EAVS Report 2013

EQUINE ASSISTED VETERAN SERVICES (EAVS)

DECEMBER 2013 REPORT

‘A place of safe refuge. ‘

The following is the report of the Equine Assisted Veterans Services (EAVS) pilot program for veterans with PTSD and MST. The program is the result of a collaborative effort between the Veterans Administration, PEACE Ranch, a 501c.3 organization and funding from the Les and Anne Biederman Foundation.  EAVS was offered 4-6 hours per week for fourteen weeks in the late summer and fall of 2013.

‘It’s the first time in many years I have felt comfortable and safe.’

Program Model

The purpose of the program was to therapeutically facilitate the reduction of clinical symptoms for veterans diagnosed with PTSD utilizing the EAGALA Model of equine assisted psychotherapy. The PTSD Checklist-Military Version (PCL-M) was used as the pre-test and post-test assessment tool to measure symptoms. The therapeutic team consisted of a VA social worker with EAGALA certification and the director of PEACE Ranch, an equine specialist with Advanced EAGALA certification. Two questions were also included in the post-test to gather anecdotal input:

1.   Please share any comments about your experience here.

2.   Please share any ideas about ways we could serve veterans and their families better.

Services were predominantly delivered in a group format consisting of between 4-8 individuals meeting for 90 minutes once a week for four weeks. Individual client sessions were offered based on recommendation of the VA clinician or veteran request.  Several group sessions for couples were offered based on veteran interest.

There was also a peer based aspect to the program which allowed for sharing between participants that was not directly facilitated by the treatment team.

‘I had a very good experience here; very uplifting, refreshing and helped with clarity, finding out that I am still useful.’

Program Measures

The PTSD Checklist-Military Version (PCL-M), a standard assessment tool within the VA, was to measure the impact of the EAGALA model of equine therapy in reducing symptoms of veterans with PTSD.  According to the Department of Veteran Affairs’ National Center for PTSD, results for the PCL-M may be interpreted as follows:

Evidence suggests that a 5 – 10 point change represents reliable change (i.e., change not due to chance) and a 10 – 20 point change represents clinically significant change. Therefore, we recommend using 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful.

http://www.ptsd.va.gov/professional/pages/assessments/ptsd-checklist.asp

Program Participants

Veterans were identified and referred to EAVS through providers at the Traverse City and Cadillac Community Based Outpatient Clinic.  Thirty participants attended group, individual or couples’ sessions.  Data was collected for 18 participants who completed the assessment after attending four consecutive group sessions. Twelve participants were not included for the following reasons:

3-transportation, driving over an hour         3-spouses

2-change in work schedule              1- birth of child, move

1-no MST or PTSD diagnosis                     1-change in health

1-active addiction, pt unsafe

The breakdown of the remaining 18 participants is as follows:

Gender Vietnam OEF/OIF MST
Men 9 1 4
Women 0 1 3

‘Today I shared more than ever before.  A marine gave me a hug.  I felt like I belonged.’

Raw data outcome for the PCLM is included below (N=18):

Pre Post +
44 23 21
40 21 19
53 36 17
74 57 17
59 44 15
60 46 14
68 55 13
61 49 12
55 45 10
74 66 8
64 56 8
85 77 8
56 51 5
61 57 4
70 68 2
75 77 2
51 57 6
28 47 19 *
Increase/Decrease

In Symptoms

Points # of Participants % of Participants Significance
Decrease 10+ 9 50% Clinically Significant
Decrease 5-9 4 22% Statistically Significant
Decrease 0-4 2 11% Unreliable
Increase 0-4 1 5% Unreliable
Increase 5-9 1 5% Statistically Significant
Increase 10+ 1 5% Clinically Significant *

50% showed clinically significant reduction of symptoms

72% showed reduction of symptoms that was statistically significant

83% showed reduction of symptoms

*The participant who indicated a clinically significant increase in symptoms answered the posttest question as follows:

“The PEACE Ranch proved to be an extremely effective holistic therapy approach.  It provided a symbolic way to think of my fears (intimidation, safety).  Horses are an amazing strong animal that can teach us a lot about trust, communication and companionship.  This program helped very much. Thank you.”

The disparity between the client’s pre/posttest and individual comment are incongruent. One weakness in the assessment tool may be the lack of an openness or “level of disclosure” measure.  Considering the guardedness inherent in PTSD, it is possible that the participant was more reticent in her first approach to the test than the second.  The pretest showed a score of 28, which was the second lowest score of the group.  The posttest score was 47 which compared to the groups posttest average of 40 appears to be an accurate score.  It could therefore be hypothesized that the pretest score was suppressed. This same dynamic could hide pretest posttest improvement for this population in general, making these results more significant.

