The Swedish Interest Association of Therapeutic Riding

1994 2014

EAT influence on Function, Activity, Participation

Easy to detect in practice

Hard to confirm in research

Hard to finance

In the very, very beginning

• Pia Tillberg (PT), Helena Sallnäs (PT), Charlotte von Arbin(PT), Rosmarie Åhlström (OT), Lena Svedberg(PT), Arja Lammi(PT), Ulrika Stengard Olsson (PT) and some others

Decided to start an association…..and constituated it 14/9 - 1994

• And they named it

• Intresseföreningen för Terapiridning ITR• The Swedish Interest Association of Therapeutic Riding

Aims of ITR

• To support the development of equine assisted therapy

IRT Plans for year one 1994

• Arrange a course in lounging or with a german physiotherapist Susanne von Dietze• Start categorizing litterature, articles, thesis• Collect information on international conferences and seminars• Poster presentation of IRT at the congress for Swedish PT´s in 1995• Decide on statutes and membership • Produce 3 newsletters a year for members

Looking in the mirror….

What happened between 1994 and 2014?

….. bridging gaps and construckting bridges…

Health care sector Equine Sector

Building skills and compensate for limited function

Enhancing quality of life and a sustainable lifestyle………………..for patients and for therapists

Building bridges ……bridging gaps ….where?

Between health care sector/equine sector

Between professionsBetween Nordic countries

Under constant construction…….education

In clinical everyday work and professional development

Persons and passions have built IRT

and volontary work

Charlotte von Arbin GHRK

Pia Tillberg, stift HippocampusHelena Sallnäs

Sven Forsling, Stall Frossarbo

Ulrika Stengard Olson, Söderåsens Forsgård

Helen Edwards Lutsch,Komhall/Little Owl

Marie Gudmanson, Aktiv Rehab

LisLott Andersson, Humlamaden Rehab

Margareta Håkanson, Pegasus

Arja Lammi, MIUN, Östersund psychiatry

Persons in IRT created development

Some projects were lasting – some were not

Evidence

Evidence

Evidence

Evidence

A longlasting board…….

• Charlotte von Arbin 1994-2013 18 years• Ulrika Stengard-Olsson 1995-2010 15 years• Viktoria Wennström Kolm 2002-2013 12 years• Bodil Tillmann 2001-2012 12 years• Margareta Håkanson 1999-2008, 2013-14 12 years• Ami Ireström 2006-2014 9 years• Pia Tillberg 1994-99, 2013-14 8 years

But here are just names….so let´s have a look at them

Chairmen 1994-2014 – and founders of IRT

Charlotte von Arbin – Lolo Chairman 1994-2013GHRK boardFRDI boardClassifyer

Pia Tillberg initiated IRT Cashier 1994-99Chairman 2013-2014Stift HippocampusProject leader in several projects 2008,11,14Teaching in the TR Education in Slovenia

18 years 8 years

PTNeurologyHabilitation

Victoria Kolm Wennström 2002 -13V chairman 2010-13

Ulrika Stengard Olsson secretary 1995 – 2010Söderåsens ForsgårdEducation Ridfysioterapeut Skåne

Bodil Tillmann cashier 2001-2012

15 years 12 years 11 years

PT´s Habilitation

Ami Ireström Social worker 2006-Certification EAT in social work

Margareta Håkanson PT 1999-2008, 2013- v chairmanProjectleaderResearchEAT in psychiatry

9 years12 years

PT Psychiatry Social worker

Certification committée 2009 -2014

Ami Ireström , Arja Lammi PTEducation MIUN responsible

Pia Tillberg 2009-12

Maria Johansson OT Marie Gudmunsson OT LisLott Andersson RN

Pia Tillberg PT

Renate SundholmSocial pedagogue Margareta Håkanson PT

Present IRT board 2014Ami IreströmSocial worker

A short overview of IRT history

Consolidation period 1994-99Struggling on 2000-2004Development 2005-2009Striving with changes 2010-2014

Basic economic conditions

• Funding consist of membership fees• Volontary work• Expences have been paid for• Telephone meetings, few physical board meetings• Representation abroad funded externally• Scarce sponsring of newsletters

Starting the growth……

Important facts

• Charlotte von Arbin was chairman in Gothenburg Riding club for disabled riders (GHRK) since it was founded in 1988• GHRK moved to Lunna 1994 and started a riding school alongside the

therapeutic riding that was carried on• GHRK and IRT have been closley intertwined 1994-2014• Charlotte published her book Hippotherapy 1994

More important facts

• Projects for clinical development of rehabilitation were financed by the state 1992 – 96, PT´s were asked to apply for funding.

