Hippotherapy and Beyond: A Comprehensive Look at OT with Horses

In this engaging podcast episode, we delve into the world of Occupational Therapy (OT) and its unique application in the realm of mental health, particularly with horses. Our guest, an experienced OT practitioner, shares valuable insights into her journey, including her dissertation focused on horses and mental health.

Discover the surprising ways in which therapy goats and horses are integrated into OT sessions to support clients dealing with anxiety and other mental health challenges. Explore three distinct pathways for incorporating horse interactions into therapy sessions: movement, partnership, and action.

Join us on this insightful journey as we explore the transformative potential of horses in the field of OT and their role in promoting mental well-being.

Transcript

0:01

Hi, welcome to animals and aquatics and OT. I'm Gina, your host, and I'm excited to share with you this interview today with Natalie. This is going to wrap up our occupational therapy, horses and mental health. Mini series now, Natalie and I connected over LinkedIn because she is completing her. Uh, post-professional doctorate at Boston university and her dissertation is on occupational therapy, horses and mental health. So this is the perfect way to wrap up our mini A Series I have a great listen

gina 0:51

I'm glad we finally got a chance here to meet and

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 0:56

Yeah, I just, can I geek out for a second? I saw that your article on I think it was the ot Continuing ed. I saw that article and I immediately was like, I have to meet Gina. I have to connect with her because. We're on the same wavelength in terms of how we're looking at equine assisted therapy and ot. And so I I'm honored to meet you and to be able to join you today.

gina 1:21

Excellent. Well, for our listeners today, Natalie is doing her dissertation on horses and mental health. And so I thought this would be a perfect time to chat and I've been doing a little mini series on horses and mental health. In And so this is gonna be our culmination here in putting together what I've been talking about and then having a little discussion here about dissertation and, and where that's leading you. So if you can start by telling us just a little bit about where you're at.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 1:59

Sure. Where I'm at in terms of like with BU or

Track 1 2:03

Yeah, where you're at in your OT journey?

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 2:07

Okay. So I guess I'll start with that I've been doing OT for almost 15 years, and I've always done pediatric work and on and off throughout that time. I have done hippotherapy. One way or the other. And it's been in Massachusetts or New Hampshire, so several barns, old programs, new programs. And so, right now I think I am kind of, I really craved going back to the drawing board because I wanted to find a way to contribute to the profession. And I wanted to also find a way to defend our position in supporting mental health with a horse. You know, I think a lot of the times when people are looking at Hippotherapy and they see it that it's done by pt, ot, or speech, you get really specific on purposeful manipulation of movement and think, okay, I just have to work on, something that requires, that can only benefit from the movement. And it largely in the research be something biomechanical, right? So something for. Or for strength And things like that.

Track 1 3:12

teeny bit

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 3:13

I think less people. Yes. Yes.

Track 1 3:17

bit on sensory.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 3:18

And so

Track 1 3:18

starting there.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 3:21

Yeah. And so, I really wanted to bring attention to how as OTs we, we can work with, people who need. Mental health support. But the horse is perfect for that, and research hasn't quite caught up to that, even though it's acknowledging that it has a place and a contribution.

Track 1 3:42

Yeah, I think So many people, both professionals and families don't understand that we work in the mental health field and that's something that I'm explaining a lot. And this semester is my pediatric semester with my occupational therapy assistant students. But next semester I teach the mental health semester and like just explaining to them, yes, we work with mental health. Yes, that's within our scope of practice and I want you to find your unique view of what OT brings. That isn't talk therapy, that isn't a worksheet, because that sort of seems to be the choices out there. It's like, well, you can have talk therapy, maybe play therapy if you're a kid, but that's about all the choices you're gonna get in mental health. And so cultivating that there is other options and OT brings that I think is so important.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 4:41

Absolutely, and I couldn't agree with you more on that. I think that in essence, just from being a rider myself and having a long history with it, that, riding is occupation. I. There are lots of therapeutic elements and terms that we use of horses, you know, in these contexts, but I really think it's so important to really focus on Yes, OTs can do. We focus on that mental health piece. They can do that with kids, they can do that with horses. We even know in the research with animal assisted interventions, so if we go, if we, we go less specific to horses and we just look at animal assisted interventions. We know that animals have a place here and they, we know that they can help in so many ways. So, you know, figuring out how do we do that with a horse from an occupation based perspective, it's just such a, such a, an opportunity for us.

