Equine-assisted learning in youths at-risk for school or social failure

Figures & data

Table 1. Statistical values showing an EQUAL intervention-by-time interaction in at-risk youths in (A) 2013 semester 2, and a similar interaction effect in an independent cross-over cohort in (B) 2014 semester 1, and (C) 2014 semester 2

	Statistical values of the interaction effect between equine therapy and time
Habits of Mind construct	β	SE	95% CI	p-value
A) Year 2013 cohort semester 2
Thinking Flexibly	1.30	0.13	[1.02, 1.58]	<0.0001*
Taking Responsible Risks	1.35	0.08	[1.21, 1.59]	<0.0001*
Managing Impulsivity	1.13	0.07	[0.97, 1.29]	<0.0001*
Persistence	1.40	0.11	[1.14, 1.65]	<0.0001*
Listening with Understanding and Empathy	1.22	0.08	[1.07, 1.37]	<0.0001*
B) Year 2014 cohort semester 1
Thinking Flexibly	0.69	0.14	[0.38, 1.01]	<0.0001*
Taking Responsible Risks	0.96	0.17	[0.57, 1.35]	<0.0001*
Managing Impulsivity	0.42	0.24	[−0.11, 0.96]	<0.081
Persistence	0.55	0.2	[0.11, 1.00]	<0.005*
Listening with Understanding and Empathy	0.49	0.29	[0.74, 1.62]	<0.010*
C) Year 2014 cohort semester 2
Thinking Flexibly	1.18	0.20	[0.74, 1.61]	<0.0001*
Taking Responsible Risks	1.64	0.30	[0.97, 2.32]	<0.0001*
Managing Impulsivity	1.27	0.18	[0.86, 1.67]	<0.0001*
Persistence	1.50	0.17	[1.12, 1.87]	<0.0001*
Listening with Understanding and Empathy	1.35	0.23	[0.84, 1.86]	<0.0001*

Notes: A multi-level model was used to test whether there were group differences in the scores of each Habit of Mind construct over time. The betas indicate the differences in slopes between the group receiving equine therapy and the group that did not, and standard errors (SE) indicate the variability of the sample cohorts. For example, for the construct Thinking Flexibly, the mean score of the group that received equine therapy relative to the group that did not improved by 1.30 over time. The betas can be considered as unstandardized effect sizes. The 95% confidence intervals (CI) are also shown; a CI covering the value of zero means the null hypothesis cannot be rejected. Finally, multiple comparisons correction (Bonferroni–Holm) was applied across the five constructs measured at an alpha of 0.05.

* Indicates that the significance survived multiple comparisons.

Figure 1. Equine therapy improves Habit of Mind scores over time in one semester in 2013. The teacher ratings for the Habits of Mind constructs: (A) Thinking Flexibly, (B) Taking Responsible Risks, (C) Managing Impulsivity, (D) Persistence, and (E) Listening with Understanding and Empathy, for students of the 2013 cohort who were in the EQUAL program compared with students who did not partake in the program, showed an increase over the semester

Figure 2. Equine therapy improves Habit of Mind scores over time in 2014 semester 1. Higher baseline measures were found in the students about to enroll in the EQUAL program in semester 1 of year 2014 for the following four Habits of Mind constructs: (A) Thinking Flexibly, (B) Taking Responsible Risks, (C) Managing Impulsivity, (D) Persistence, but not (E) Listening with Understanding and Empathy. The teacher ratings for four Habits of Mind constructs (A) Thinking Flexibly, (B) Taking Responsible Risks, (D) Persistence, and (E) Listening with Understanding and Empathy, for those students in the EQUAL program, compared with students not in the program, showed an increase over the semester

Figure 3. Equine therapy improves Habit of Mind scores over time in two semesters in 2014. Higher baseline measures were found in the waitlisted students about to enroll in the EQUAL program in semester 2 of year 2014 for the following three Habits of Mind constructs: (C) Managing Impulsivity, (D) Persistence, and (E) Listening with Understanding and Empathy. The teacher ratings across five Habits of Mind: (A) Thinking Flexibly, (B) Taking Responsible Risks, (C) Managing Impulsivity, (D) Persistence, and (E) Listening with Understanding and Empathy, for those students in the EQUAL program, compared with students not in the program, showed an increase over the semester