• ”Stiftelsen Hippocampus” with Pia Tillberg and Helena Sallnäs and ”Body Awareness on horseback” Margareta Håkanson, were financed 1992-96 as rehabilitation projects

• During the 95 - 99 ”Dagmar money” financed clinical rehabilitation projects for PT´s and other professionals in primary care

1994-95 what happened around us

• Sweden referendum on EU 94, joined EU 95• Rural policies in Europe influences Sweden from now on• Finance crisis in the world• Estonia sunk• Personal assistance became a right in Sweden (LSS) and the care

sector was turned towards focusing on patients rights• Evidence based medicine was asked for and treatment without

evidence was questioned from 1993/94 and onwards• Projects were supposed to create new evidence

The Board 1994-99

Charlotte von Arbin PT 1994-

Pia Tillberg PT 1994-99Helena Sallnäs PT 1994-96Rosie Åhlström OT, 1994-96Lena Aztalos, PT 1997-

Christina Ingvarsson PT 1995-99 Ulrika Stengard Olsson PT 1995 -Agneta Olofsson Ehnertz OT 1997-Cecilia Karlsson OT 1997-99

Lena Svedberg PT 1994-96

7 PT3 OT

ITR will be IRT 1995

• New name – IRT• Honorary membership to Kristina af Geijerstam• Workshop on how to establish TR in society and in documentation

1994-99 Consolidating IRT

• Education –stift Hippocampus and PT further education Uppsala• Library – GHRK/Lunna• International conferences – IRT Chairman board member of FRDI• 1 st Nordic meeting – GHRK/Lunna• Neurological Rehabilitation in focus in general in therapeutic riding• Close cooperation with SEF• Sports riding, para dressage riders and driving

What happned around us 1999?

•Region Västra Götaland, Region Skåne and Region Gotland were founded – the map for health care sector was rewritten, new organisations paralysed decisionmakers•Funding for national rehabprojects ceased•Therapeutic riding projects at psychiatric clinics in Östersund, Skellefteå and Vänersborg•Heading for a new millennium

The Board 2000-04

Charlotte von Arbin PT 1994 -Margareta Håkanson PT 1999-Kerstin Bergqvist, PT 2001-03

Lena Aztalos PT 1997-2000Lena Solders PT 1999-2001Bodil Tillmann PT 2001-

Ulrika Stengard-Olsson PT 1995-Agneta Ehnertz OT, 1997-2004 Viktoria Wennström,Kolm PT 2001-

Beate SpangenPT 2000-01

10 PT1 OT

Struggling on in IRT…2000-2004

• Terminology • Survey among members; education important• ICF used by board members in discussions• Courses for therapists were arranged by IRT/GHRK in Movement

analysis, body awareness on horseback for Ann Marie Petterson, Balance in Movement for Susanne von Dietze Pollak• Charlotte v A and Ulrika SO offers 100% EAT in their work• IRT full member of FRDI• Negotiations with different universities without results

Struggling on in IRT… 2000-2004

Stretcing out towards others

•EU-Equus•Pegasuseurope•Nordic meetings 2000,02,04•Seminars on EAT in Psychosocial work and psychiatry 2000,2001 in Gothenburg and 2004 in Östersund

What happened around us 2004?