Track 1 5:32

When I think I've found that some of my clients that are having trouble with anxiety and depression and self-esteem, they've actually connected with our therapy goats as well. And so we've had, OT sessions where our therapy goats are incorporated because they're Easy to transport, and they're a little less intimidating. They're a little easier to get to know because they're about 40 to 50 pounds and they're, they're kind of little and easy. And so some of our clients, we've actually started there, especially when anxiety is an issue. And then, We've been able to move to the stable if we need an alternative location or if they're just ready for something else. And then layering in the movement has been really helpful because then we get the sense more of the sensory piece, we get more of the body awareness piece. We can do more with body scanning and more self-awareness as we get to then working with the horses. So it's been really interesting to see some of our clients make that transition. Now when you were treating and incorporating hippotherapy, how did you find that layering in between the movement piece and maybe some of the more focused mental health interventions? I.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 6:50

Good question. I think for me so, uh, just to kind of have this out there too, I am not I'm not credentialed in Hippotherapy, but I have been to both the certification courses for level one and two, the American Hippotherapy Association. I have a, of a good understanding of how important the movement is. And for me it's always sort of been a foundational component. It always has to be in place to kind of help make the magic happen. When you're looking for that, like Perfect combination, right? Because we don't want to end up with a child who's overstimulated from their movement or who just isn't having enough fun because they're not getting enough input from their movement. So I feel like it's the, uh, foundation of what you need to know to do that aspect well, and I feel like without even really trying, you know, you can blend a lot of elements of mental health in that So that's that. And for me it's different with every kid. It's different with every horse. It's different with every ride. So I think A lot of times, even when I go into a session while I have, a treatment plan and I have my goals I'm, I'm ready to go with a moment as well. So I think that it's really important for anybody who's like interested in going into this area of practice to really, uh, think about how. Sometimes, it's not necessarily in the perfect therapy plan, it's in the facilitation, right. So I think one of the things I've kind of gotten a little hung up on just in thinking about this and we put this out there to see what your thoughts are on this too, but we get so fixated on looking at the horse as a tool, right. The horse is a tool, but. For me, what I'm really looking at, especially in my dissertation, is that the horse is a tool, but it's also the intervention. And that horse child relationship for me is the intervention. Right? So I facilitate a lot of what I'm doing and a lot of how I do that is through including the horse in the conversation, you know, so, um, it's kind of like almost that therapeutic use of self where a therapist may interject their, their thoughts and opinions on, on something to help someone get, a, a client get through something. My horses help kids do that when I'm working with them. And so I have a funny story I can share with you. It's so funny, it's actually really sweet, but I had this little boy who had some V motor concerns and he really wanted to learn how to tie his shoes and there was just too much frustration happening at home for him to want. To be able to try and practice. He was so burned out. And so while we didn't focus on that right away because we needed to build rapport and a routine and to get familiarity with the whole process what ended up happening was he tied his shoes for. Horse and it happened so naturally, but I had so much a good sink with my horse team at the time that we were able to communicate really carefully without it being too obvious to the child. And what had happened was his shoe fell off while he was on the horse while we were walking along. And so, you know, we queued the horse to stop and, um, and then I had just brought it to his attention. I said, oh no. Jack noticed that your shoe fell off. You can't ride without your shoes on. What are we gonna do? And so it's kind of pulling in the, the child to then engage in this kind of scenario that you create, right? And As the horse has his head turned a little bit back we're creating this conversation with the horse. And, and sure enough you know, we put the, the shoe on and we practiced tying it and we got some really great effort out of that. And he tied his shoe for this horse. And so it's really beautiful. Even, you have these things to work on, but there is sort of an art to not over-planning it because, The horse child relationship really is the intervention in my mind. And I think there's something really special about that.

