HIPPOTHERAPY STANDARDS
See Glossary for clarifi cation and defi nition.* H1 MANDATORY Is there written evidence that the therapist/health professional who provides direct treatment ser-vices in a hippotherapy program meets the following qualifi cations:
1. Is licensed, registered or certifi ed to practice a nationally recognized health care profes-sion in accordance with his/her state practice acts?
2. Maintains current professional liability insurance?
3. Is a PATH Intl. Registered Therapist or hippotherapy clinical specialist (HPCS)? If not, is there a policy in practice that a Professional Association of Therapeutic Horseman-ship International Registered Therapist or HPCS supervises the treatment sessions conducted by non-PATH Intl. registered therapists?
4. Has received training in the principles of hippotherapy, equine movement and equine psychology?
Yes No
Interpretation: In part 1, therapists practicing hippotherapy have traditionally been occupational, physi-cal therapists and speech language pathologists. However, hippotherapy may also be practiced by other licensed, registered or certifi ed health professionals with a strong treatment background in posture and movement, neuromotor function and sensory processing.
In part 3, it is the PATH Intl. Registered Therapist or HPCS’s responsibility to evaluate the skills of therapists/health professionals in the program and provide appropriate supervision and training. A PATH Intl. Registered Therapist or HPCS does not need to be present during the hippotherapy treatment ses-sions performed by non-PATH Intl. registered therapist or HPCS. However, the supervising therapist/ health professional must be available on a regular basis for consultation and education.
In part 4, the intent of the standard is to ensure that a non-PATH Intl. registered therapist or HPCS has adequate training in order to carry out a safe and effective hippotherapy treatment. This information and training should be provided by a PATH Intl. Registered Therapist, a HPCS, a PATH Intl. Certifi ed In-structor or other equine and therapy professionals available to the program.
Compliance Demonstration: Visitor observation of WRITTEN documentation of therapist’s/health professionals licenses/registrations/certifi cations; professional liability insurance certifi cates; PATH Intl. registration certifi cates or board certifi cation, or log of therapist/health professional training by the program; director description of therapist/health professional training process.
*H2 MANDATORY DNA (does not apply): If center does not have a PTA and/or COTA providing treatment services. Is there written evidence that the physical therapist assistant (PTA) and/or certifi ed occupational therapy assistant (COTA) who provides treatment services in a hippotherapy program meets the following qualifi cations:
1. Is certifi ed, registered or licensed to practice as a physical therapist assistant or certi-fi ed occupational therapy assistant in accordance with the state/provincial regulations governing the respective practices?
2. Maintains current professional liability insurance?
3. Is the COTA and/or PTA a Professional Association of Therapeutic Horsemanship In-ternational Registered Therapist, and if not, the COTA and/or PTA has received train-ing in the principles of hippotherapy, equine movement and equine physiology?
4. Has a written policy in practice at the center stating that a PATH Intl. Registered Therapist or hippotherapy clinical specialist (HPCS) of the respective fi eld evaluates, develops the treatment plan and supervises the COTA and/or PTA in accordance with the regulatory laws of the respective states/provinces?
Yes No DNA
Interpretation: Part 1, therapists practicing hippotherapy have traditionally been occupational, physi-cal therapists and speech language pathologists with a strong movement background. However, hip-potherapy may also be practiced by PTAs and COTAs under the supervision of licensed or Registered Therapists of their respective fi elds, and in accordance with the state regulations governing the practice of occupational therapy, physical therapy and speech language pathology. The requirement that PTAs and COTAs be licensed, registered or certifi ed in the particular state or province in which they practice refl ects that they are practicing their profession based on the standard of practice established in the par-ticular state/province in which they reside.
In Part 3, the intent is to ensure that a PTA and/or COTA has adequate training in order to carry out a safe and effective hippotherapy treatment. This can be achieved by meeting the requirements delineated by the PATH Intl. Registered Therapist process, or by specifi c training under the direction of a PATH Intl. Registered Therapist or HPCS.
In Part 4, it is the responsibility of the supervising PATH Intl. Registered Therapist or HPCS to develop the treatment plan of any patients that receive treatment from a PTA and/or COTA. It is the responsibility of the PTA and/or COTA and the respective supervising therapist/health professional to adhere to state regu-lations. Requirements for documentation and frequency of supervision may vary according to state law. It is critical for personnel to realize that the supervising PATH Intl. registered PT, OT or SLP is ultimately responsible for the provision of occupational and physical therapy services within the hippotherapy session.
Compliance Demonstration: Visitor observation of WRITTEN documentation of PTA’s and/or COTA’s licenses/registrations/certifi cations, professional liability insurance certifi cates; log of PTA and/or COTAs professional training; the WRITTEN policy on PTA and/or COTA supervision by a PATH Intl. Registered Therapist or HPCS of the same profession.
H3 DNA (does not apply): If the therapist/health professional is a volunteer and not paid for services rendered.
Is there a written contractual agreement between the therapist/health care provider/contracting agent and the center?
Yes No DNA
Interpretation: The employee contract may include salary or wages (if applicable), length of employ-ment, benefi ts, who is responsible for provision of professional and general liability insurance coverage, termination standards (such as “at will”), and reference to job description and other personnel policies. The independent contractor agreement should include: terms of payment, length of contract, who is responsible for professional liability and general liability coverage, who is responsible for paying the various taxes, services to be performed. Legal counsel should be consulted in regard to these and other possible provisions, such as releases of liability and indemnifi cation language.
H4 DNA (does not apply): If facility does not bill for services.
Is there written evidence of billing policies and procedures?
Yes No DNA
Interpretation: The fees should be refl ective of the local treatment fee schedules.
Consultation with insurance companies and other therapy agencies is recommended to learn about third party reimbursement procedures.
Compliance Demonstration: Visitor observation of WRITTEN policies and procedures.
H5 Is there a written policy in practice on the number of hours that each equine can be worked in a hippotherapy program:
1. Per working session? 2. Per day?
3. Per week?
Yes No
Interpretation: A “working session” is a period of continuous use without any lengthy break. Special consideration should be given to equines that are involved with hippotherapy. The rationale for the schedule of each equine should be based on the size and type of patients served.