Table 2. Correlation between rate of change in scores over the semester and grade-point average (GPA) scores at semester end in Year 1 students in (A) semester 2, and an independent cross-over cohort of Year 1 students in 2014 of (B) semester 1, and (C) semester 2

Habits of Mind construct	β	SE	p-value	r ^2
A) Year 2013 cohort semester 2
Thinking Flexibly	1.10	0.24	<0.0001*	0.13
Taking Responsible Risks	0.96	0.21	<0.0001*	0.12
Managing Impulsivity	1.05	0.23	<0.0001*	0.12
Persistence	0.67	0.21	0.0017	0.08
Listening with Understanding and Empathy	0.85	0.20	<0.0001*	0.10
B) Year 2014 cohort semester 1
Thinking Flexibly	0.62	0.16	0.00027*	0.14
Taking Responsible Risks	0.30	0.15	0.058	0.04
Managing Impulsivity	0.53	0.19	0.0043*	0.09
Persistence	0.58	0.17	0.0011*	0.10
Listening with Understanding and Empathy	0.44	0.17	0.0099*	0.09
C) Year 2014 cohort semester 2
Thinking Flexibly	0.78	0.26	0.0032*	0.10
Taking Responsible Risks	0.80	0.24	0.0009*	0.12
Managing Impulsivity	0.99	0.27	0.0004*	0.13
Persistence	0.76	0.28	0.0079*	0.09
Listening with Understanding and Empathy	0.60	0.20	0.023	0.05

* Indicates significance at alpha of 0.05, Bonferroni corrected for multiple comparisons.