Track 1 10:59

Yeah, so. I, I will try to keep my thoughts in order here. So, starting at the beginning with the horse being the tool, like I, I think of the movement is one of my tools and that the horse isn't the tool at all. But the movement is one of the tools that I have and one of my approaches with mental health is sometimes we need to move. And I just was listening to another podcast recently where they were talking about The foundations of E M D R. And when E M D R came out, it was like, well, where's the basis for this? And then as they started to catalog people, people walking actually scan left to right, left to right, and that was the basis for it. And the podcaster made a comment. He said, yeah, but too bad. You can't do therapy while you're walking. and I thought, well, obviously you're not a nature-based therapist because we walk all the time and when our clients are on the horse, right, they're get, they're walking and I think that movement piece opens up so much and so kids will suddenly start disclosing. I mean, same that side by side, right? You're not face on, you're not making that direct eye contact. You're side by side. They can talk and you don't have to like look right at them so they can open up and disclose and feel safe. So movement is one of my paths I say that I might take because they may need that. And then connection, that partnership piece, which is what you were just talking about with the horse. And so maybe my first characteristic there isn't the movement. Quality or movement characteristic, but it's the partnership piece. And so it's a horse that's going to give me the reactions that I need, which might be less or more. I might need a horse that is more reactive, that's gonna do those things that, that say to that client like, Hey, don't do that. Or, oh, I'm interested in what you're doing. Or the horse that is very, very level. And isn't going to overreact because the client is so overreactive. And then my last pathway is action for our clients that really need to start taking action. And so that's where I incorporate a lot of the barn types of activities where it's caring for the horses or caring for something else. Because they need to start taking action in their life. They need to be able to make decisions. They need to feel confident and empowered in what they're doing. And so the action track or the action pathway has a lot of those types of activities. I. So that they can start getting empowered. And that horse is a motivator. You know, it's like, well, I'm not doing it for me and I'm not doing it for Miss Gina. I'm doing it for Jack. Or I'm doing it for Tootsie, because that is then meaningful to them, and it isn't just one more adult placing a demand on them. And I think especially as we get into that preteen teen, Then that becomes a really important factor because I find with my tweens and teens that giving that bit of distance between me as like the authority figure and the request. Can be huge. So, you know, I can, I don't have to make the request, like you said, Jack can make the request to tie the shoe or Tootsie can make the request to have her stall done for the evening. And that's the pathways I think of when I'm thinking about incorporating those horse interactions into OT sessions from that mental health perspective, which is definitely different than that kind of pure sensory, which, I, I have a lot of heart there in, in, in the sensory world. Or, you know, biomechanical where I used to see so many kids that had the more traditional physical disability. And you did come from it from a, the very, I just taught N D T this week. So like motor learning and N D T, so like where you came at it from a very motor learning, N D t, positional handling. Side of things. So I think there's such a broad range just as an OT of, of like what you might be looking at. But mental health really, it does require us to step out of some of the things that we've already been doing maybe and, and find some new pathways.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 15:18

Absolutely. And I think that's, that's one of the really exciting things about working with horses and working with a, a variety of individuals who might have Diverse needs, right? There's a lot of places to kind of, integrate different elements of the equine. So whether it's the, something unmounted versus mounted or something, in the environment or something focused while they're on the horse moving. There's so many ways for us to kind of tap into into mental health. And I think sometimes what, where it gets a little confusing is that we're not necessarily able to always. Rule out one variable from the other. So while we think we're working on this therapeutic activity, we're also moving at the same time. And so movement's always kind of been there and oftentimes is. So I think that that's where it gets a little bit tricky is not realizing when you have so many variables going on in your session and then figuring out, okay, which part of it. Was really that piece or was it the combination. But I do love it because I think, you know, there's such an opportunity within the scope of occupation where we can engage a client or could be an adult or a child, you know, in a purposeful activity that creates and leads to motivation that is something so different than what they've been used to.

