Terminology

Recently the topic of terminology in the field of Equine-Assisted Activities and Therapies (EAAT) has been coming up. There are already some really good articles out there already that address this issue, such as the “Top 10 Hippotherapy Myths and Misconceptions” by Speech In Motion, “The T Word” by Hoof Falls & Footfalls, and most recently the PATH Intl. CEO Kathy Alm sent out a “quarterly communication” (May 2018) about “the issues of confusing and inconsistent terminology throughout the field of EAAT” and how PATH Intl is going to try to do something about it. I don’t want to reinvent the wheel by writing yet another article about it, but I think it’s important to post something here because I’m sure there are readers who are unaware need and update! So I’ll attempt to paraphrase what’s going on and offer some additional insight. I’d love to hear your thoughts in the comments section!

Basic Terminology in EAAT

The most common terms I hear in the EAAT field and their most basic definitions, summarized in my own words:

Therapeutic Riding – Not found in most dictionaries. PATH Intl. defines it as: “an equine-assisted activity for the purpose of contributing positively to the cognitive, physical, emotional and social well-being of individuals with special needs.” I would add, because it’s what I’ve been taught at PATH Intl. trainings, is that this is done by a certified therapeutic riding instructor who uses the natural therapeutic benefits of the horse (primarily movement, but also acceptance, motivation, etc.) to achieve the rider’s life goals through teaching riding skills.

Adaptive Riding/Horsemanship – Riding or horsemanship lessons for people with special needs which uses various adaptations of equipment and teaching techniques to help them participate safely in learning the skills needed in equine activities for recreation (fun, exercise, socializing, and competition), not for rehabilitation. It is closely related to the adaptive sports industry. (Note the biggest difference from “Therapeutic Riding” is that Adaptive Riding does not claim to contribute to the mental/physical/emotional benefit of the person).

Equine-Assisted Activities and Therapies – This is a “broad term used to describe various activities and therapies that incorporate a horse and human in partnership.” (Carrie Hammer, D.V.M., Ph.D.) I think of it as the catch-all term for the whole industry. It includes:

  • Equine-Assisted Activities, which are horse-related activities such as therapeutic riding, ground activities, shows, demonstrations, etc. involving a team of certified instructors, volunteers, and equines
  • Equine-Assisted Therapies, which are  services/treatments by a medical professional that use equine activities and the horse environment as a tool to achieve re/habilitative goals
  • Equine-Assisted Learning, which “is an experiential learning approach that promotes the development of life skills for educational, professional and personal goals through equine-assisted activities” (PATH Intl)

Therapy – noun. In general, it is a treatment to help a person get better from the effects of a disease/disorder/injury by a remedial/rehabilitative/curative process (dictionary.comCambridge Dictionary). In the medical and professional world, it more specifically treatment interventions provided by a licensed/credentialed health professional (a PT/OT/SLP) mental health professional, social worder, or MD, with the focus on re/habilitation.

Therapeutic – adjective. Tending to give a beneficial healing effect to help cure, restore, or improve health, happiness, and the overall function of a person (AHA) (Merriam-Webster) (Cambridge Dictionary). It is used to describe drugs and medical treatment, and also activities, benefits, effects, claims, exercise plans, diets, etc. This is historically a broad term as defined above, but is becoming more narrow:

  • now that the word “therapist” means a licensed professional, medical dictionaries and professional associations define “therapeutic” as being done only be a licensed therapist
  • now that we have health insurance systems, the word “therapeutic” is being used as a billable code when provided by licensed therapists
  • at the same time the public has been using the term to describe activities outside the work of therapists, such as horseback riding or journaling or yoga can be therapeutic, claiming that these activities provide natural therapeutic benefits.

Hippotherapy – The use of a horse’s movement and environment as a tool or strategy by an Occupational Therapist (OT), Physical Therapist (PT), or Speech-Language Pathologist (SLP) to address functional outcomes and therapy goals – riding skills are not used unless they are a part of achieving these goals. Note:

  • Hippotherapy is NOT a type of therapy/treatment/service/practice provided – rather the professional provides OT/PT/SLP services using hippotherapy as a tool.
  • Therapists bill for the OT/PT/SLP services provided on the horse, not for hippotherapy.
  • It’s not a “hippotherapy program” but an OT/PT/SLP service being provided using hippotherapy.

Hippotherapist – This is not a real word, rather it’s an OT/PT/SLP professional providing services incorporating hippotherapy.

Horse/Equine Therapy – These are not real terms, as the horse doesn’t provide the therapy and is not a therapist, but people still use them a lot to indicate Therapeutic Riding or EAAT. However, I’ve read these terms may refer to therapy for horses.