• Birdflu

• Olympic games and Paralympics in Athens

• The Tsunami in south east asia

The Board 2005-09

Charlotte von Arbin PT, 1994-Margareta Håkanson PT 1999-2008Marie Louise Nilsson, Spec Ped 2009-

Bodil Tillmann PT, 2001-Viktoria Kolm PT, 2002- Eva Lindsjö Lindell PT 2005-06Ami Ireström, Soc w, 2006-

Ulrika Stengard-Olsson PT 1995-

Helen Edwards Lutsch MD 2005-09

6 PT1 MD1 Soc work1 Spec ped

2005-09 Period of Development

• Terminology HUT/EAT is recommended• University coarse MIUN 2005• First students from MIUN 2005 fulfilled education 2008• Membership qualifications changed, less PT dominance• Certification 1 Susanne von Dietze courses 2005• Developing EAT in social sector• IAHAIO Tokyo declaration 2007

2005-09 Development

• Green care and SLU cooperation• Department of Agriculture – projects• National Horse Society – projects• Scientific publications, articles and thesis, • Scientific projects and other projects• Certification of therapists 2005 BiM and 2008 IRT-certification• Quality indicators for providers of facilities for EAT• Ethical rules• Starting to certificate members in the new system

2009 what happened around us

• Economic crisis in the world

• Barac Obama installed as new president – sitting on horseback as back pain prevention highlighted i CNN News in connection to this

• Hard new rules on sick leave in Sweden • More private actors in health care sector

The Board 2010-14

Charlotte von Arbin PT, 1994-2013Margareta Håkanson PT 2013-Marie Louise Nilsson, Spec Ped 2009 -13

Bodil Tillmann PT, 2001-12Viktoria Kolm PT, 2002- 13Ami Ireström, Soc w, 2006-Lena Grip, Psol 2011-12 Pia Tillberg PT 2013-Maria Johansson OT 2014-

Ulrika Stengard Olson PT 1999-2010Ida Runge, Soc w 2011-13LisLott Andersson RN, 2014-Renate Sundholm, Soc w 2014-

Marie Gudmundsson OT 2013 -

6 PT3 Soc work2 OT1 RN1 Psol1 Spec ped

Striving on in a changing world 2010-2014• Tuning in the certification process• Multiprofessional board• Professionalisation - participating in int conferens”Sittsymposium”• Participating at professional conferences for psychotherapists

• Discussing PR strategi• Discussing self employed members situation

What happened around us 2010-2014• EAT courses at Malmö university and Linnéuniversity rise and fall• Norwegian-Swedish education planning• Projects on EAT in Dalecarlia (neurology), Stockholm (autism), Skåne

(nature assisted therapy)• Network building in Region Skåne IRT/Equine sector/health care sector

• Research projects on EAT going on in Stockholm, Gothenburg, Linnéuniversity, Linköping a o• Research networks; humanistic network on human horse studies, network

on sports technology, international networks, research network at ESH

Looking in the mirror….

From different perspectives………

Building bridges between professions…..

Equine assisted therapy

Demand multiprofessional cooperation and/or multiprofessional competence

On humans – with and without functional limitationsOn horses

Professonalisation

• Profession or occupation / exclude or preserv - working on diversity has been the Swedish choice

• Cerating legitimacy in two worlds – health care and equine sector, terminology, networking

• Research and education development 1994-2014

Work conditions influence on the process of professionalization • Most therapists worked 10-20% with EAT wihtin ordinary health care

employment 2000-2008

• In projects 100% working on professional issues in EAT became possible

• 2000 100% EAT professional work at Habiliteringen in Gothenburg for IRT chairman Charlotte von Arbin

• 2004 50% EAT professional work at Region Skåne with education and supervision as special task – 100% was offered

The map for work conditions changes• 1994 all members are employed in the health care sector• 2014 more than 16% of the members are self employed

Today• Health care sector is divided into public and private care• Funding of care is not entirely public • The patients may ask for interventions not available in the public system

• We do not know the effects for self employed IRT members

IRT – strategies for development of EAT

Defining terms: Therapy and leisure riding in EAT

Bad health Good health

Wellness

Disease

Therapy TherapyFaRAdapted leisure riding

Adapted leisure ridingTherapy

Leisure ridingAdapted leisure riding

Expanding therapeutic use 1994 -2014

A process from physical rehabilitation to

preventing illness and promoting health

Learning and achieving skills on the horse

Learning and achieving skills with the horse

Learning and achieving skills from the horse

Professions represented 1994 and 2014

1994-95 94 members• PT 63 67%

• OT 17 18%

• RN 3 3 %

• Special ed 8 8 %

• Physician 1 • Psychotherapist 1

• Student 1

2014 62 members• PT 25 40%• OT 4 6%• RN 4 6%• Spec ed 6 9 %• Social pedagogue 2• Psychologist 3• Physician 2• Social worker 5 8%• Priest 1• unknown prof 5 8%