Track 1 16:40

Yeah, I know a lot of the families that we are working with the child either absolutely refuses counseling, any sort of talk therapy, and the parent is coming to us and saying, well, they like animals. Like, can you do something and. It's like Absolutely. Yes. And we have a great opportunity and a little bit of a door opening and like you said, you know, there's that rapport building period where we are taking our time and we're, we're moving slow and talking to the family to try to figure out, okay, what are some historical facts that maybe I need to know? What else have you tried that was or was not successful in getting the path of how the client got to us and then figuring out What is that secret sauce that I can put together that's really going to turn the tables from, whether that's school refusal or inability to complete self-care tasks. We're seeing a lot of challenges kind of across the board with clients Is is not just one area necessarily that they're coming to us for, but. Being able to be at the stable where we have lots of tools at our disposal, and then having something that's going home to the family so that there's good carryover and good communication has been something that we've found has been very effective because what we're doing in the session, I wanna make sure that whether it's family or school can take some of that and reference it. So that way that that child has better carryover, how have you incorporated the carryover piece into your client's plan of care as opposed to, our direct, direct treatment session time. I think

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 18:37

I think it has varied based on the setting that I was in at the time, and also the client needs. So sometimes it might have been maybe picking one thing that they can continue to work on at home. That's going to be the most effective rate. And that's, it's really hard because there are times where, you could have a situation and that one thing you want them to work on is not gonna happen with their FA family because maybe that's a touching point. It's figuring out. If and what it is that you ask. And I think making it a reasonable ask if you do, you know, provide, home programming to some degree. I think that, there was a time where I worked in a private therapeutic school and there was opportunity to have cross collaboration where we had our students go out in the middle of the school day for their hippotherapy services and then they would go back to school and, and the whole idea was that we wanna make sure these students are getting these Sensory opportunities, these movement opportunities, these time to have interactions with people and horses outside of that, that context. But we want them to come back regulated. We want them to be ready to learn and feel comfortable when they, when they get back to school, right. And have that, that perfect level of arousal. And sometimes it was great and sometimes it didn't. But that's, that's how you figured it. You know, lending itself into seeing, like, how does it influence someone? I had the opportunity to see, okay, you know, making checklists for teachers or interviews with teachers and going through okay for the next half hour, reading their level of arousal or whatever it was to see like, is this. Is, was this a good fit? And it might have been a good fit for the day, or it could have been something off, like the child was coming down with something, you know, but we could always usually piece it back to something, whether it was like, yep, it was the wrong horse, or, oh, we didn't do this, or they're getting sick, or something like that. But, so I think I had kind of, opportunities to see, you know, what you pick and choose. I, I would say that in my pediatric practice, sometimes it's, it's less of like a physical exercise and stretch, and maybe it's talking with families about how to have conversations with their kids and in a way where they're learning through contexts that are occurring. for example, if you have a child who's having a lot of reactivity issues and aggression at school it's setting them up for success by talking about how to be around people and give space or how to ask for space and modeling that and practicing that and going out in environments where you're talking about that instead of hitting on that touch point. Because I think sometimes Especially when you're getting into that element of mental health that sometimes you have to be really careful about what that carryover is. And sometimes there isn't anything that I'm necessarily giving the first few sessions until I get a better handle on some of the, the dynamics and and what's going on. I think it's, it's can be really complicated sometimes. And you wanna make a recommendation that's going to Facilitate success and motivation. So I think for me it's, it's, it's very, depending on the, on the context, but I think having a plan that facilitates some kind of success and it be real small is really good to focus on.