The Terminology Issues

The following seem to me to be the main issues with the current state of the terminology in the EAAT industry, based on what I’ve been reading.

Inconsistent Terminology & Definitions

First, there is an inconsistency in the definitions of the terminology between the public, instructors, therapists, medical world, and professional association. This is listed in the definitions above. What more, the different professional associations (PATH Intl, American Hippotherapy Association, etc.) each have come out with their own definitions for the terms, which may not be exactly the same. It’s important to note that this inconsistency comes from the fact that these industries are still developing and therefore the definitions of these words are still developing too.

Second, there is an inconsistency in the terminology used between EAAT programs to describe what they do. For example, some centers call it therapeutic riding, others call it EAAT, and others still use the term horse therapy.

Third, there is an inconsistent use of the word “therapeutic.” Most of the public still use “therapeutic” to describe a healing health benefit in general (crying or yoga can be therapeutic), while at the same time the therapists and medical/insurance world use it to mean a health benefit specifically provided by a licensed therapist. The EAAT industry uses the first more general definition in “therapeutic riding” because it recognizes that the horse provides “natural therapeutic benefits” despite the riding instructors not being therapists. However, many people assume when “therapeutic” is used in a title like that it refers to being done by a therapist.

Issues in Public Understanding

The inconsistent terminology leads to issues in the public correctly understanding what we do and what services we provide. The most common one is that in using the terms “horse therapy” or “therapeutic riding” the public often  misinterprets it to mean “therapy” by a “therapist.” This term can also lead to people not correctly understanding what services your program provides – they may expect you to help their child achieve goals that only a therapist could help them achieve, and get frustrated when you teach them riding skills.

Legal Issues

Incorrect terminology can lead to legal issues, particularly if people are actually claiming to provide therapy when they are not qualified therapists, whether for dishonest marketing reasons or simply in ignorance using the wrong terminology.

Research Issues

When there is inconsistent terminology between research studies, it is practically impossible to compare results or compile a consistent body of work. The EAAT industry is running into this problem as it is currently trying to increase the amount of research in the field in order to legitimize the industry. We have all seen the benefits of what we do, but we need the data and scientific studies that substantiate our claims to the public (who use our services), healthcare providers (who refer clients to us), and insurance and government agencies (who are currently slow to pay for EAAT). The EAAT industry also needs more research to increase its own data-backed knowledge base within the field, which allows everyone to improve the services given to our riders and to improve the welfare of our equines. However, it has been hard for the EAAT field to progress in this area due to the inconsistent terminology.

Issues of Voice and Image to the Public

This flows from all of the above. If the industry is not consistent in its terminology, it cannot have a cohesive body of evidence to present to the public, and it cannot have a cohesive voice with which to share it. The public will continue to be confused about what we do and the validity of EAAT. We all need to be on the same page in order to improve public understanding of what we do and bring more people into the industry.

Issues for Therapists

All of this creates issues for therapists as well (PT/OT/SLP). The public doesn’t understand the difference between what they do and adapted/therapeutic riding, which may prevent people from using their services. Insurance companies don’t understand the difference either, which makes it harder for therapists using hippotherapy to get insurance coverage. This can create a rift between therapists and instructors, when really we should be working together – when a client is far enough along in their therapy sessions that they can balance and communicate on the horse, they can start with adapted riding! And if a rider isn’t far enough along in their balance or communication abilities to learn riding skills, we should refer them to therapists using hippotherapy! We want to get along with practitioners in other industries that use the horse, not frustrate them and make their work harder.

Issues with Insurance

Insurance companies and government agencies like Medicaid have been reluctant to cover EAAT because of all the above reasons (misunderstand what we do, limited research, inconsistent terminology, etc.).  Thinking it’s “just a riding lesson” prevents therapists from getting insurance (as noted above), and thinking that EAAT is not beneficial prevents it too from getting covered.

What PATH Intl. Is Doing About It

I’m not a PATH Intl. employee or representative, just an instructor member; PATH Intl. didn’t ask me to write this post, I myself want to bring up what they’re doing about it because I appreciate that they recognize the terminology issue and are starting to do something about it.

As explained in the recent quarterly communication (May 2018), PATH Intl. has set the goal of achieving “term definition agreement among the major stakeholders in EAAT,” which they just received a grant to do, through an “all-inclusive, data-driven process facilitated by trained consultants.” The steps appear (to my best understanding) to be 1) gather all the existing EAAT terminology in the US, 2) use it to create and take a survey given to PATH Intl members and other important stakeholders, 3) hire a professional facilitator to facilitate an in-person meeting of people representing the EAAT field and other related fields, in which they use the survey data and their professional opinions to agree on terminology and 4) publish a “Baseline Definitions Resource Guide” by February 2019, of which 5) “each stakeholder will ask their members to adhere to the definitions” to create consistency across organizations and research.

