Advancing the Science and Practice of Equine-assisted Services through Community-Academic Partnerships

The first author (BF), an academic from the University of Wisconsin-Madison, partnered with staff from two Wisconsin centers that offer equine-assisted services, BEAMING, Inc., and Three Gaits, Inc. Together, they jointly identified a need and desire to increase the quality of life of older adults with dementia and their families through community-based programming. BF then contacted a research associate (the fourth author, SM) from the Community Academic Aging Research Network (CAARN) to help launch the participatory research study. The purpose of CAARN is to bring together academic researchers and community partners to conduct clinical and dissemination research related to healthy aging (University of Wisconsin-Madison Institute for Clinical and Translational Research, 2020). SM organized an introductory team meeting so that the academic could share existing evidence on the Riding in the Moment program with not only leadership from BEAMING, Inc., Hearts & Horses, and Three Gaits, Inc., but also with other key stakeholders in health and aging organizations located near the two centers. These key stakeholders included directors and staff from Aging Disability Resource Centers and local senior centers. During this initial meeting, team members realized the potential of Riding in the Moment and started discussing plans for how different research activities could support the goals and needs of the two local Wisconsin communities. In addition to organizing this first introductory team meeting, SM also assembled a ‘tailored advisory board’ consisting of representatives from aging and healthcare organizations, agencies, and foundations. Throughout the research study, representatives from the board intermittently attended team meetings to offer advice and dynamic perspectives related to the Riding in the Moment program.

The OT^ee HORSPLAY program of research is an example of traditional research that originated in academia. As a Ph.D. student, the second author (CP), conducted a review of research related to equine-assisted services for youth with ASD and found that, despite the prevalence in practice, there was little research to guide occupational therapists who incorporate horses into their services for youth with ASD (McDaniel-Peters & Wood, 2017). To address this problem, she sought to establish a program of research investigating occupational therapy in an equine environment to promote social and behavioral outcomes in youth with ASD. She approached Hearts & Horses to assess their interest in such a research study, and was met with enthusiasm. The community-academic partnership focused on OT^ee HORSPLAY was established in 2017 and is about to begin a third research study together. CP has led the team by writing grants to fund the research, leading data collection and analysis, and disseminating results. Staff and occupational therapists at Hearts & Horses have played key roles in defining critical elements of OT^ee HORSPLAY, recruiting participants, and providing the intervention. CP has repeatedly sought input from stakeholders at Hearts & Horses, but has ultimately been the responsible party for making research decisions.

As described earlier, team members participated in an introductory meeting to not only establish a partnership model, but discuss differing agendas and commitment. At the start of the meeting, each member shared more about their position and background and areas of expertise. These introductions helped the team establish rapport and get to know what each other’s agendas may be before proceeding with a participatory research study on the adaptation and implementation of Riding in the Moment. At the time of the meeting, BF had started a tenure-track faculty position and thus, shared that she was most interested in building her program of research. Besides seeking to obtain grant funding for the research study, she also expressed interest in increasing her stakeholder engagement skills, building relationships with her local community, and developing manuscripts for consideration for publication. On the other hand, the community partners including staff and volunteers from BEAMING, Inc., Three Gaits Inc., the Aging Disability Resource Center, and the local senior center expressed interest in expanding their existing programs to include more age-friendly or community-based activities. Many community partners also acknowledged the importance of enhancing their own skills through access to dementia care and human-animal interaction and safety trainings. By the end of the meeting, all team members’ perspectives united around a shared commitment—to improve the quality of life of older adults with dementia and their families through adapting and implementing Riding in the Moment in Wisconsin.

As discussed above, CP decided on the aim of the OT^ee HORSPLAY study, and approached administrators and providers from Hearts & Horses to assess their interest in partnering on the research study. These individuals had previous experience with research studies, and valued research. Furthermore, occupational therapy services to youth with ASD had been offered at Hearts & Horses for some time. Altogether, therefore, much of the staff and expertise needed to launch this program of research already existed at Hearts & Horses. Ultimately, our eventual community partners at Hearts & Horses expressed enthusiasm for the partnership, and all parties agreed on a shared commitment to developing and evaluating occupational therapy in an equine environment for youth with ASD.