Compliance Demonstration: Visitor observation of WRITTEN documentation and personnel description of scheduling procedures.
H6 Is there written evidence of a system in practice for training the therapist/hippotherapy team members that include the following:
1. Orientation to the hippotherapy program’s policies and procedures? 2. Hands-on training:
a. Rehearse emergency procedures? b. Rehearse safety procedures? c. Transitions on and off equine?
d. Practice patient handling techniques? e. Practice equine handling techniques?
f. Rehearse a mock therapy session to ensure a coordinated team approach prior to patient participation?
Yes No
Interpretation: In part 1, HPOT program policies and procedures may include: philosophy of the pro-gram, vision statement, intake and discharge criteria, fee schedules, cancellations, weight and size limits of patient, behavior management issues, administrative structure/lines of communication, releases of liability and informed consent forms.
In part 2:a, emergency procedures may include: a fall from a equine, seizures, an injury from a kick, acute illness, fi re and emergency dismounts in all treatment situations such as leading/long lining/T-HPOT.
In part 2:b, safety procedures may include: approaching equines, restraining equine for grooming and tacking, working around the equine, checking condition of equipment, checking the fi t and security of the equipment on the equine, transitioning patients on and off equine, stabilizing the patient on the equine, introducing extraneous pieces of equipment to the equine/patient during the lesson (e.g. balls, rings, towels, etc.)
In part 2:d, patient handling techniques may include: lifting and carrying, transitioning on and off equine including ‘handing off’ a patient to an already mounted therapist/health professional/COTA/PTA for T-HPOT session, stabilizing the patient on the equine, therapeutic handling techniques when the therapist can not be the person mounted behind the patient in a T-HPOT session, facilitating and inhibiting tech-niques and other treatment techtech-niques.
In part 2:e, equine handling techniques relevant to hippotherapy may include: leading by halter or bridle, therapeutic lunging, long lining, lunging.
Compliance Demonstration: Visitor observation of WRITTEN documents and materials. Personnel description of orientation and hands-on training.
H7 Are there training and conditioning methods specifi c to hippotherapy in practice for the equines placed in hippotherapy?
Yes No
Interpretation: It is understood that the quality of the results achieved in hippotherapy are directly re-lated to the quality of movement of the hippotherapy equine. Therefore, it is important to maintain the suppleness and strength of the hippotherapy equine through training and conditioning.
In T-HPOT, due to the increased stress, it is particularly important that the conditioning emphasize the elevation of the topline through strength and fl exibility training. The equine has to be gradually ac-customed to the distribution of weight behind the center of gravity and desensitized to the input of the additional leg pressure near the fl ank.
Compliance Demonstration: Visitor interview and personnel description of training and conditioning methods.
H8 Are the following documents available on-site for each patient?
1. Prescription from a physician IF required by the therapist’s/health professional’s state practice act?
2. Treatment plan that includes long-and short-term goals?
3. Progress notes, completed on a regular basis, that refl ect the treatment and its modifi cations based on the response of the patient?
4. Re-evaluations, completed on a regular basis, that update the goals and plan, make rec-ommendations for further treatment, discharge or transition into another program?
Yes No
Interpretation: Patient documentation will refl ect the practice acts of the therapist’s/health professional’s respective profession. The areas of evaluation, long-and short-term goals and the implementation of the principles of hippotherapy may differ based on the educational background of the therapist/health pro-fessional.
Compliance Demonstration: Visitor observation of randomly selected patient fi les of each therapist/ health professional involved in hippotherapy.
*H9 MANDATORY Is there a system in practice to ensure that the equine handler during all hippotherapy sessions has received training specifi c to the needs of a hippotherapy session?
Yes No
Interpretation: In this instance the equine handler is the person in charge of the handling of the equine during the hippotherapy treatment. The person should have extra training in handling equines specifi -cally for hippotherapy and recognizing signs of stress in equines.
Compliance Demonstration: Visitor observation of hippotherapy session and personnel interview.
H10 Is there a system in practice that requires the hippotherapy team to select the following prior to each patient treatment session:
1. Equine?
2. Equipment for equine? 3. Equipment for patient?
4. Number and role of volunteers/personnel?
Yes No
Interpretation: The system in practice may include a posted written list of the required information that is readily available to the team at the treatment site.
In part 2, the equipment for the equine may include: various saddles and surcingles, stirrups, halter, bridles and bits, various pads, side reins, leads, long lines, lunging equipment, boots or bandages for equines legs, various types of whips.
In part 3, the equipment for the patient may include belts, rings, balls, neck straps on the equine, etc.
H11 DNA (does not apply): If not offering T-HPOT.
Is there written documentation of:
1. The rationale for the use of T-HPOT rather than HPOT to address specifi c treatment goals?
2. Periodic re-assessment of the ongoing need for T-HPOT?
Yes No DNA
Interpretation: T-HPOT has potential for increased stress on the equine and increased risk for the patient and therapist/health professional or COTA/PTA. There needs to be written justifi cation that T-HPOT is the only option for treatment and that the potential benefi t will outweigh the potential risk. In addition, signifi cant patient progress is essential to justify the ongoing use of T-HPOT.
Compliance Demonstration: Visitor observation of WRITTEN documentation of rationale for treatment and re-assessment of the patient.
H12 DNA (does not apply): If not offering T-HPOT.
Is there a written policy in practice for patients who are deemed clinically appropriate for T-HPOT that includes the following:
1. The combined weight of the equipment, patient and therapist/health professional or COTA/PTA does not exceed 20% of the equine’s weight?
2. The patient participating in T-HPOT with helmet is not taller than the chin of the therapist/health professional or COTA/PTA’s when mounted?
3. The patient does not exceed the weight of the therapist/health professional or COTA/PTA? 4. The patient demonstrates physical behaviors (voluntary or involuntary) that can be
safely managed by the therapist/health professional or COTA/PTA? 5. The patient or parent/guardian signs an informed consent acknowledging
the inherent risk of a T-HPOT session?