Table

1. Treatment design
Information on intervention condition
Length of contact for each session	180 min
Number of contacts	2013: 75 students
	2014 semester 1: 58 students; 2014 semester 2: 59 students
Content of treatment	There is a structural training manual that the providers follow, which can be furbished on request. An example of the first session is provided here as an example. The first session is an introductory session where instructors and participants get to know each other and various general safety behaviors around horses. Thereafter, each session consist of three activities; horseplay, horsemanship and riding. In horseplay, participants engage in various games with the horse that emphasizes the various Habits of Mind. An example of such a horseplay activity is “Catch the Pony”. In this game, participants are to figure out how to catch the horse given the head collar and lead rope. Minimal instructions are given (largely in regards to safety) and participants have think flexibly and be persistent to be successful at the activities. Horsemanship consist of activities that revolves around skills regarding care for the horse. Such skills require the application of the Habits of Mind to be successful. For example, picking the horse hoof for the first time requires persisting from the participant as it could take a number of attempts before one successfully does it independently. Riding is a mounted activity where various riding skills are taught. To be successful at riding, participants would have to practice the various Habits of Mind, due to the nature in which the horse and rider interact with each other. For example, if the rider is feeling nervous, managing their impulsivity of pulling the reins for balance is interpreted by the horse to stop instead of continuing to walk. After each activity, a debrief is conducted, processing with the participants what Habits of Mind was practiced and how they could apply them in various situations
Duration of contact over time	16 sessions × 180 min = 2880 min
Information on comparison condition
Length of contact for each session	no contact
Number of contacts	2013: 85 students
	2014 semester 1: 59 students; 2014 semester 2: 58 students
Content of treatment	none (As EQUAL has been integrated into the core school curriculum, the students attend classes as usual)
Equivalence between intervention and comparison conditions
Method to ensure that the intervention is equivalent between conditions	None for the pioneering batch of 2013. In 2014, EQUAL was formally incorporated into the school curriculum, as part of a cross-over intervention program
Method to ensure that the length and duration of therapy is equivalent for participants within conditions	The providers follow a structured training manual. Since EQUAL is part of the school curriculum, the students partake in EQUAL during school hours
Specification of provider credentials needed	The providers in one session comprise of personnel trained in horses (accredited by the British Horse Society) and personnel with a Bachelors in Psychology
Theoretical model upon which the intervention is based is clearly articulated
The active ingredients are specified and incorporated into the intervention	The intervention works on the premise that horse-based activities provide opportunities for students to practice, experience, and process the positive consequences of the following five Habits of Mind; Persisting, Managing Impulsivity, Taking Responsible Risk, Thinking Flexibly, and Listening with Understanding and Empathy. This is done by getting students to verbally reflect if they practiced any of the habits of mind that lead to their success and instructors pointing out to them the habits of mind skills that were used that allowed them to achieve success at each horse-based activity (as each activity is ongoing and during the debrief/wrap up segment after completion of each activity). Reflection sheets are also given to the students to reflect on each habit of mind
Use of experts to determine whether the intervention protocol reflects the underlying theoretical model	The intervention was primarily based on the Habits of Mind, developed by the Costa [cite), that was embraced by the school as integral character skillsets. The program was designed together with the teachers of the school
Plan to ensure that the measures reflect the hypothesized theoretical constructs/mechanisms of action	The activities of each session were planned with the aim of eliciting the Habits of Mind
Potential confounders that limit the ability to make conclusions at the end of the intervention are identified	The session is conducted to a large group of students. Although many personnel are involved in each session, it is acknowledged that some students may be slower to learn, and that the duration of the session may not be sufficient for these students to fully grasp and link the activities to the Habits of Mind
Plan to address possible setbacks in implementation (i.e. back-up systems or providers)	There are contingency plans to conduct the sessions indoors in case of inclemental weather such as rain. For example for the horseplay activity Pinky and the Brain, the activity was to get the horse and tack it up with some taking the role of the hand and others the brain. While the activity conducted outdoors allows for more dynamism (e.g. getting the horse in a sand paddock might require more persistence), it could be conducted within the confines of the stable too
2. Training of the providers of intervention
Description of how providers will be trained (manual of training procedures)	The main facilitator of the program would meet up with the treatment providers(facilitators) before the start of each semester, and go through the sessions with them. Hence, before the start of each semester, all facilitators have to be familiar with the entire EQUAL lesson manual. Briefings at the start and the debriefings at the end of each session were performed to ensure every facilitator was on the right track. Before the start of the sessions, the facilitators would run simulated activities to familiarize themselves with the intervention procedures. At the end of each session, debriefing would be held for feedback
Standardization of provider training	In the case of new staff members, they would be assigned to an experience mentor to guide them through the process
Assessment of provider skill acquisition	Although the horse trainers and psychologists were accredited, no formal assessments specific for EQUAL were carried out, due to staff and funding limitations. However, the main primary facilitators would always be around during the sessions to ensure other newer facilitators are adhering to the guidelines of the EQUAL program manual. If need be, extensive interviews are carried out for the new staff hires before the start of the semester. There was no staff turnover during the semester
Assessment and monitoring of provider skill maintenance over time	No formal assessments specific for EQUAL were carried out, due to staff and funding limitations. However, briefings at the start and the debriefings at the end of each session were performed to ensure every facilitator was on the right track. Before the start of the sessions, the facilitators would run simulated activities to familiarize themselves with the intervention procedures
Characteristics being sought in a treatment provider are articulated a priori. Characteristics that should be avoided in a treatment provider are articulated a priori	Advertisements placed for new hires of facilitator positions specify either a degree in psychology (at least a Bachelor’s level) and/or formal training in horses (accredited by the British Horse Society). The facilitators are required to have a good command of English, and are concerned and comfortable with helping children and youths who may be experiencing problems in an academic setting
At the hiring stage, assessment of whether or not there is a good fit between the provider and the intervention (e.g. ensure that providers find the intervention acceptable, credible, and potentially efficacious	Potential hires were first asked to volunteer for the program to see how they fit (and if they are a good fit with the program)
3. Delivery of intervention
Method to ensure that the content of the intervention is delivered as specified	The treatment manual is given to all treatment providers before the start of the semester so that they can deeply understand the content of the lessons. Before the start of the school semester (during the term break), the facilitators would run simulated activities to familiarize themselves with the intervention procedures
Method to ensure that the dose of the intervention is delivered as specified	All students who are present goes through the same activities for each session (e.g. session one activities are always the same for all classes)
Mechanism to assess if the provider actually adhered to the intervention plan	The main facilitators of the program, who have been around since the inception of EQUAL, are always around for the entire sessions
Assessment of non-specific treatment effects	No
Use of treatment manual	Yes
There is a plan for the assessment of whether or not the active ingredients were delivered	Yes, this study serves as an assessment of whether EQUAL is effective by examining whether there is improvement in Habits of Mind over time
There is a plan for the assessment of whether or not proscribed components were delivered	No, this study does not examine whether components of the EQUAL are unhelpful or unnecessary
4. Receipt of intervention
There is an assessment of the degree to which participants understood the intervention	Facilitators ensured that the participants were able to perform each horse activity, and corrections were made on the spot
There are specification of strategies that will be used to improve participant comprehension of the intervention	Facilitators used visual cues to aid their training (e.g. mimicking the motions they were to perform). Also for participants who learned better kinesthetically, they were taught while participants were simultaneously performing the task
The participants’ ability to perform the intervention skills will be assessed during the intervention period	Although no formal assessments are conducted for the students, the high facilitators-to-students ratio ensure that the students partake in active on-the-spot learning
A strategy will be used to improve subject performance of intervention skills during the intervention period	Activities are planned to ensure that the horse skills are taught in a progressive manner. For example, learning how to get the horse to walk and halt is taught before learning how to turn the horse)
Multicultural factors considered in the development and delivery of the intervention	Yes, for example, in a case of a student whose language abilities are poor, efforts are made to speak in colloquial language or through the means of hand signals and physical demonstrations. More often visual demonstrations were used, and when needed, participants were hand guided and/or physically supported when necessary
5. Enactment of treatment skills
Participant performance of the intervention skills will be assessed in settings in which the intervention might be applied	Yes, his or her abilities to handle the horses are performed on the spot, by the facilitator
A strategy will be used to assess performance of the intervention skills in settings in which the intervention might be applied	Yes, there is an academic rubric for assessing how the students, through the EQUAL program, may have cultivated certain Habits of Mind. The rubric is used by teachers who do not carry out the EQUAL intervention. See below “Rubris for evaluating students’ Habits of Mind”