‘The hands-on approach and interaction with the horses is like therapy at warp speed. ’

Themes

Early in the course of the EAVS program, it became evident that veterans were experiencing a calming effect as a result of the program.  Across gender and type of trauma, veterans experienced EAVS as a soothing, relaxing activity despite exposure to a new environment and new people. Some veterans reported improvement in sleep on the days following their EAVS appointment. Seven veterans who had been unable to attend traditional VA groups were able to attend EAVS and even look forward to it. Spouses offered anecdotal evidence that veterans previously reluctant to leave the safety of home began to look forward to ‘horse therapy day‘.

Another theme is the ripple effect EAVS had on other areas of the veterans’ lives.  Based on interaction with the horses, a veteran identified that his communication style could be much gentler. This impacted family relationships and social situations that the veteran stated would normally end in verbal or physical aggression.  Another veteran stated ‘I found my happy place’ which gave him confidence to move forward in other areas of his life.  Another veteran became aware of his ‘military’ communication style and reflected on the pressure this put on his family; he began working with his spouse to make changes.  Again and again we heard veterans comment that the experiences at PEACE Ranch stayed with them and informed other parts of their lives.

VA therapists noted how EAVS directly impacted and facilitated the veterans’ individual therapy work:

“He has made significant progress and continues to be motivated to move ahead…

equine therapy group had the biggest impact on him. It was the first time he really pushed himself to be in a more social situation. It increased his self-esteem immeasurably”.  MST Coordinator

“She is taking more risks in therapy since attending 5 sessions of Eagala therapy, taking greater responsibility for her therapy and recovery.” CBOC therapist

“She had wanted to spend time sleeping, not caring about grooming or self-care, and now notes that this has shifted significantly.” CBOC therapist

“After an experiential session of Eagala therapy, she started making a connection from being a victim to seeing her role in her symptoms.” CBOC therapist

Summary

In summary, the Veterans Administration and PEACE Ranch collaborated to provide EAGALA Model equine assisted therapy for Veterans diagnosed with PTSD.  Groups met weekly for 1.5 hour sessions for four consecutive weeks. The PCL-M was used as a pretest posttest assessment tool.   The results showed that 72% of the participants indicated a reduction in symptoms that was statistically significant while 50% of the participants indicated a reduction in symptoms that was clinically significant.  It is reasonable to conclude that EAGALA Model equine assisted therapy provided in this format is effective in the reduction of symptoms for veterans with PTSD.

‘It helps me stay in the here and now.’

Considerations for the Future

There are a number of areas for consideration in the next phase of the EAVS program.   Combat veterans of OEF/OIF are noticeably absent from the population sample. Efforts to recruit combat veterans from this era were largely unsuccessful. Younger veterans have competing interests of young families, work and/or school. Future programming will need to successfully target this group.

The sample size is obviously small. The program began late in the year.  With an earlier start date, more data can be captured.  Different kinds of data or research tools may need to be considered to capture EAVS impact on depression, anxiety or family relationships. The addition of a three month follow up with the PCLM would provide additional information on the longer term impact of EAVS.

Due to EAGALA’s interest in equine research in general and programs for veterans specifically, there may be further collaborative opportunities for research.

There are two areas which veterans identified.  They asked that the program be expanded from four weeks to six or eight weeks. At the end of four weeks, veterans felt they were just beginning to bond with their group – they wanted more. As veterans became excited about the equine program, they expressed interest in sharing this with their families.  Several couples sessions were offered with positive results, largely in the area of communication.  As PTSD certainly impacts the family, it would be interesting to see the impact of incorporating the family as partners in healing.

One potential area for expansion could include Traumatic Brain Injury. Due to the experiential nature of the EAVS program, there could likely be benefit.  Mood disorders, which are impacted by changes in activity level and socialization, may also benefit.

For veterans who have completed the EAVS program and would like to continue, a mentor program may be appropriate. No one has more credibility with a veteran than ‘someone who’s been there.’  Utilizing veteran mentors may be a successful strategy in recruiting OEF/OIF veterans.

Finally, transportation costs were an insurmountable barrier for some veterans.  Transportation assistance through the VA or community programs would make this program accessible to a wider population.

Responses to Post-Test Questions

1.  Please share any comments about your experience here.

I had a very good experience here; very uplifting, refreshing and helped with clarity, finding out that I am still useful, in fact maybe refined due to all that I have experienced. Thank you.