Yes No DNA
Interpretation: As the combined weight and positions of the patient and therapist/health professional or COTA/PTA greatly increases stress on the equine’s back and loin area, there should be a determined limit based on the equine’s conformation, condition and the generally accepted fi gure of 20% of the equine’s weight. A 1,000 pound horse, for example, should not carry more than 200 pounds of combined weight, assuming good conformation and conditioning. The height limitation for the patient helps to prevent inju-ry to the face and head of the therapist/health professional or COTA/PTA should the patient’s head move quickly backwards. This also helps to ensure that the size and weight of the patient is within the ability of the therapist/health professional or COTA/PTA to safely handle. Physical movements and behaviors, such as extensor thrust, tantrums, fl ailing, etc., that are unable to be managed safely by the therapist or COTA/ PTA would be a contraindication for the use of T-HPOT. The patient’s family and treatment team needs to make an informed decision about participation in T-HPOT due to the increased risk of this activity.
Compliance Demonstration: Visitor observation of WRITTEN policy and signed forms, personnel description and visitor observation of T-HPOT session.
*H13 MANDATORY DNA (does not apply): If not offering T-HPOT.
Is there written evidence of a procedure in practice to determine the duration and frequency of the T-HPOT equine’s schedule, including:
1. Maximum of 30 minutes per session inclusive of transitioning onto and off the equine? 2. Sessions scheduled on non-consecutive days?
3. No more than two sessions per day in non-consecutive sessions?
4. Limited involvement in other equine-assisted activities on the same day in which the equine is involved in T-HPOT?
Yes No DNA
Interpretation: A record should be kept of the number of times the equine works in T-HPOT and in other capacities. Given that T-HPOT is a stressful activity for the equine, consideration should be given to a lighter schedule for that equine on a T-HPOT day.
Compliance Demonstration: Visitor observation of WRITTEN documentation.
H14 DNA (does not apply): If not offering T-HPOT.
Is there written evidence in a T-HPOT session of the competence of the therapist/health profession-al or COTA/PTA on the equine, demonstrating a well-profession-aligned, secure seat and position at profession-all times, during the following:
1. Riding at a walk, trot and canter with and without stirrups?
2. Sitting at a walk in the T-HPOT position (behind the equine’s center of gravity) while being led or long lined during changes of pace, serpentines, fi gure of 8 and transitions to and from halt?
Yes No DNA
Interpretation: Evidence of riding ability may include, but is not limited to, PATH Intl. certifi cation at the advanced level; Pony Club C-level or higher; comparable CHA certifi cation; a letter from another instructor who has PATH Intl. advanced certifi cation, Pony Club C-level status or CHA comparable cer-tifi cation who has observed the therapist/health professional or COTA/PTA demonstrate the above listed skills, in person or by video.
Compliance Demonstration: Visitor observation of WRITTEN documentation and interview of personnel.
H15 DNA (does not apply): If not offering T-HPOT and/or the individual providing the patient han-dling is the licensed therapist/health professional.
If the person providing the patient handling in a T-HPOT session is the COTA/PTA and is not the therapist/health professional, is there written evidence that s/he has been trained in the use of therapeutic handling and is under the direct supervision of the therapist/health professional dur-ing all sessions?
Yes No DNA
Interpretation: In order for treatment to be effective, the individual providing the patient handling should have suffi cient knowledge and skill to facilitate the patient’s progress according to the treatment plan. The therapist must directly supervise this individual during all T-HPOT sessions in accordance with their state practice act.
Compliance Demonstration: Interview of personnel and visitor observation of WRITTEN evidence of competence.
H16 DNA (does not apply): If not offering T-HPOT.
Is there a procedure in practice for the use of tack in a T-HPOT session that ensures the following: 1. The pad used to protect the equine’s back is large and long enough to accommodate
both the patient and the therapist/health professional or COTA/PTA on the equine? 2. The pad is safely secured to the equine?
3. There is a handle/handhold accessible to the therapist/health professional or COTA/ PTA on the equine?
Yes No DNA
Interpretation: Saddles, English or Western, are inappropriate for T-HPOT due to the displacement of the weight of the therapist/health professional or COTA/PTA on the equine over the equine’s loin area, and the interference and possible cause for injury to the therapist or TA on the equine by the cantle of the saddle.
In T-HPOT the protection of the equine’s back is of prime importance. Size and length of the pads should cover the equine’s back and sides so that the patient and the therapist/health professional or COTA/PTA on the equine sit comfortably on the pads and not on the equine’s back. The pad should be of a material suffi cient to protect the equine’s back with shock absorbing and weight distributing prop-erties with consideration given to the balance and position of the patient. For safety, the pad must be secured so that it does not slide.
In an emergency, the therapist/health professional or COTA/PTA on the equine should have easy access to a secure handle, for balance, not to control the equine. Examples may be the handle of a surcingle, a properly fi tting neck strap or other reliable tack.
H17 DNA (does not apply): If not offering T-HPOT
Are there written policies and procedures in practice to ensure that a T-HPOT session has the following:
1. A team that includes a leader, 2 sidewalkers and the therapist/health professional or COTA/PTA if the equine is led (personnel to patient ratio of 4:1); an equine handler, header, 2 sidewalkers and the therapist/health professional or COTA/PTA if the equine is long lined (5:1)?
2. The therapist/health professional or COTA/PTA is not responsible for the equine? 3. The sidewalkers who are matched in height and strength to the size of the patient,
therapist/health professional or COTA/PTA and equine?
Yes No DNA
Interpretation: The responsibility of the therapist/health professional or COTA/PTA is the safety and handling of the patient, not the control of the equine. The responsibility of the equine handler is the safe control of the equine. For the safety and comfort of all concerned, it is recommended that the sidewalk-ers’ shoulders are equal to or taller than the hips of the therapist/health professional or COTA/PTA when the therapist/health professional or COTA/PTA is on the equine.
Compliance Demonstration: Visitor observation of WRITTEN policies and procedures, interview with personnel; visitor observation of a T-HPOT session.
DRIVING STANDARDS
See Glossary for clarifi cation and defi nition.*D1 MANDATORY Are all driving sessions conducted by or under the direct supervision of an instructor who holds Professional Association of Therapeutic Horsemanship International Certifi ed Driving Instructor status?
