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  • Scope of Practice and Equine-Assisted Activities

    Every behavioral health service is defined by its scope of practice. A scope of practice protects the public by defining the focus and limitations of a service. Without these parameters, an individual might practice outside their area of knowledge and unintentionally do harm to clients seeking help. Therefore, professional behavioral health services have an established scope of practice that 1) defines the actions those professionals are allowed to take in their practice, 2) the preparatory education, training and supervision required to complete those actions, 3) proof of competency to complete the designated actions typically in the form of an exam measuring knowledge, and letters of recommendation from supervisors indicating competence, 4) rules and regulations established by the federal and state governments in order to monitor and regulate those services, and 5) continued education and supervision requirements in order to remain current on evidence-based and best practice standards.

    Wikipedia describes scope of practice as, “the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. Each jurisdiction has laws, licensing bodies, and regulations that describe requirements for education and training, and define scope of practice.” For instance, a psychiatrist would not perform brain surgery, a mental health therapist would not prescribe medications, a behavioral aid would not diagnose a mental illness, an adaptive/therapeutic riding/horsemanship instructor would not treat mental illness and an equine specialist would not provide a mental health therapy session.

    These limitations are established for each level of service because as the scope expands so does the education, training and supervision requirements. For instance, a Psychiatrist must obtain a medical degree and complete a residency. Whereas a licensed counselor must complete a master’s degree and typically 3000 hours of supervised work, of which 1500 can sometimes be pre-degree. The continuing education requirements for Psychiatrists is on average (across the United States) 58 hours, whereas for a professional counselor it’s on average 32 hours.

    The various levels of services and/or professionals that exist in behavioral health services by degree requirements are as follows:

    • Medical Degree professionals such as Psychiatrists
    • D. or Ph.D. professionals such as Licensed Psychologists
    • Master’s Degree professionals such as Advanced Practice Nurse Practitioners
    • Master’s Degree professionals such as Licensed Professional Counselors, Social Workers, Marriage and Family Therapists, School Counselors, in some states Licensed Addiction Counselors, etc.
    • Bachelor’s Degree professionals with additional Continued Education hours such as Licensed Addiction Counselor
    • Bachelor’s Degree professionals with additional training from a Licensed Mental Health Agency such as Case Manager, Behavioral Aid, Youth/Peer Support Specialists, etc.
    • Highschool Diploma / GED professional with additional training from a Licensed Mental Health Agency such as Case Manager, Behavioral Aid, Youth/Peer Support Specialists, etc.

    The last two levels of professionals are sometimes referred to as paraprofessionals and have a variety of titles for their positions within agencies or institutions. These are individuals who are not behavioral health professionals but who provide behavioral health services within a licensed agency or accredited institution under the supervision of a professional and according to that agency’s policies and procedures. Examples could be employees of an institution who provide behavioral support to youth living in a residential facility or employees offering peer support or mentoring to clients involved in outpatient services. These individuals interact with clients offering positive behavioral supports to assist the individual in developing positive coping skills and reaching their treatment goals. These paraprofessionals are trained by the facility to perform the specific competencies as required by law. They are typically trained in how to implement specific behavioral interventions, document the client’s progress and participate in regular (usually at least minimally weekly) supervision to report progress and adjust interventions as needed.

    Not only does scope of practice differentiate the various levels of services, but it also differentiates within the levels. For instance, there are different types of licensed counselors who each have their own scope of practice. There are mental health counselors, addiction counselors and school counselors to name a few. Each of these types of counselors can further their scope of practice by specializing in certain areas such as a type of methodology or a population. Incorporating horses would be a specialty area.

    Just as there are a variety of types of behavioral health services, there are a few different popular types of certifications for the specialty area of incorporating horses:

    • Certifications for the licensed professional who wants to incorporate interactions with horses in their professional practice.
    • Certifications for non-licensed practitioners such as horsemanship trainers/instructors, life coaches, behavioral aids or other paraprofessionals who incorporate interactions with horses in the personal growth and development activities they provide.
    • Certifications for the riding instructor who would like to adapt riding lessons for people with disabilities.
    • Certifications for equine specialists / handlers who would like to assist the licensed professional when they incorporate interactions with horses in their sessions

    The second bullet point is a noteworthy category of provider that is popular in the specialty area of incorporating horses. This individual can either hold a degree or not and is certified as a life coach providing personal growth and development service. The scope of practice of these individuals is not in the area of providing behavioral health services and treatment. Rather, they provide a type of “self-help” experience with horses that is beneficial, but not to be confused with behavioral health treatment.

    If a professional or paraprofessional would like to incorporate interactions with horses with their clients, they would first need to become experienced with the scope of practice of their profession and then delve into understanding the scope of practice for the specialty area of incorporating horses. A person who does not already have the education, training and supervision of one of these behavioral health service areas is not competent to facilitate behavioral health sessions that incorporate interactions with horses by attending a workshop that teaches how to facilitate interactions with horses. In fact, learning how to facilitate interactions with horses is only one small part of the whole. Incorporating horses in behavioral health services involves first mastery of the behavioral health service, second, mastery of equine science, behavior/cognitions and welfare and lastly, mastery of facilitating interactions with horses both on the ground and mounted if including mounted work.

    When seeking to further your education and possibly obtain certification be sure to explore whether the certifying agency is aware of these scope of practice standards and provides adequate education, training, supervision and ongoing monitoring to ensure all providers of that certification are practicing according to their appropriate scope of practice and evidence-based, best practice standards.

    It is easy to be confused about the scope of practice of incorporating horses in behavioral health services. Many people are not certain of what incorporating horses really is. They think it is its own behavioral health service and give it titles such as “Equine Therapy” when there really is no such thing. A definition or scope of practice of “equine therapy” does not exist. There are only behavioral health services, or sometimes life coaching / self-help services that include horses such as addiction counseling that incorporates horses or life coaching that incorporates horses, etc. It is imperative that regardless of which type of professional you are that you operate within your scope of practice recognizing the limitations of your professional preparation.

    To learn more about incorporating horses in behavioral health services, click here to access the online course.