Members 1994-2014

Surveys members 2000-2006

68

18

11

3

Medical treatment

Psycho social treatment homes

Day care centres

Special pedagogics

P

P

PP H N

H P Pv

Pv ,S H =5

H N Pv

HP

H VH =6

N P H =10

P Pv H N=9

P

VH

H VH N Pv =12

H

H VH P= 17

P psykiatri

H habilitering

VH vuxen habilitering

N neurologisk rehabilitering

Pv primärvård/smärt-rehabilitering

Medical treatment

Survey on location of Equine assisted terapy in Sweden July 2008

Financed by Swedish Horse Society, Dept of Agriculture and Swedish university of Agricultural Sciences

MH09

Code of Ethics

Inspired by • PegasusEurope’s Code of Ethics

• EFMHA’s and EAGALA’s codes of ethics

• Completed by Swedish adjustments

• Multiprofessional

MH09

Code of Ethics

An etical code aim to enhance sensitivity and understanding in therapy

MH09

Code of Ethics

Different aspects

• Own profession• Client• Professional responsibility• Horses• Cooperating professionals

MH09

Code of Ethics

Towards professional role• Own professional ethical code has to be followed and

respected• Laws and regulations has to be considered and followed• The therapist must not show false qualifications or

otherwise be unserious

MH09

Code of Ethics

Towards clients• Security• Goals• Assessment• Acceptance• Physical contact• Records• Secrecy

MH09

Code of Ethics

Professional responsibility

• Further education and training• Self awareness of skills and limitations• Personal intergity• Security responsibility and risk assessment

MH09

Code of Ethics

Horses

• Respect the horses need for wellbeing• Select appropriate horses for therapy• Take care of and train the horse according to age and

educational level

MH09

Code of Ethics

Cooperating professionals

• Give sufficient information of aim of therapy• Give appropriate tasks possible to accomplish• Stress etical rules and personal integrity• Inform of secrecy rules

MH09

Development of structured education - non university education

2001 -2014 ”Balance and Movement”, international course A-D in movement analyses and treatment in EAT 29 participants fullfiled D course – IRT/GHRK

2004 -14 structured further education in Region Skåne for PT’s in habilitation/child care 20 pt´s fulfilled

Development of structured education EAT – outside IRT at university level

• Negotiations Uppsala university 1994-99• Negotiations university of Gothenburg 2001-03• Negotiations SLU 2000-2003

Finally things happened elsewhere• Academic courses ground level 2005-13, Miun,Malmö, Linné• Academic courses advanced level 2014 ESH

Academic courses 2005-2014

Ground level”Therapeutic riding” Middle University College 2005 -09

”Use of horses in social work, 1 and 2” Malmö university college 2010-13

•Use of horses in social work Linne university 2011-12

Advanced level

”Horses as therapeutic resource” 7,5 hp Ersta Sköndal university college 2014

”Balance in movement A-D” – accepted as further education in PhD studies 2008 Gothenburg university

Scientific articles published 1985-2014• Peer reviewed articles 20141018 • Key words: therapeutic riding OR hippotherapy OR equine assisted

therapy

The library

• During the years the collection of articles went on for the library which was placed at GHRK

• During 2013 the library was digitalised

• New homepage give members only acess to the digitalised library

• Some books and articles will be preserved at ESH library some at GHRK

Building bridges between Nordic countries

Planning for Nordic cooperation-1995

• Started already 1995 but it took long time to get contact and to find the time to get the five Nordic participants together

Nordic meetings

• 1999 Sweden Terminology, education, documentation, organization

• 2000 Denmark Guidelines for a nordic education of therapists and instructors

• 2002 Norway Practice based research, twinriding, evidence based practice

• 2004 Island PT therapy, education, project on patient with Parkinsons disease and the future development of nordic cooperation

• 2006 Finland sensory aspects on neurodevelopment, ethics, centred riding

• 2008 no meetings…….. Ethics and a nordic ethical code was suggested

• 2012 1st Nordic research seminar at ESH, Stockholm• 2014 2nd Nordic research seminar at ESH, Stockholm

2006 -2013

• Sweden invited for 2008, 2009, 2010 but did not fulfil the plans

• A new board 2013 decided to start the process from another angle and turned towards Norway …… and cooperation on education….