It’s the first time in many years I have felt comfortable and safe.

I think it has been good.  It gave me a lot to think about and compare to our action and communication.  A peaceful, relaxing and comforting place to be.  I wish I had more time to enjoy.

Very calming enjoyable experience.

The PEACE Ranch proved to be an extremely effective holistic therapy approach.  It provided a symbolic way to think of my fears (intimidation, safety).  Horses are an amazing strong animal that can teach us a lot about thrust communication and companionship.  This program helped very much. Thank you.

This program was very useful as in eye opening.  The beginnings of trust as in feeling it, My interest in this therapy has taken off!  I found the purpose to pursue a goal that emotions are many and how we deal with them is just as important in maintaining and reaching that goal. Very supportive facilitators.

Fun thought provoking peaceful, soul searching, making connections facing fears and doubts.  Uplifting, spiritual.  I’m glad we didn’t ride the horses because we would have been focused on learning to ride instead of finding inner strength and peace.  I felt this was a time for personal growth.

WOW!  The hands on approach and interaction with the horses is like therapy at warp speed.  The girls also do a group together where we just talk and this really brought up things about ourselves that we may not have discovered.  I loved the vague guidelines and then allowing us to interpret them however we wanted by using our imagination.  Wonderful experience.  Jackie and Jan are fantastic.  Thank you for the experience.

Interesting, learned a little about myself.

Being around horses is nothing new to me but we have been without them for about 6 years and I did not realize how soothing it was to have them walking around and wanting to be touched. What was new to me was being in a group of individuals that are having some of the same feelings and situations as me.  Being with two older gentlemen that were in their 60s made me realize that I may have to battle these feelings for a while and I am going to have to learn to cope with them.

The PEACE Ranch has given me the opportunity to talk with different Vets and to do it in a relaxing situation not in some place where the alcohol does the talking . We were able to have conversations where the ladies were not close by and it seemed to help the others to talk more directly with the group.  They had a couple of tasks for us to do and it really made you think about yourself and where you were heading in the future.

The 1 1/2 hours was perfect in length for each session

I can’t really come up with any negatives about the program.

Overall I thought it was a very good experience and I am going to give it a little more of my time and efforts.

I learned a lot about herd dynamics.

I look forward each week to coming to PEACE Ranch.  It has been a great experience and another step in healing.  The knowledge that I have gained here will be remembered and passed on to all that interested.  I came here not knowing what to expect but found it all to be good.  Thank you Jan and Jackie, this has been great therapy.

My experience at PEACE Ranch is heart warming.  I’ve made some new friends and learned a lot about horses.  I was made to feel welcome and treated with respect.  Without question being with horses and learning about them is very therapeutic. Being at PEACE Ranch is a good place to be.  IT is quiet not rushed or pressured a place of safe refuge.

I have a great respect for Jackie Kaschel and Jan Tharp. Very few therapists can get close to combat Vets.  Every Vet feels comfortable with each of them and feels secure with their knowledge of Combat Stress.

I am having a beautiful experience with the horses.  It’s a distraction for me. It helps me stay in the here and now.

Great.  It’s all been good and moving and has REALLY HELPED me grow and look at my life.

Today I shared more than ever before.  A marine gave me a hug.  I felt like I belonged.

My experience with the horses was good, very soothing.  I’m looking forward to next week.

2.  Please share any ideas about ways we could serve veterans and their families better

Believe a bit more on group discussions would help others to open up.  Longer trips, maybe 2xs

a week for a month.

Great Day, Great people Great horses. Glad I came but still struggling.

Bring in people who are willing to learn how to help.

I think you are doing great keep up the good work.

Longer # of group weeks.  4 is good but 6 could be better.  We could get deeper into feelings etc. or a second round later.

How about some kind of spouse or family night.  Maybe the night at introduction.

Keep on doing what you are doing, Do More.

I would really like to share this wonderful experience with my wife.

The course should be a minimum of 6 weeks because it takes a while to get to know the other Vets, the therapists, get comfortable with the horses and environment.  At the beginning of the first class encourage the Vets to give as much detail about their military experience as possible. Such as what was your job (detailed) where were you (detail) what dates he was in the combat zone etc.  Combat stories are not necessary at the beginning.  This information is important to form a bond at the beginning.

Traveling a long distance to meeting area a hardship and can not do on regular basis.  Travel pay would help in continuing such meetings.

Get more people involved and keep doing what you’re doing.  Finally somebody cares.

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