Track 1 22:14

Yeah. I think one of the key things you said there is what's one thing? What's one thing that we can send them home with? I always say, what's one question I can ask? So in that beginning phase, like I. Or if we're moving along a little bit, what's one question I could ask? Because I found, like initially it was like I wanted to tell them all the things and I realized like telling them all the things they were never gonna do all, if I could just pick one thing at any given time or ask one question at any given time, I got a much better response from the family. And one of the things that we've been really key in tracking is sleep. And sleep after sessions. Sleep within the next three days of sessions to see if we're hitting that kind of just right level. And like you said, if we're changing horses and so maybe we're getting different movement, different sensory input, then I'm coming back to that sleep question at a later time and saying like, okay, we are, we're trying a new horse now. The movement input is different. The response pattern is different. I want you to let me know about sleep again. If there's any sleep disruptions, if they're sleeping better, like next couple days before we see each other again next week, make sure that you're keeping an eye on sleep because it can have such a big effect. And I have occasionally, hit miss that Mark and the parent can be like, oh my God, they didn't sleep at all like it was the next two nights. And really by night three then they started to get back to their usual pattern. And I think in the light of sharing funny stories I had a student a level one student who was really good, who was working with a client that had Come in. And she came in at the, basically the same time that this client came for their initial OT eval. So this OT student saw them right from the beginning. And so they were doing some activities with the client. And I was like, okay, that's great. And then the level one student did their 40 hours and they left. And I was like, yes.'cause my turn now it's finally my turn. Like, I don't, I don't feel like this student had really been challenging the, the client enough. So I was like, I like, I'm gonna do it today. I did it. I did it. We did some different positions and we were coming back and we stopped near the barn and, and the client literally jumped off the horse, took his helmet, threw it, and ran to the car. And I was like, I think I overdid it because he had never, like, never done that before. I was like, Huh. It's very interesting. So we had a very interesting discussion with the parent after that. I was like, well, I wanted to challenge him a little bit more. But clearly we we went right past that. So it was a very interesting kind of experience for me of like, looking at that the student really had done a nice job in getting that just right level. And what I thought that person's capacity was for taking in more input and being able to stay connected and regulated. Was inaccurate. So I will never forget him just to like, he's like, I'm done. I got off, took the helmet off, went right to his car. Okay. So yeah, that ability to make sure we're hitting that, that just right place and, and I think it can be so different when we are working with kids with those mental health challenges because they can come in such a different state. Week to week. I mean, not that that's not true for our kids with autism or a physical disability, but you can't read it sometimes as well. Sometimes they're really good at hiding it and they come in and they're like, hi. I'm like, I'm really happy to see you today. like, what are we doing? And then you're like, 10 minutes in and they're, they're sobbing. And you're like, where did that come from? And then I'll talk to the parent after. I'll be like, oh, like. So how is, and then they all of a sudden they're like, oh yeah, well they had a blow up with their teacher and like, text me next time.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 26:09

Yes. I've actually had that experience too where I have a kid in the session we're getting. Into our usual routine and most of the time my parents are present, but sometimes they're not depending on the situation. It's sort of a case by case,

Track 1 26:23

Mm-hmm.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 26:24

judgment call. But this particular child was a lot more talkative with his father present. And what was so amazing was he could sort of be the catalyst for, for conversation in terms of recapping, okay, I haven't seen you for a week. What happened? How was your week? And I'd go and ask the little boy and he'd be like, I, I don't know. So when I had the, sort of, it kind of pictured it like a triangle. It was me, the child and the father. But we were able to sort of work the corners of that triangle to facilitate a conversa, a therapeutic conversa conversation and recall what had happened. And if I hadn't had that father's, involvement, we, I would've never known that there was that blowup at school. Or he got sent home two days last week. And so even just Having that little bit of information from a caregiver before a session is ideal and huge. And I usually ask that of my families. I'll tell them, please let me know ahead of time. Or when we check in, you can give me a quick overview. It's not a, detailed by detail breakdown because we don't need to relive it and rehash it, but it is helpful to know how do I wanna frame my session so that I can touch on some of these pieces and make it feel like a safe experience for the child.

Track 1 27:38

Yeah, I think you brought up, or it, it, that spurred an interesting thought in my mind. So when we're incorporating horses, we almost always have a team. I. we have a horse handler. We might have a therapy aid or a sidewalker with us, and that's very different than any other mental health setting. There is no other really mental health setting where you have relatively untrained eyes and ears hanging out in your like session.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 28:08

Sure.