Hearts & Horses’ mission is to “promote the physical, cognitive, emotional and social well-being of people with special needs through equine-assisted activities and therapies” (Hearts & Horses, 2020). Hearts & Horses is a leader in the industry of equine-assisted services, and is held accountable to provide high quality services to the community. The center has premiere accreditation from the Professional Association of Therapeutic Horsemanship, International (PATH, Intl), and therefore must also abide by all PATH, Intl safety standards (PATH Intl, 2017). The Temple Grandin Equine Center at Colorado State University is committed to integrating education and research in equine-assisted services (Temple Grandin Equine Center, 2020). The OT^ee HORSPLAY study has provided opportunities for several Undergraduate, Master’s, and Ph.D. students to complete theses and dissertations, therefore providing learning opportunities for students. As a result, some aspects of the research study have complied with academic timeframes to allow students to graduate on time. Furthermore, CP is the principal investigator of the OT^ee HORSPLAY research and is currently a post-doctoral fellow held accountable to conducting high-quality research, as evidenced by obtaining funding and publishing manuscripts. Finally, the OT^ee HORSPLAY program of research has had several funding sources (Carl and Caroline Swanson Foundation, 2021; Horses and Humans Research Foundation, 2021; Human-animal Bond in Colorado, 2021), so the research studies are often held accountable to funding agency expectations and timelines.

All partners work hard to honor each other’s priorities, making compromises when different priorities compete with one another. For example, at Hearts & Horses, services are typically provided in 8-week sessions, with 2-week breaks after the session to allow staff and horses much-needed time off. However, to maintain a high-quality research design, it was critical that OT^ee HORSPLAY was provided for 10 continuous weeks. Therefore, staff at Hearts & Horses re-arranged their typical session schedule to accommodate the research design. As another example, the most coveted timeslots for community members to participate in equine-assisted services are after-school times, so that youth do not have to miss school. Therefore, the research was scheduled to occur during morning times, even though those times are less convenient for research participants, so that Hearts & Horses could continue giving the most valued time-slots to the community members they serve. The ability of each partner to articulate their needs, honor each other’s priorities, and problem solve, has been essential to the success of the OT^ee HORSPLAY research program.

The study team included individuals with training in participatory and community-engaged research designs, qualitative and quantitative research analysis, education, equine-services, health and aging, community organizing, dementia care, occupational therapy, and social work. These individuals brought unique skills and approaches to the study. For example, BF presented ways to increase reliability and dependability of the study; SM from CAARN provided considerations for building community-academic partnerships and sustaining and growing the Riding in the Moment program; the directors at Hearts & Horses, BEAMING Inc., and Three Gaits, Inc. offered information on their existing programming and business model, equine-industry safety standards, and training requirements; the graduate student research assistant applied data collection, analysis, and study management skills; and the directors from health and aging organizations supplied information on how best to recruit and engage older adults with dementia and their families, as well as the community as a whole in the Riding in the Moment program. Over the course of four months, these team members helped develop and refine implementation and curriculum manuals for the Riding in the Moment program. These manuals are critical to the long-term success and sustainability of the Riding in the Moment program because they outline step-by-step processes and activities to be used by centers and other partner sites that offer equine-assisted services (Sullivan et al., 2001). In particular, the manuals can help individuals understand what the Riding in the Moment program is designed to do, what steps are required to design and implement the program, and what measures can be used to evaluate whether the program has improved established goals. Each team member contributed their diverse skills and perspectives to the development of these manuals.

The OT^ee HORSPLAY team is comprised of several professionals with distinct skillsets. The principal investigator, CP, is a post-doctoral fellow with her Ph.D. in occupation and rehabilitation science. The associate executive director of Hearts & Horses (third author, TM) has acted as the site coordinator; she is a certified therapeutic riding instructor and equine specialist in mental health and learning. The occupational therapists that deliver the intervention have training from the American Hippotherapy Association, and years of experience providing occupational therapy in an equine environment to youth with ASD. Several other employees at Colorado State University have provided consultation throughout the research study, including occupational therapists, a licensed clinical psychologist, a statistician, equine scientists, and a veterinarian. Defining roles clearly at the beginning of each study has fostered success; each partners’ role has been consistent with a traditional research partnership, where the academic oversees all research decisions and the community partner provides valuable input and implements the intervention. As principal investigator, CP has been responsible for obtaining funding, determining research methods, overseeing data collection and analysis, and disseminating results. The site coordinator communicates with the Hearts & Horses team, and manages all on-site elements such as horse selection, arena space, volunteers, and scheduling. The occupational therapists provide their clinical expertise to inform intervention development, conduct occupational therapy evaluations, and provide the intervention. Each team members’ unique skillset is valued. Several formal and informal processes, described in the next principle, have helped to foster relationships based on mutual respect to ensure all perspectives are heard.

