Hoopes, K. , Extension Assistant Professor, Utah State University Extension
Schultz, J., Director, Rehabilitation Counseling Program, Utah State University

ABSTRACT

Military personnel and veterans experience a high level of mental health service needs. However, frequently they do not access the services that are available to them due to social stigma and other negative beliefs regarding mental health services. This article describes the development of a pilot equine based program for military personnel and veterans, designed to increase resiliency and a sense of community among participants. Preliminary evaluation results are provided. 

Introduction

A recent US Army study to assess risk and resilience in service members showed that 25% of our military have experienced some level of mental health issues, such as depression and post traumatic stress disorder (PTSD) (Ursano et al., 2014). Each military branch has developed resiliency programs to increase psychosocial support and the ability to deal with common stressors. However, research shows that veterans tend to underutilize mental health services that are available to them (Vogt, 2011). The most cited barrier to accessing mental health services was beliefs about mental health, and mental health treatment efficacy. Influencing beliefs included experiencing stigma, concerns regarding social perceptions, the potential for being devalued and discriminated against, and assuming that mental health services will not be effective (Vogt, 2011). In an effort to counteract these barriers, a pilot project was designed to provide participants with an equine based experience that would engage both active duty military and veterans in supportive and resiliency building activities. The purpose of this article is to describe the components of the pilot project, and present preliminary outcome data.

Current research has shown clinically significant benefits from therapeutic horse activities with military personnel, veterans, and family members (LaFleur, 2015) to address a variety of psychological issues (Masini, 2010), and relational adjustment issues between couples (Russell-Martin, 2006). The Utah State University (USU) Equine Extension implemented a pilot program called Ride Utah! to support military families. Based upon a Biopsychosocial Model of intervention (Melchert, 2014), this program integrates mental and physical wellness, social activities, and family, peer, and mentor support components to build resiliency in participants. Opportunities were organized throughout the state of Utah that allowed military personnel to participate in a group trail ride, a meal, and voluntary professionally moderated discussion focused on relationship and resiliency issues.

 

Program Outline

During 2016 and 2017, Ride Utah! put on twenty-nine different trail rides across Utah. Collaboration between university faculty, county offices, local citizens, and state and local military units is vital to the success of the program. Campus faculty initiated the program, provided training and networking, oversaw registration and paperwork, and arranged for a licensed professional to facilitate the group discussion. Participating county faculty provided event coordinators, selected ride supervisors and ride locations, arranged for meals, and facilitated the event. Local citizens provided horses, tack, time, and equine expertise. State and local military units partnered in advertising and contacting participants.

 

Table 1: Project objectives and activities. Objectives and associated activites include elements that have been shown to increase resiliency.

Objectives	Associated Activities
Provide participants opportunities for physical activity in an outdoor environment. Provide participants the opportunity to explore life lessons from an experiential activity. Provide participants the opportunity for socializing with members of the military community.	Conduct a safe recreational equine trail ride for military personnel and a guest. Hold a group discussion led by a licensed professional. Topics might include marriage and family relationships, adapting to civilian life, or other issues as deemed important by the attending professional. Provide a trailside meal for participants.

 

Military personnel and guests were invited to sign up for a trail ride via internet social media, flyers posted with Utah National Guard, email lists, word of mouth, USU organizations, and local networks. Online registration was used to enroll participants. Pre-ride instruction was provided to prepare participants for the ride and ensure an enjoyable experience. Participants were encouraged to wear clothing appropriate for trail rides to promote safety; long pants and close toed shoes were required and use of sun protection and insect repellent were encouraged.

Ride supervisors were vetted and trained by the USU Equine Extension Specialist. Individuals from USU Campus Faculty conducted training sessions with extension faculty and volunteers on military etiquette, proper procedures for possible PTSD situations, CPR, first aid, and trail ride safety. Horses and tack appropriate for trail rides and riders' abilities were selected and procured by ride supervisors partnering with local groups and citizens. Ride locations were chosen throughout Utah, with trails being chosen for length, ease, and accessibility.  