Yes No
Interpretation: Direct supervision means the instructor is at the activity site and is aware of and respon-sible for the program activity in the arena or on the premises.
Compliance Demonstration: Visitor observation of driving session and certifi cate.
D2 Does the center have guidelines to determine the selection and placement of equines for the driving program?
Yes No
Interpretation: Equines placed in a driving program should have demonstrated qualifi cations that in-clude, but are not limited to the following:
1. Be 5 years of age or older 2. No stallions may be selected
3. Be in sound condition with a good temperament and good driving manners 4. Have at least 2 years of varied driving experience, alone and in company 5. Be reliable and obedient under all conditions
6. Stand still for harnessing up, putting to, loading and unloading wheelchairs and when instructed
7. Have no objection to being overtaken from the rear or having vehicles in front or passing
D3 Is there an equine training and conditioning program in practice that is specifi c to the needs of the driving program?
Yes No
Interpretation: An equine’s satisfactory performance in harness depends on being driven regularly by experienced personnel who can effectively carry out schooling and conditioning specifi c to the driving program.
Compliance Demonstration: Visitor interview and personnel description of training and conditioning program.
D4 Is there a written procedure in practice that requires the regular inspection of the harness to en-sure proper fi t and maintenance?
Yes No
Interpretation: To ensure safety, the harness must be suitable, strong, fi t correctly and be regularly main-tained and inspected for condition of leather, stitching and wear points. Inspection records should be kept.
Compliance Demonstration: Visitor observation of WRITTEN documentation and personnel de-scription of procedures.
*D5 MANDATORY During a driving session, is there a means of attaching a lead rope to the equine?
Yes No
Interpretation: A lead rope should be available for ease of control by the header. This can be attached to any type of halter, a head collar with a ring, or a ring attached to the noseband. It is important that this does not interfere with the bridle or bit. Unless the header is leading the equine, lead ropes should be re-moved before driving commences. At no time should the lead be left attached around the equine’s neck.
*D6 MANDATORY Is there a written procedure in practice that ensures the vehicle is regularly maintained?
Yes No
Interpretation: Vehicles should be inspected regularly for wear of parts, greasing of axles, loose nuts and tire wear. Maintenance records should be kept.
Compliance Demonstration: Visitor observation of WRITTEN documentation and personnel description of procedures.
D7 Is there a written procedure in practice to ensure that the vehicle and driving terrain are suitable for the equine?
Yes No
Interpretation: The weight of an equine is generally the best guide for how much weight the equine can pull. The ratio of the weight of the equine to the weight of the vehicle and its load can vary from 1:1 for diffi cult terrain to 1:3 for walking on good fl at surfaces. Other factors include the size and strength of the equine, the road surface and grade, equine shoes and traction, the vehicle, the type of work and the weather.
Compliance Demonstration: Visitor observation of driving area, WRITTEN documentation and personnel interview.
D8 Is there a procedure in practice to ensure that the vehicle is suitable for the participant and his/ her disability?
Yes No
Interpretation: The motion provided by the suspension and balance of the vehicle should be appropri-ate for the participant. Vehicles should have a dashboard to protect participants from mappropri-aterial thrown up by the equine’s feet. Participants should be able to brace their feet on the fl oorboards and may need a footrest. Traditional vehicles with easy access may be used for semi-ambulatory participants. Those in wheelchairs may need specialized vehicles with loading ramps or lifts.
Compliance Demonstration: Visitor observation of vehicles and personnel description of procedures.
*D9 MANDATORY Is there a policy in practice to ensure that the equine is put to the vehicle prior to anyone entering the vehicle?
Yes No
Compliance Demonstration: Visitor observation of driving session.
D10 Is there a policy and procedure in practice that the driving areas are clearly defi ned and routinely maintained?
Yes No
Interpretation: The best areas:
1. Have a level, smooth surface suitable for wheeled vehicles, e.g., no deep sand 2. Are free of holes and obstacles
3. Have entrance and exit gates wide enough for driving vehicles 4. Are routinely maintained
Compliance Demonstration: Visitor observation of driving area and personnel description of mainte-nance procedures.
D11 Is there a policy in practice to correlate the size of the driving area to the number and size of vehicles in the session?
Yes No
Interpretation: In determining the size of the driving area, consideration should be given to the size and number of turnouts, skill level of the participants and need for additional volunteers.
D12 Do all driving activities for beginning participants take place in an enclosed area free from other activities?
Yes No
Interpretation: Safety will be maximized if driving activities for entry level students take place in an en-closed fenced area. The fl at surface of the boards should be on the inside. Cable, pipe or barbed/smooth wire are not recommended. Public roads are not recommended. Do not mix riders, or other activities, and drivers. A beginning participant’s reins are attached to the saddle, breast collar terrets or to the lead halter.
Compliance Demonstration: Visitor observation of driving area and activities and interview of personnel.
D13 Is there a written procedure in practice to train volunteers and personnel specifi cally for driving?
1. Volunteers and personnel should be trained in offering assistance to the equine and par-ticipant as needed throughout the driving lesson?
2. Volunteers and personnel should be trained in procedures to handle the equine and quickly release him/her from the harness and vehicle in an emergency?
3. Volunteers and personnel need to be instructed in the operation of all securing mechanisms and procedures for entering and exiting the vehicle?
Yes No
Interpretation: Requirements for driving are different from other equine activities, and volunteers and personnel need to know the language, precautions, procedures, equipment, etc.
Compliance Demonstration: Visitor observation of WRITTEN documentation and interview with personnel.
D14 Is there a procedure in practice to assign specifi cally trained volunteers and personnel in
designated roles as needed in the driving program?
Yes No
Interpretation:
• An able-bodied whip (ABW) has a second set of reins and is always in the vehicle before the partici-pant enters and after the participartici-pant exits. This may be, but does not have to be, the instructor.
• A header works with only one turnout, assists in the preparation of the equine and vehicle, stands at the equine’s head with a lead rope attached while the vehicle is being entered or exited and takes control of the equine when needed.