Table

Habit of Mind
Listening with Understanding and Empathy: Ability to be present in the situation. Ability to listen and respond appropriately to others.
Points to look out for:
• The student makes eye contact with the person speaking to them • The student faces the person who is speaking to them • The student responds appropriately • The student asks questions when they don’t understand • The student finds ways to understand what is being said
Managing Impulsivity: Ability to respond to a situation by thinking through it rather than reacting to it.
Points to look out for:
• The student listens to instructions • The student gathers information and things they need before they start work • The student asks for clarifications when they are unsure about what to do • The student waits for their turn or raises their hand before answering a question • The student is in control when on a task • The student thinks through a question before answering • The student completes what they set out to do
Thinking Flexibly: Ability to consider the points of view of others. Ability to generate new ideas which take into consideration varying points of view.
Points to look out for:
• The student listens to other people’s ideas • The student can compromise and work together with a group • The student can accept criticisms and suggestions
Taking Responsible Risks: Ability to take risks in the work they do. Willing to try something new despite difficulty and fears of failure.
Points to look out for:
• The student is not afraid of trying even though the task is difficult • The student volunteers to participate in class activities • The student tries new things
Persisting: Ability to approach a problem or difficulty and try different ways of solving or overcoming it.
Points to look out for:
• The student keeps trying • The student focuses on the task • The student asks for help