On the day of the ride individuals met at the designated ride location. Registration forms, liability releases, and photo releases were filled out. Helmets were made available and highly encouraged. Equipment and tack were checked prior to individuals mounting. Horses and riders were paired by the ride supervisor according to rider’s experience and size. A few minutes of riding instruction was then provided. Trail rides lasted between 1 – 2 hours depending on participants' abilities and determined by the ride supervisor. After the ride took place a trailside meal was provided by 4-H groups, extension faculty, and volunteers.  

A group discussion followed the meal. It was beneficial to have the group discussion facilitator participate in the trail ride, as it provided an opportunity to build rapport with participants. The purpose of the group discussion component of the program is to gain insights into, and appreciation for, life events through reflection and discussion centered around the events of the ride. The discussion group was intended to expand the benefit of the ride (experiential component) into the participant’s everyday life, rather than being a psychotherapeutic activity. The discussion facilitated the group’s recognition of principles and constructs that occurred during the ride (e.g. trusting the horse) and applying them to one’s life situation. It is the role of the group discussion facilitator to make the underlying principles and constructs overt and facilitate the process of group members identifying applications for their own lives. Having a group discussion facilitator who is familiar with military personnel was extremely beneficial.

 

Evaluation and Discussion

During the course of the program, 451 individuals have participated with over 130 volunteers. Among the participants, 162 were military personnel and 101 were guests of the participants, usually family members. Program evaluation occurred as individuals were asked to voluntarily participate in a pre- and post-ride survey to help determine if the activity increased resilience (resilience being defined as the ability to cope with stressors in life). This survey is the Conner-Davidson Resilience Scale (Davidson and Conner, 2018). The survey consists of 10 statements in which participants rate themselves on a scale of 0-4, before and after the ride. Examples of ten questions include: “I am able to change”, “I try to see the humorous side of problems”, “I feel that coping with stress can strengthen me”, and “I am not easily discouraged by failure”. The participants rated themselves for each of the 10 questions with the following scale; 0 - Not true at all, 1 - Rarely true, 2 - Sometime true, 3 - Often true, and 4 - True nearly all of the time. 

During the two years of the program 127 pre- and post-ride surveys were filled out. Out of a possible 40 points (higher scores indicate higher levels of resiliency), the average pre-ride score was 30.5 and the average post-ride score was 33.8, showing an average increase of 3.2 points. A two-tailed t-test generated a statistically significant difference between pre- and post-ride survey scores (p = 0.00002). It is clear from the data that an individual participating in the equine based experience does experience an increase in resilience. Verbal and written comments demonstrated that participants were very grateful for the opportunity to participate in these trail rides. Participants reported that their lives were touched, friendships were formed, and relationships were improved. Personal stories and gratitude shared provided further evidence that this is a valued program that could be easily replicated, thus expanding the potential benefit to individuals, families and communities throughout the nation.

 

References

Davidson, J and Conner K. (2018). Connor-Davidson resilience scale (CK-RISC) manual. Unpublished. www.cd-risc.com.

LaFleur, L. (2015). Therapeutic horseback riding with military veterans: Perspectives of riders, instructors, and volunteers. Antioch University, Dissertations & Theses. 238. https://aura.antioch.edu/etds/238.

Masini, A. (2010). Equine-assisted psychotherapy in clinical practice. Journal of Psychosocial Nursing and Mental Health Services 48: 30–34. doi:10.3928/02793695-20100831-08.

Melchert, T.P. (2014). Biopsychosocial practice: A science-based framework for behavioral health care. American Psychological Association. doi:10.1037/14441-001.

Russell-Martin, L. (2006). Equine facilitated couple therapy and solution focused couple therapy: A comparison study. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 67(9-B) pp. 5421 (Accession no. 2007-99006-199).

Ursano, R., Colpe, L., Heeringa, S., Keslser, R., Schoenbaum, M., Stein, M. (2014). The Army study to assess risk and resilience in servicemembers (Army STARRS). Psychiatry Interpersonal & Biological Processes 77:107. 10.1521/psyc.2014.77.2.107. 

Vogt, D. (2011). Mental health – related beliefs as a barrier to service use for military personnel and veterans: A review. Psychiatric Services, 62(2), 135-142. 

 

 

 

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