• An assistant instructor may be needed for a group lesson.
• A sidewalker/spotter may need to be available to offer any additional assistance. Additional side-walkers may need to be on the ground for beginning participants. Spotters may be an additional safety requirement for advanced whips. Volunteers on wheels may be needed on the trail.
• A wheelchair attendant may be needed who understands the wheelchair mechanisms and can assist the instructor with the entry and exit of the participant in a wheelchair from the driving vehicle. • A person should be designated as the vehicle maintenance person for safety checks and should be
knowledgeable in the care and maintenance of the driving vehicles.
Compliance Demonstration: Visitor observation of driving session and personnel interview.
*D15 MANDATORY Are there procedures in practice to assist participants to safely enter and exit each vehicle and that address the specifi c needs of the participants in the presence of the Professional Association of Therapeutic Horsemanship International Certifi ed Driving Instructor?
Yes No
Interpretation: Each program should establish procedures so that participants can quickly and safely enter and exit from each vehicle. These procedures will vary from vehicle to vehicle and should include, but are not limited to:
1. The presence of a header at the equine’s head.
2. The presence of the ABW in the vehicle prior to the participant entering and after the participant exits the vehicle.
3. Any adaptations necessary for vehicles that are being used. These procedures should be reviewed and updated periodically.
D16 Are trained headers always present and available to assist at all times during driving sessions for each turnout?
Yes No
Interpretation: Headers should always be close enough to render immediate assistance.
Compliance Demonstration: Visitor observation of driving session and personnel interview.
*D17 MANDATORY Is there a procedure in practice for the Professional Association of Therapeutic Horsemanship In-ternational Certifi ed Driving Instructor to verify the driving qualifi cations of the ABW including, but not limited to, that the ABW:
1. Is 18 years of age or older?
2. Has at least 50 hours of experience driving equines in varied settings?
3. Is trained in the use of the second set of reins and in assisting the participant while driving, if needed?
Yes No
Interpretation: Competency of the ABW is vital. The ABW should also have good upper body strength and drive regularly in addition to the session within the program.
Compliance Demonstration: Visitor interview with driving instructor and ABW.
D18 Is there a procedure in practice for the PATH Intl. Certifi ed Driving Instructor and ABW to check the complete turnout and to assess the attitude and soundness of the equine prior to the driving session?
Yes No
Interpretation: The ABW should check the harness and vehicle and warm up the driving equine prior to the participant being mounted and assess the attitude and soundness of the equine in order to maximize the safety during the session.
*D19 MANDATORY DNA (does not apply): For advanced independent drivers.
Is there a procedure in practice that the ABW is in the vehicle and has a second set of reins to take control of the driving equine during the session if needed?
Yes No DNA
Interpretation: A second set of reins attached to the bit will enable the ABW to take control in case of emergency or if the participant tires. Reins for the participant may be attached to the halter, terrets, saddle rings or bit depending on his/her skill level. Reins of a different color/type/texture/width for the ABW and the participant may be helpful for clearer identifi cation.
Compliance Demonstration: Visitor observation of driving session.
*D20 MANDATORY DNA (does not apply): For advanced independent drivers
Does the ABW hold the reins and take control of the equine before the participant enters and re-main in the vehicle until after the participant exits?
Yes No DNA
Interpretation: The control of the equine and vehicle should be safely maintained by the ABW while the participant enters and exits the vehicle. The header also assists.
*D21 MANDATORY DNA (does not apply): If the participant does not use a power wheelchair.
Is there a policy in practice to ensure that safety considerations for power wheelchairs include but are not limited to:
1. Battery power is off and battery is safely encased or removed while wheelchair is in vehicle?
2. Appropriate larger size and stability of the vehicle?
3. Ability of equine and equipment to pull the considerably increased weight? 4. Adequate device for entering and exiting the vehicle?
Yes No DNA
Interpretation: It is preferred that only manual wheelchairs are used in the driving vehicle due to the excessive weight of power chairs. The decision to use a specialized or power chair should be carefully thought out considering safety, the welfare of the equine, insurance and program policies.
Compliance Demonstration: Visitor observation of driving session and personnel interview.
D22 DNA (does not apply): If participant does not use a wheelchair.
Is there a policy in practice to ensure that the wheelchair occupant is secure in the wheelchair? If needed, is the seat belt or harness of a quick release type?
Yes No DNA
Interpretation: A Velcro seat belt or similar type of harness may improve the stability and balance of the participant.
*D23 MANDATORY DNA (does not apply): If there is no wheelchair in the vehicle.
Are all wheelchairs secured while in the driving vehicle?
Yes No DNA
Interpretation: The wheelchair should be secured in the vehicle in such a manner that it cannot move in any direction. The wheelchair locks are required to be in the locked position. It is recommended that all securing methods have a quick release mechanism. All attendants are required to understand how the quick release mechanism works. Methods will vary with construction of vehicle.
Compliance Demonstration: Visitor observation of wheelchair in driving vehicle.
*D24 MANDATORY DNA (does not apply): If there is no wheelchair in the vehicle.
Is there a procedure in practice to ensure that only one wheelchair is in the driving vehicle at a time?
Yes No DNA
Interpretation: Only one wheelchair is allowed.
*D25 MANDATORY DNA (does not apply): If ABW has no impairment that limits his/her ability to respond to safety issues.
If the ABW has an impairment that limits his/her ability to respond to safety issues, is at least one other trained able-bodied person always in the vehicle?
Yes No DNA
Interpretation: For safety reasons, it is preferred that only one person with an impairment is in the vehicle at a time. Should it be necessary to use an ABW who also has an impairment that limits his/her ability to respond to safety issues, a vehicle is required to be used that can carry at least one other trained person to assist as necessary.
Compliance Demonstration: Visitor observation of driving sessions and personnel description of procedure and equipment.
D26 Is the vehicle equipped with a working auditory signal to get attention in case of an emergency?
Yes No
Interpretation: The presence of a cellular phone, bell or whistle can be necessary in the event of an emergency should more able-bodied assistance be needed.