Building brigdes…..

Health care sector Equine sector

Riders with functional disabilitiesFunding and maintaining educational levels for all involved

TherapistsProfessional developmentPrevention and promotionHealth politicsGreen care

Horse knowledgeSportsRural politicsHealth politicsGreen care

IRT – Swedish Equestrian Federation

• Close personal relations between IRT board members and Swedish Equestrian Federation from the beginning 1994 and onwards

• Mutual support of parariders

• Development of classification systems nationally and internationally

• Cooperation in education of instructors for riders with disabilities

• Cooperation on education materials for disabled riders

Cooperation EU Equus 1999-2005

• IRT chairman at the ministry of sports preparing EUEquus meeting 1999 as representative for the equine sector

• IRT chairman involved with EUEquus seminar in Skara 2000 as representing part of the equine sector

• IRT chairman participate at Pet Night i Bruxelles 2005

Swedish Horse Society and Dep of Agriculture

• IRT participating in survey of therapeutic riding financed by NHS 2008

• IRT part in project on certification, quality assurance and ethical code for EAT 2008

• Negotiations on cooperation 2014

Exchange of knowledge

• Swedish university of Agricultural sciences (SLU) and IRT negotiation on education in Animal assisted therapy 2000 – no sucess

• IRT tries to lobby for special education for instructors in theraputic riding 2009 – no success

• IRT negotiate with Strömsholm on education for therapists 2014……

Under construction – education

2013 – a new start of Nordic cooperation….

• Norway initiating a meeting with IRT in Oslo on future collaboration in education

• Aim – creating a higher education for therapists within the ordinary educational system available for nordic students and adjusted for working students

2014

• Inital contact with Higher Vocational Education in Skara and at Strömsholm

• Meeting representatives from Norway and Sweden in June and November to plan the frames for education

• Planning start of education in 2016

….. bridging gaps and construckt bridges…

Health care sector Equine Sector

Lasting cooperation within professions and the Nordic countries for 20 years

We still fight with legitimacy within the health care sector and patients acess to rehabilitation has ceased

Comparing IRT 1994 and 2014

1994 plans• Arrange a course in lounging or with a

german physiotherapist Susanne von Dietze

• Start categorizing litterature, articles, thesis

• Collect information on international conferences and seminars

• Posterpresentation of IRT at the congress for Swedish PT´s in 1995

• Decide on statutes and membership • Produce 3 newsletters a year for

members

2014 plans• In cooperation withErsta Sköndahl

högskola arrange Nordic Seminar in EAT• Celebrate 20 years with IRT• Continue the cooperation on

nordic further education in EAT • Support clinical work within EAT• Support access to EAT• Actively increase membership in

IRT

Reflections on todays challenges

• Lifestyle – lack of time, sitting, digitalizing,social network on line, • Few volontary workers available for NGO work• Mental and Stressrelated ill health more evident than physical

limitations• Public finansed care is withdrawn for those with lasting functional

limitations• Short time economy rules public funding• Diversity of new caring and coaching professions in selfemployment

sector• Urbanisation – and need for rural development

Visions for the 20 years to come 2014-2034• EAT will be recommended as a cost effective and sustainable rehabilitation

available to those who are in need

• Centres and multiprofessional teams will be available in most communities

• Nordic further education in EAT is prerequisite for therapists in the field

• EAT is public funded as ”best choice” in rehabilitation and prevention

• EAT will be primary choice in rehabilitation for persons with permanent functional limitations and for persons suffering from stress related ill health

The Swedish Interest Association of Therapeutic Riding

1994 2014

Thank you for listening!