The participatory study team has moved through various research stages, together. As described earlier, the team was formulated with an introductory meeting. After rapport and agendas were established, the team decided to submit a grant proposal to the Human Animal Bond Research Institute. The proposal was focused on understanding the implementation of piloting the Riding in the Moment program at BEAMING Inc. and Three Gaits Inc. Study team members worked together to formulate the study objectives, data collection and analysis methods, and plans for funding. To strengthen the grant proposal, community partners completed letters of support for the study. Unfortunately, the grant proposal did not receive funding. This news brought the team back together to discuss next steps for moving the Riding in the Moment program forward. To help strengthen a future grant submission to the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s R21 Exploratory/Developmental Research Grant (PAR-20-033), the team decided to jointly collect some preliminary data and develop program manuals and a manuscript. These actions help demonstrate a prior history of a positive working relationship among the community-academic partnership.

BF conducted interviews and focus groups with all study team members (i.e., administrators and staff at centers that offer equine-assisted services and aging centers) to learn specific suggestions and considerations for adapting and implementing the Riding in the Moment program in Wisconsin. The interviews and focus groups were conducted in a semi-structured manner that allowed for new ideas or questions to be brought up. The graduate student research assistant helped BF transcribe and analyze these data. The team then went through a member checking process. Here, preliminary findings were presented to the entire team during a focus group to increase the authenticity of the work (Creswell, 2013). Every team member reflected on and interpreted the meaning of the findings. Information gleaned from the interviews and focus groups was used to create the curriculum and implementation manuals for the Riding in the Moment program. BF initiated a team meeting to review the manuals so that every team member could contribute last thoughts. Lastly, the team decided to describe the nuts and bolts of their community-academic partnership in the form of a manuscript. BF took the lead on developing the manuscript outline and first draft, with frequent email contact with team members to learn their perspective on content, organization, and format. Authorship and acknowledgement of team members for the manuscript were based on contribution to the study and writing process. Prior to submission to a peer-reviewed journal for consideration for publication, BF referred all team members to the International Committee of Medical Journal Editors authorship guidelines (Guidelines can be found here: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html). Altogether, this iterative process helps ensure that the research work will be used locally and that all team members are accountable for all aspects of the work (International Committee of Medical Journal Editors, 2020; Suarez-Balcazar et al., 2006).

Several mechanisms have facilitated dialog and information sharing throughout the OT^ee HORSPLAY research program. At the outset of each new study, partners meet with one another to discuss the aims and methods of the study. Then, throughout the study, there are several formal mechanisms to capture stakeholders’ perspectives; the purpose of the dialog and information sharing has evolved throughout each stage of the research program. In the first study, occupational therapists participated in extensive interviewing in order to elucidate the critical elements of the intervention. Once a first draft of the intervention manual was developed, a focus group with key stakeholders captured collective feedback on the manual, which led to several revisions and improvements. In the second study, occupational therapists completed surveys and participated in focus groups focused on the feasibility and acceptability of the newly manualized OT^ee HORSPLAY intervention. In the third study, key stakeholders will once again complete surveys and participate in focus groups. Feedback from these interviews, surveys, and focus groups informs revisions to the intervention manual, and guides next research steps (Smith et al., 2007). These formal mechanisms of information sharing are always funded, so that all partners are paid for their time and expertise. At the conclusion of each study, the principal investigator presents results to all stakeholders at Hearts & Horses, and shares manuscripts as they are published.

This principle signifies that evaluation should be consistent with characteristics of the community-academic partnership. In addition to selecting evaluation strategies that will best answer the research questions, academics and community partners should also think about their roles, responsibilities, and expectations in “identifying an evaluation approach and tools; analyzing the results; and disseminating and utilizing information” (Baker et al., 1999, p. 90). For example, academics may be interested in capturing specific participant health outcomes as a result of the program or intervention, whereas the community partner may be more interested in gathering structural or process level information (Agency for Healthcare Research and Quality, 2015) like the amount of time required to implement the program or intervention, or the ratio of providers to participants. Academics frequently use findings to inform subsequent grant proposals and develop manuscripts and professional presentations. On the other hand, community partners often use findings to help communicate the relevance and impact of a program or intervention on a community and bolster sustainability efforts (Koné et al., 2000). Regardless of the intended evaluation purpose and outcome, academics and community partners must refer back to the defining qualities of the partnership model to determine the overall use of evaluation strategies.