INTERACTIVE VAULTING STANDARDS
See Glossary for clarifi cation and defi nition.V1 Does the center have a policy and procedure in practice to determine the selection of the prospec-tive equines for the interacprospec-tive vaulting program, including the following considerations:
1. Age?
2. Soundness in body and mind? 3. Height, build and conformation? 4. Temperament?
Yes No
Interpretation: An equine chosen for interactive vaulting must be trained in lungeing/longeing. Interac-tive vaulting poses additional stresses to an equine’s physical and mental well-being. It is recommended that an equine should be at least six years of age or older as an equine younger than six years of age is not likely to have an adequately developed mind and body for the focused and demanding work of in-teractive vaulting. The equine’s conformation should be evaluated specifi c to use in inin-teractive vaulting. This includes soundness on all four legs within the gaits used for vaulting and has a non-reactive back, loin and neck areas. The equine should be monitored for pain indicators particularly in the back area. Mares or geldings are recommended. The size of the equine in relation to the size of the vaulters is a necessary consideration to maintain the equine’s comfort and to allow the vaulters suffi cient room on the equine’s back to perform the desired movements securely. A good temperament is demonstrated by an equine that appears to be calm and content with the work that he/she is being asked to perform. Interac-tive vaulting requires that the equine not become upset by people approaching from all sides.
For example, the equine needs to accept people approaching from all directions when movement games are a part of the interactive vaulting activities.
Compliance Demonstration: Interview of personnel and observation of the interactive vaulting pro-gram.
*V2 MANDATORY Is there a policy and procedure in practice of a training and conditioning program, specifi c to the equine involved in interactive vaulting, to include:
1. Lungeing/Longeing?
2. Equipment specifi c to interactive vaulting? 3. Gymnastic exercises?
4. Continued conditioning?
5. Ongoing training to different vaulting exercises and movement games on and around the equine?
Yes No
Interpretation: An interactive vaulting equine is one who is obedient on the lunge/longe line and can maintain a circle while in balance at all the gaits being requested. A progressive training and condition-ing program is one that allows the equine to build skills based on previous traincondition-ing sessions. Strength and endurance must be developed over a period of time for the equine to become comfortable perform-ing the work that is beperform-ing asked of it. The equipment and activities used are specifi c to the discipline and require additional training to ensure safety.
Compliance Demonstration: Personnel description of the training and conditioning programs for each equine involved in the interactive vaulting program.
*V3 MANDATORY Is there a written policy and procedure in practice to limit the workload of each interactive vaulting equine specifi c to the individual equine?
Yes No
Interpretation: Interactive vaulting places additional stress on the equine. The equine is required to work on a circle, in balance, with vaulter(s) performing movements that require additional balance reactions by the equine. Because of these additional requirements it is necessary to adjust the equine usage from the core standard describing equine usage. The equine’s condition, pace and types of riders all enter into this decision. It is recommended that an equine be involved for a maximum of 60 minutes per lungeing/ longeing/vaulting session. There should be an interval of at least 6 hours between lungeing/longeing/ vaulting sessions. An equine should be used for a maximum of 6 lungeing/longeing/vaulting sessions per week. Some equines may not be conditioned suffi ciently to maintain the outlined requirements.
Compliance Demonstration: Visitor observation of WRITTEN documentation and personnel description of scheduling procedures.
V4 Does the center maintain written records indicating the vaulting equipment assigned to each equine participating in the interactive vaulting program?
Yes No
Interpretation: To ensure safety, the vaulting equipment is suitable, strong, fi ts correctly and is regularly maintained. The vaulting instructor/lungeur/longeur should be knowledgeable in the correct use of the equipment. Padding needs to be suffi cient to protect the equine’s back in relation to the weight of the vaulters and has suffi cient density to block the vaulter’s movements from causing pain to the equine. Some of the pain responses that might be displayed by the equine include wringing the tail, hollowing the back, pinning the ears, biting the air or grimacing. Consideration should be given to the use of the following vaulting equipment:
1. Type of bridle used. A smooth snaffl e (such as an eggbutt or loose ring) with no more than two joints with a noseband. A full cheek or D-ring is not appropriate if using a lunge/longe line to the bit as it can interfere with effectiveness. A properly fi tted lunge/longe cavesson may be used in addition to or instead of a bridle.
2. Type of vaulting surcingle. Consideration should be given to choosing a fl exible or non-fl ex-ible vaulting surcingle. The level of the vaulters will infl uence this decision along with the fi t to the equine. The non-fl exible surcingle is used for more demanding moves and should be treated just like a saddle with a tree that must be fi t to the individual equine.
3. Type of side reins.
4. Type of padding that allows suffi cient protection to the equine’s back in relation to the weight of the riders.
5. Type of padding under the surcingle in the girth and wither areas of the equine.
6. Type of girth. A non-elastic girth is necessary to help keep the surcingle from moving.
7. Type of lunge/longe line. A web lunge/longe line with a non-swivel snap or clip is preferable. 8. Type of lunge/longe whip. The lunge/longe whip should be of suffi cient length to reach the
equine’s hindquarters without the lungeur/longeur moving from the center of the circle. 9. Type of protective boots or wraps for the equine, as needed.
V5 Is there a procedure in practice for volunteer and personnel training specifi c to the needs of interactive vaulting?
Yes No
Interpretation: Additional skills are required of volunteers and personnel participating or assisting in in-teractive vaulting. These skills are in addition to the training for equine-assisted activities and therapies and may include, but are not limited to, instructions in vaulting exercises, gymnastics, group dynamics, emergency response and spotting.
Compliance Demonstration: Visitor interview with personnel; observation of the interactive vaulting session.
V6 Is there a policy in practice for vaulter attire?
Yes No
Interpretation: For safety, comfort and welfare of the equine and vaulters, vaulting attire should be ap-propriate to the activity. The following attire is recommended:
• Good choices for footwear include lightweight canvas shoes, aqua socks, gymnastics or vaulting shoes. Poor choices include heeled and or heavy-treaded shoes, riding/paddock boots or sneakers. • Long hair should be tied back.
• Clothing should fi t snuggly. Loose clothing poses a safety concern. • No jewelry.