I am excited that PATH Intl. is trying to get consistency not just among their own members, but other organizations and people who are a part of the EAAT industry!

What YOU Can Do About It

Here are some ideas about what you as an EAAT instructor can do about the terminology issues:

Clarify The Therapy Thing

Make sure people know you are not a therapist and do not provide therapy – you are a certified therapeutic riding instructor who teaches adapted riding. (Unless you actually are a therapist…then you will give a different explanation).

I still tell people I am a “therapeutic riding instructor” because they is the term they have probably heard before. But I go on to immediately explain it’s actually “adapted riding” and that I’m not a therapist, I’m a regular riding instructor who has a special certification to make adaptations for people with disabilities and keep it super safe for them. I teach people how to ride – how to go, steer, and halt – and I also use the horse’s movement and other “natural therapeutic benefits” to help the riders reach their life goals, like improve balance or relax muscles. (See “The T Word” by Hoof Falls & Footfalls for how Sarah P explains it – her explanation is probably much better than mine!)

Use the Right Terminology

Currently it’s probably best to call what we do “adapted horseback riding” or “Equine Assisted Activities and Therapies (EAAT),” since “therapeutic riding” can be confusing, and “horse therapy” isn’t even really a thing. It totally depends on the context, though – if you have time to explain what you mean by “therapeutic riding,” then use it! If you don’t, go with the term that people are most likely to understand – probably “adapted horseback riding” (I’ll be the first to admit that EAAT takes too long to say so I never use it!). Most important, when PATH Intl. comes out with their official statement on terminology, follow that!

What more, encourage your center to use the right terminology, especially on their website and marketing. Don’t use terminology that implies you provide therapy when you don’t. Don’t use the wrong terminology to market your services just because it will attract more customers.

When giving presentations to organizations in your community, take a moment to address terminology and what you actually do vs. common misconceptions. Preferably at the beginning of your presentation so the terms are clear throughout the rest of it.

What I’m Doing About It

As I wrote this post I starting thinking about what terminology I use on this blog and how clear I am in defining it.

I’ve tried to use the right words for what we do, because I discovered Speech In Motion’s post about terminology early on. I’ve tried to be an advocate for teaching riding skills, not rehabilitational goals we have no business claiming to teach (although we can tailor how we teach those riding skills to promote those life goals). I chose to call this blog “Lesson in Therapeutic Riding” because at the time it was the most common term for what we do, a term that was (and still is) used by PATH International, and I figured it was the term that most people would use when internet searching for a blog like mine. I would hope that by looking through the blog the misinformed reader would realize what “therapeutic riding” is and that we’re not therapists.

However, I recognize that I don’t address correct terminology anywhere on the main page, and only briefly mention it on the “About” page – probably not enough to make it crystal clear to a slightly-confused-newcomer what the blog is actually about. SO I’ve decided to:

  • put a blurb in the sidebar that always shows about terminology
  • put a special terminology note in the “about me” page
  • probably create a “read me first” page for newcomers that clarifies terminology and where to start on the blog to learn more (perhaps the first lesson in TR is that it’s probably not the TR you are thinking of…)

I hope this post clarifies the issue for people, instead of making it more confusing. I’ll admit it took me a long time to write and edit this because it brought up so many bunny trails, like what’s the history of terminology in EAAT and what are the contributing factors to these issues? It also brought up so many questions – can something BE therapeutic if it happens outside the guidance of a licensed therapist? If so, SHOULD it be called therapeutic if the broad definition fits, but the public misunderstands it? If we don’t call it therapeutic horseback riding, what alternative name is there that recognizes the “therapeutic benefits” – beneficial riding? Is the main issue inconsistent terminology between people groups, or incorrect terminology (like the use of therapeutic)? All these questions I don’t have answers to, so I’m glad PATH Intl. is at least trying to take a step toward answering them.

(source)

Do you have anything to add? What are your thoughts?

p.s. Stay tuned for a free giveaway of the book Joey: How a Blind Rescue Horse Helped Others Learn to See, a new book about a blind therapeutic riding horse!

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Note: This is not professional advice, this is a blog. I am not liable for what you do with or how you use this information. The activities explained in this blog may not be fit for every rider, riding instructor, or riding center depending on their current condition and resources. Use your best personal judgement! If you would like to contribute an activity or article, please contact me here, I would love to hear from you!

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