therapy services include:
         1. Adaptive equestrian sport
            1. Prepares people with diverse needs to participate in events and competitions in equine disciplines such as driving, dressage, reining, and Western or English riding.
            2. Trainers have expertise related to their specific equine disciplines, competition requirements, possible adaptations for athletes with diverse needs, and representative organizations.
            3. Benefits of participation may include motivation and opportunities to excel as competitive athletes, physical fitness, self-confidence, and social inclusion.
         2. Adaptive riding or therapeutic riding
            1. Focuses on skillfully adapting riding to make the naturally healthful benefits of riding and horses accessible to individuals and groups with diverse needs.
            2. Instructors have expertise in riding instruction across the continuum of horsemanship skills (groundwork to riding).
            3. Benefits potentially include physical fitness and improved cognition, emotional, social, or behavioral skills.
         3. Driving
            1. Teaches individuals with diverse needs how to safely participate in driving activities with horses. This can occur with many types of vehicles, including carriages, sleighs, or wagons, and can be adapted as needed.
            2. Instructors have expertise in techniques of safe driving and its instruction.
            3. Benefits potentially include improved physical fitness or cognitive, emotional, social, or behavioral skills.
         4. Interactive vaulting
            1. Engages individuals and groups with diverse needs in movements and gymnastic positions around and on horses and vaulting barrels.
            2. Instructors have expertise pertaining to the principles and techniques of vaulting.
            3. Benefits may include improved physical fitness, social skills and communication, problem-solving, and teamwork.
5. Recommended discontinuing the use of problematic terminology:
   1. Equine therapy
   2. Equine-assisted activities and therapies
   3. Equine-assisted therapy
   4. Equestrian therapy
   5. Hippotherapist and hippotherapy clinic or program
   6. horse therapy
   7. Horseback riding therapy and therapy riding

The adverse impacts of these terms, which lack clarity and transparency, were identified through the survey and summit. Adverse impacts include:

• Consumers having difficulty identifying and accessing services that best meet their needs
• Payers establishing inaccurate payment codes and requirements based on misinterpretations of terms
• Therapists experiencing funding barriers, denials, and having to request repayment of legitimate therapies
• Journalists using sound bites such as “horse therapy” in stories and thereby obscuring from the public’s view the distinct nature and value of the particular services about which they are reporting
• Promoting terminology inconsistencies in the literature
• No profession, academic degree, professional license, or state regulation was known to exist that supported the above-named therapies as legitimate stand-alone therapies.
• They are potentially legally indefensible for providers and misleading to stakeholders.

The article provides specific reasoning for the discontinuation of each of these problematic terms on pages 92-93.

The terminology recommendations were endorsed by a majority of the summit group and the Boards of Directors of AHC, CHA, E3A, HHRF, and PATH Intl. AHA, Inc.’s Board of Directors disapproved of associating therapies under the same umbrella of equine-assisted services as learning and horsemanship, yet agreed that the other recommendations were a tremendous step forward. AHA’s response can be found here. Votes of the Boards of Directors of EAGALA and CBEIP were pending at the time of the article’s publication.

We have recently confirmed that CBEIP did endorse the terminology recommendations after the article’s publication.  Rumor has it that EAGALA did not endorse the terminology recommendations, but we have not yet been able to confirm this.

Summary of Authors’ Main Discussion Points

1. The most important recommendation stemming from this process was that stakeholders adopt terminology that precisely and accurately identifies distinct types of services and meaningfully distinguishes between them, and discontinue the use of terminology that is imprecise and potentially inaccurate or misleading. The use of such terminology may benefit the field in a number of ways as well as prevent or mitigate future terminology-related problems.
2. The use of the recommended unifying term, Equine-assisted Services, if used as intended to reference two or more services, may also prevent or mitigate terminology-related problems. It must not be reduced to a single homogenous service, however.
3. Ongoing questions and challenges:
   1. There was disagreement on the use of therapy-first language. Licensed therapy professionals who recommended using therapy-first language and discontinuing the use of “equine-assisted” to define therapy (as in as equine-assisted psychotherapy (EAP)) argued that it erroneously implied a different stand-alone therapy from that of psychotherapy itself. Other licensed therapy professionals disagreed and reported that the use of terms such as EAP had not been problematic.
   2. Some noted that the modifier, equine-assisted, was universally recognized and aligned with widespread uses of animal-assisted and was therefore preferable to terms like equine-facilitated or equine-guided.
   3. The use of adaptive riding and therapeutic riding were questioned and there was some disagreement regarding the best terms to describe services in which riding was adapted to make the benefits accessible to persons with diverse needs. The historic use of “therapeutic riding” to label any service incorporating horses was rejected. Likewise, the adjective, “therapeutic”, was rejected insofar as it implies that therapeutic riding is a type of therapy. Yet, therapeutic riding is viewed as a highly recognizable term, both nationally and internationally, and has been used for more than half a century. Adaptive riding, a more recent term, aligns with terminology in adaptive recreation and sports while accurately conveying that the activity is adapted. Ultimately, valid preferences for either term were recognized.
4. The authors maintain that the article is a living document and they encourage critical evaluations of all recommendations plus ongoing monitoring of any positive or negative impacts of the recommendations.

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Want to learn more?  Watch a Horse Sense Webinar in which Lissa Pohl (one of the authors) shares more about this project and this publication.