Record Keeping Introduction

I have received quite a few questions about how to do rider progress notes and tracking their progress. Over the past year I’ve very slowly working on some posts about these topics. I’ve compiled info PATH Intl. Workshops I’ve attended, barns I’ve worked at, people I’ve talked to, and online forums. But the more I worked on this series, the more I realized how little I know and got discouraged. However, I recently listened to a Life Coach School Podcast on Productivity in which she talks about productivity as not how much time you spend on something or how perfect it is, but how much output you actually produce; and that to produce a lot, you need to shoot for B average work, because if you shoot for perfect you’ll be working on it forever; and that not everything you produce is going to be a win, so produce a lot, which gives you more chances for a win, and all the producing gives you more energy to produce! Butt officially kicked. So I’m diving in and going to post this series even though it may only be B average work, even though I don’t have examples from every single barn in the world, and even though I may finish and decide it’s organized horribly, because I suspect people want the information I do have more than they want it in complete A plus perfection. All that to say, this is by no means comprehensive, so please please please add to this in the comments!

This series will be split into the following posts:

  1. Record Keeping Introduction
  2. Progress Notes
  3. Assessments
  4. Tracking
  5. Methods & Examples

So without further ado…

RECORD KEEPING

Record keeping for the adaptive or therapeutic horseback riding instructor usually includes (at most barns I’ve seen):

Keep Rider Records Up To Date

  • Registration paperwork
    • Personal Information
    • Health History (update yearly)
    • Liability Releases
    • Photo/Personal Info Consent
    • Physicians Statement (renew yearly)
    • Atlantoaxial Instability Medical Clearance for riders with Down Syndrome, including a neurological exam (renew yearly)
  • Regular Assessments
    • Initial Rider Assessment – completed before entering the program
    • Annual/Session Rider Assessments
    • Goals & Objectives – setting them, recording when they are met, re-evaluating them
    • End of Session Updates
    • Annual Rider Paperwork Updates
  • Progress Notes – usually weekly
  • Incidence Reports
  • Rider Tracking Information

Help with Horse Records

  • Horse Usage Records
  • Horse Health Records

Help with Program Records

  • Attendance Forms
  • Program Tracking Information
  • Parent/Rider Surveys

INTRODUCTION TO PROGRESS NOTES, ASSESSMENTS & TRACKING

Therapies of all types (physical, occupational, speech, recreational, etc.) incorporate progress notes, assessments and tracking into their programs. Since equine assisted activities & therapies (EAAT) are loosely based on these therapy models, they too incorporate these methods of planning effective activities and programs. But first, let’s make sure we’re on the same page about exactly what these are.

Definitions

In the following posts I’ll be focusing on the following and want to define them for you ahead of time so you know what to expect. These definitions are used to describe what I see most barns doing, but I’m sure the components could be divided up differently.

Progress Notes = reports that document the lesson with an update on the client’s current status toward their goals. At its most basic, it includes a summary of the lesson, notes on the rider’s attitude, strengths and weaknesses, whether or not they reached the objective or goal (or how close), and recommendations for the future.

Assessments = are reports that documents the client’s current status in relation to their goal, riding skills, abilities, and other factors the program may want to use when rewriting client goals or analyze for a particular purpose. Examples of common assessments are the Intake Assessments, Pre-Session Assessments, Post-Session Assessments, and/or Annual Assessments.

Tracking = the term I’ll use to describe collecting specific rider data for a later purpose, usually to assess a rider’s progress or to report information about the program and its effectiveness to donors and for grants. Tracking can be done by pulling information from pre-existing progress notes and/or assessments, or by a separate method of collection. Examples of common data that is tracked includes what disabilities are being served, what types of goals are being set, what percentage of goals are being met, and forms of program effectiveness or rider improvement. (Note that what I am talking about is completely different from tracking data for scientific research, which is a whole different topic that I won’t be getting into.)

Requirements

What is actually required for an adaptive or therapeutic horseback riding program regarding progress notes, assessments, and tracking? It depends on the certifying body that you are associated with. If you are not part of a certifying body, it is still beneficial to follow their standards to keep your program up to the best practices of the industry. Since I am certified through PATH Intl, I’m going to focus on their standards.

PATH Intl.’s Standards for Certification & Accreditation Equestrian Skills Standards 1 (ESK1) states that there must be a written record of participant progress and activities on-site, and recommends that “a written update of progress be maintained on a regular basis,” but they don’t specify how to do this, nor endorse a certain method, so it is up to each center to create their own policy and methods that work best for them.

The Administration and Business Standards 23 (A23) states that the center must have a policy for updating participant and volunteer information annually and reviewing this updated info to assess the participant or volunteer’s current status. Again, it gives a few suggestions but greatly leaves the method of doing this up to each barn.

So as we can see, not much guidance is given on the specifics (for example, what to include in your progress notes and how often to do them), because every barn is different, and what they do depends on the needs and purposes of their specific program. So, let’s think about these…

Purpose & Benefits

The purpose & benefits of all progress notes, assessments, and tracking) are very similar and often overlap. I think they fall into two categories:

1) Instructor Use

  • To improve lessons & teaching
    • help you evaluate the lesson so that you can plan what to do next time and how to instruct better.
    • keeps you focused your rider’s lesson objectives and yearly goals, instead of getting off track.
    • help you evaluate the rider’s pasts and current state, so you can plan future goals and objectives.
    • help you identify and handle rider issues by recording when they started and how they were addressed.
    • help you make informed decisions by keeping a record of related information (such as deciding a rider’s ability to participate or progress)
  • To progress clients
    • helps you track progress toward your rider’s goals
    • holds you accountable to the goals and objectives you set for your rider
    • provides a place to re-evaluate how to best achieve the rider’s goals
    • gives you the information needed to create new goals and objectives
  • To communicate with colleagues
    • Provides a substitute or new instructor with information about the rider, their history, and their goals (especially when they cannot talk to you in person)
    • Helps keep consistency between instructors by providing information about how an instructor works with a particular client, so the next instructor can keep things the same.

2) Program Use

  • Documentation
    • Per PATH Intl.’s Standards, it is best practice to have records of a rider’s activities, progress, and problem areas.
    • It provides a current status on the rider’s progress toward their goals and details of their participation history, should these ever be needed by their caregivers or therapy providers.
    • Improves professionalism.
  • Holds staff accountable
    • Holds instructors accountable to quality teaching by asking them to evaluate their lessons
    • Holds instructors accountable to the goals they set for their riders by requiring them to evaluate participant outcomes and how effective their plan is
    • Holds center staff accountable to whether their program is delivering the services it claims to deliver
    • Creates your program’s culture – whether progress notes are important, whether instructors do them, how helpful they are, professionalism, etc.
  • Program Analysis & improvement
    • Allows you to analyze your program’s effectiveness (by recording the progress of your clients), which shows you where you need to improve
    • Allows you to analyze your program’s demographics (disabilities, where clients live, types of goals, age, etc.), which helps you improve programs and marketing
    • You can customize analysis for what your program needs to know!
  • Program Reporting
    • Allows you to create reports for your needs, such as: annual reports, donor reports, board updates, parent reports, public presentations, and compile information for grants.
    • Pull information for grants (such as demographics, effectiveness, disabilities served, etc.)
    • Pull information for presentations (such as client ages, goal types, disabilities served, etc.)
    • Use for industry reporting (if programs would use the same consistent tracking and reporting methods)

This may seem overly detailed, but it’s important to think through the purpose of these documents for your particular program, because only then can you set them up to be of easiest use to your staff and most effective use to your program.

In the next post I’ll focus on progress notes. Stay tuned!

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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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