• Medical alert bracelets should be acknowledged, secured and covered. • There should be no food items in the mouth (such as gum).
Compliance Demonstration: Visitor interview of personnel and volunteers; observation of an interactive vaulting session.
V7 Is the vaulting barrel:
1. Designed and constructed of materials of a strength and size to accommodate the vaulters, personnel, equipment and activities for which it is used?
2. Suffi ciently padded, free of sharp and/or protruding objects and includes built-in or attached handles?
3. Placed in a location with suffi cient clearance to mount and dismount safely? 4. Placed in an area that has even, soft and resilient footing?
Yes No
Interpretation: Vaulting barrels can vary in material and size. The support of the barrel should not in-terfere with the movements of the vaulters while mounting or dismounting. Bolts and welds need to be covered smoothly. Handles should be protected for safety and comfort of the vaulters (for example, may be wrapped with vet wrap or duct tape). Some prefer to construct the vaulting barrel without built-in handles and add a surcingle on the barrel to provide the handles in a more realistic manner. The vaulting barrel needs to be stable enough to avoid tipping over when used vigorously. For further information on vaulting barrels contact the American Vaulting Association or US Pony Club.
Compliance Demonstration: Visitor observation of the vaulting barrel(s); interview of personnel.
*V8 MANDATORY DNA (does not apply): If the vaulter is wearing an ASTM-SEI helmet.
Is there written documentation on each vaulter who does not use an ASTM-SEI helmet according to the Guidelines for Non-Use of Helmets in Interactive Vaulting?
Yes No DNA
Interpretation: Professional Association of Therapeutic Horsemanship International core standards in-clude a mandatory program standard for use of ASTM-SEI recognized safety helmets for equestrian use while mounted or driving. There has been some evidence that the use of helmets in higher level vaulting activities may be a safety concern. If a vaulter or a vaulting program is at the level of providing sport vaulting, then it is recommended that the program pursue sanctioning by a sport vaulting organization. However, there are some participants in interactive vaulting who might be at a higher skill level that might offer them opportunities to participate in higher level vaulting activities, but are not yet ready for a sport vaulting program. It may be safer for these vaulters not to wear a helmet (as long as allowed by local laws). However, documentation for such a decision is necessary and must answer all the questions posed in the Guidelines for Non-Use of Helmets in Interactive Vaulting.
Guide-*V9 MANDATORY Is there evidence that all instructors directly supervising interactive vaulting sessions hold a PATH Intl. Vaulting Certifi cation?
Yes No
Interpretation: PATH Intl. offers an Interactive Vaulting Certifi cation. A person who pursues the certi-fi cation must already hold at least a PATH Intl. Registered Instructor Certicerti-fi cation. The candidate must then attend an interactive vaulting workshop and pass a two-phase examination. The fi rst phase is for lungeing/longeing (which must be successfully passed prior to pursing the second phase). The second phase is for interactive vaulting.
Compliance Demonstration: Visitor observation of documentation of certifi cation.
V10 Is the vaulting area:
1. Clearly defi ned 2. Free of obstructions? 3. Even?
4. Routinely maintained?
5. Has a radius of at least 30 feet (9.14m), allowing a lunging circle of 60 feet (18.28 m)? 6. Has a minimum ceiling clearance of 16 feet?
Yes No DNA
Interpretation: The ideal vaulting area should allow for a lungeing/longeing circle of 60 feet (18.28m). Such an area provides suffi cient distance from any walls, fencing or obstructions and ensures that the vaulters have suffi cient room for dismounting and movement games that might occur outside of the 60 foot lungeing circle. Ways to clearly defi ne the vaulting area include, but are not limited to, fencing (no barbed or slick wire), arena walls, cones or raised rails that the equine can see clearly. The boundary materials should be routinely maintained to maximize safety for the equine, vaulters and/or personnel. The footing of the vaulting area should be maintained to keep it even, soft and resilient. An equine mov-ing on a circle in the same space will make ruts or tracks; these must be regularly groomed. The footmov-ing should be neither slick nor too deep for the comfort and safety of the equine and the vaulters. Shavings, sand or a mixture of both are examples of, but not limited to, the options available. The American Vault-ing Association recommends for competition a minimum of 4 inches and a maximum depth of 6 inches of footing. Some surfaces suitable for therapeutic riding may not be safe for interactive vaulting.
Compliance Demonstration: Visitor observation of the vaulting area; personnel description of the maintenance procedures.
*V11 MANDATORY Is an additional person always present and available to assist at the activity site during all interac-tive vaulting activities?
Yes No
Interpretation: The additional person may be needed to call for help or assist in an emergency.
Compliance Demonstration: Visitor interview of personnel and additional person; observation of an interactive vaulting session.
EQUINE-FACILITATED PSYCHOTHERAPY STANDARDS
See Glossary for clarifi cation and defi nition.*EFP1 MANDATORY Is there written evidence that the mental health professional who provides direct treatment
services meets the following qualifi cations:
1. Is credentialed (licensed, certifi ed, etc.) as a mental health professional who has met the criteria to legally and independently provide psychotherapy and/or mental health coun-seling in the state (or country) in which the services are being delivered?
2. Maintains current professional liability insurance?
3. During all EFP sessions, is a Professional Association of Therapeutic Horsemanship International Certifi ed Equine Specialist in Mental Health and Learning (ESMHL) or is assisted by a PATH Intl. ESMHL; and when conducting mounted EFP sessions, is a PATH Intl. Certifi ed Instructor and a PATH Intl. Certifi ed ESMHL or is assisted by a PATH Intl. Certifi ed Instructor and a PATH Intl. Certifi ed ESHML.
Yes No
Interpretation: Legal requirements for the practice of psychotherapy and/or mental health counseling vary from state to state in the United States. It is the responsibility of the center to provide the neces-sary documentation of the ability to independently provide services in order to comply with its state and country laws and this standard.
Compliance Demonstration: Visitor observation of WRITTEN legal licenses/certifi cations, insurance documents, and visitor observation of EFP session.
EFP2 Is there a written contractual agreement between the mental health professional and the center?
Yes No
Interpretation: The mental health professional, whether a paid employee, a contractor or an unpaid pro-vider, should have a written agreement that clearly delineates the relationship between the provider and the center. The contract may include performance expectations; compensation; who is responsible for professional and general liability coverage; length of employment, contract, or donation of services; tax responsibilities; termination guidelines (such as “at will”); reference to job description and other person-nel policies.
EFP3 Is there a written consent for evaluation and treatment specifi c to psychotherapy available on site for each client?
Yes No
Interpretation: The legal and ethical practice of psychotherapy/counseling requires formal, written agreements between the client (or his/her legal guardian) and the therapist prior to treatment being initi-ated.
Compliance Demonstration: Visitor observation of randomly selected WRITTEN documents.
EFP4 Is there a written procedure in practice for release of information specifi c to psychotherapy and/ or mental health counseling to an outside source concerning a client receiving equine-facilitated psychotherapy and/or mental health counseling?
Yes No
Interpretation: The mental health professional providing treatment to a client in equine-facilitated psy-chotherapy or mental health counseling may receive requests from outside sources requesting release of information. This information is considered confi dential and must be treated as such. The mental health professional and the center need to have a procedure both written and in practice for dealing with such requests as well as a form (these forms should be HIPAA compliant) to facilitate the request. Such out-side sources could include probation offi cers, other therapists or child and family caseworkers.
Compliance Demonstration: Center explanation of procedure; visitor observation of randomly selected WRITTEN release forms.
*EFP5 MANDATORY Is there a procedure in practice that requires written documentation for personnel and
volunteers to be:
1. Assessed for ability to work with particular clients or client populations? 2. Consistently involved?
3. Oriented to the equine-facilitated psychotherapy program? 4. Oriented to the needs of the specifi c clients whom they assist?
5. Involved in post-session processing with the mental health professional, PATH Intl. Cer-tifi ed Instructor, PATH Intl. CerCer-tifi ed Equine Specialist in Mental Health and Learning and other pertinent people?
Yes No
Interpretation: The practice of EFP may necessitate the inclusion of specially screened and trained vol-unteers or personnel. Because of the nature of EFP programs, it is necessary for the volvol-unteers or per-sonnel to be thoroughly knowledgeable and experienced to provide the standard of service required in an EFP program. This includes a maturity level that must be assessed for appropriate behavior and conduct during EFP sessions. To obtain and maintain this standard, personnel and volunteers must receive ad-ditional and ongoing training. They should be thoroughly oriented to the program’s philosophy, mission/ vision statements, intake criteria, cancellation policies, administrative structure/lines of communication and other related program components.
EFP assistants should also receive very specifi c information related to client-centered issues, such as client behaviors, treatment plans and confi dentiality policies. (Examples: treatment goals, behavioral modifi cation programs, early signs of behavioral escalation, medication side effects, appropriate per-sonal boundaries - physical, emotional, social). Consistency and commitment from the EFP assistants are necessary in order to provide stability of treatment to the clients. Post-session processing enables the team to review the session in order to address issues, concerns and plan for the future.
Compliance Demonstration: Visitor observation and interview; observation of randomly selected WRITTEN documents.
EFP6 Is there a procedure in practice to assess and address the supervision and consultation needs of the PATH Intl. Certifi ed Instructor, PATH Intl. Certifi ed Equine Specialist in Mental Health and Learning, the mental health professional and the EFP assistants?
Yes No
Interpretation: Clinical supervision provides all those involved with the treatment process an opportu-nity to share, explore and address issues related to countertransference (i.e., personal feelings that arise during client contact) as well as to process issues related to treatment provision (e.g., problem-solving to modify a treatment approach and to consistently implement the plan). The amount of supervision is left to the center and professional after the procedure to assess and address the clinical need for such super-vision has been carried out.
*EFP7 MANDATORY Does the facility include a private area suitable for conducting a confi dential interview or
processing session with an equine-facilitated psychotherapy or mental health client?
Yes No
Interpretation: In the circumstance in which a client is unable/unwilling to participate in equine activi-ties, is decompensating psychiatrically or behaviorally, or just needs a confi dential place to process or share feelings, it is essential that the mental health professional and client have a space in which to meet. The space does not have to be an offi ce but should offer a place to sit down and have a private conversa-tion.
Compliance Demonstration: Visitor observation of the area that is used for interviewing/processing.
*EFP8 Is there evidence of written documentation available at each activity site for each client:
1. A comprehensive intake assessment?
2. A treatment plan that includes specifi c psychotherapy/mental health counseling goals? 3. Periodic review?
4. Ongoing client progress notes?
Yes No
Interpretation: Typically, a primary mental health professional’s documentation includes a comprehen-sive mental health assessment including chief complaint, psychosocial history, alcohol and drug history, symptom assessment and diagnostics. The treatment plan specifi es the needs of the client, goals of treat-ment, therapeutic modality and time frames for achievement. The treatment goals and plans should indi-cate that reviews and updates are occurring on an ongoing basis. The fi le should indiindi-cate that a screening for possible behavioral/psychiatric precautions/contraindications was done initially and is addressed on an ongoing basis as needed. Ongoing progress should be noted each visit. However, some mental health professionals see clients as an adjunct treatment and will have access to the above information through the primary mental health treatment provider/agency. If this is the case, a signed release of information should be present in the client’s fi le and there should be evidence of periodic liaison with the primary mental health professional. The licensed/credentialed mental health treatment provider documents the client’s status, therapeutic interventions employed, and client’s responses to the intervention, while the Professional Association of Therapeutic Horsemanship International Certifi ed Instructor documents the equine’s status, responses and horsemanship skills addressed in the session. (Both of these responsibili-ties may be addressed by the same person, if that person is dually trained.)
EFP9 DNA (does not apply): If the program does not conduct research effi cacy studies.
Does the program have a written procedure in practice for conducting research effi cacy studies involving the program’s participants, equines, personnel and personnel/volunteers?
Yes No DNA
Interpretation: Programs involved in investigative studies are advised that they should comply with federally recognized standards and requirements for the conduct of research effi cacy studies involving human and/or animal subjects.