Track 1 28:09

And how have you. Handled that. Have you found any special tips or tricks for helping your therapy team to understand be what's, like, what's going on without disclosing more than they need to know?

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 28:31

Yeah, that's a great question. So, I generally don't go into detail with my horse team because they, they just don't have, the right to know some of that detail. But that being said they also kind of understand that and to a degree have already worked with a variety of people. I think that one of, there's two really important pieces with the horse team that I think are really important that Continuity. So having multiple experiences together as a team. So you figure out how to communicate so that you understand how for, sessions will run together, but then you learn how to communicate in a way where it's therapeutic and maybe not as direct, so that the child is really seeing that wink or that shaky, subtle shaking of the head or that sign to go. So I think, I think continuity is super important and I think that. When we are on the same page, just in terms of communication, that's where it's like your role of horse leading right now in turning that horse's head when my, when they're in enough of that session to know and I'm saying, look, Jake is looking. You dropped your shoe. It's enough of that cue where Yep, the horse is looking, you know, we're just bent to the side a little bit. So I think that that's, that's one, one piece of it is that just having kind of a system and a predictability in your sessions to a degree in terms of how you operate and run a session. Having worked in different barns, I've seen it done differently, very differently across people. So I think that's Really important in terms of, I think, how much do you say versus not say? I try not to say too much to create a bias. I really try to keep my horse team, my horse leader, my sidewalk, very task oriented. I. So if I'm going to need full support for Trott down the long side, on the next lap we're, we're talking about it. We're we, we know what we're doing, we're ready to roll and function and do what we need to do for that child. So I think that that's really important in the horse team. I think what I also rely a lot on though, in, in those situations where you kind of had alluded to when the, the child is. Maybe not talking as much or starts talking a lot I think what's super important is looking at how my horse is reacting in that moment. So the more I know a horse, the more predictable I can be in terms of making an inference about, okay, if this child, like for example, I had a horse that would always stop when a child was starting to lose their balance. And that was just something that he always did, and that was the quirk for this horse. But it made him great because if I didn't catch it, which, you know, that's what we have our eye for, it happens. Um, but it could be the most subtle thing. But I know that horse is stopping for something that I can't see in that moment. So I need to look really closely. Right. My horses are telling me too, so my horse is part of that team. So I think kind of knowing the quirks of your horses too is Is, um, is really important.

Track 1 31:43

I find some of our team members are very intuitive in understanding that I'm guiding a conversation in a particular direction. I. And, they play along. I don't, I don't have to be explicit. And so many of our kids are so tuned in, you know, like you were saying about those discussions beforehand, most of my caregivers parents, they don't want to have that discussion in front of other kids because the kid is picking up on everything. And so we have those over the phone, over text, through our parent portal communication system. But with my therapy team and trying to decide like how much do I need to let them in on the type of conversation or where I'm going and like I said, some are very intuitive and they see where I'm going or what types of examples I'm giving. And then other ones I'm like, were you listening at all? Like

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 32:42

Sometimes what I'll do too,'cause I think a lot of times, like my horse teams have generally known, okay, I have this child coming in they have a history of this, so in an emergency we need to be prepared for this type of situation. Right. And I think this really comes from experience just doing this, you know, over and over again. So I really think that there is, like you said, that the forecasting of like, how do I brief my team to make sure at least. We're ready to perform in a way that's gonna be effective. But I feel like even, um, you know, in thinking about years past with other horse teams, like I will sometimes ask. So, and I think, well, people might know that about me, so if I'm not kind of directing and asking for really specific things to happen as they're, as we're going along, I might be in a conversation with a child, but I'll say, Susie, can you tell me a time that you felt really scared when you were at school? And then I pull them into the conversation. So it's almost like a cue. I think my horse team kind of looks for my cues to say, okay, I can step in.

Track 1 33:40

Well, and that's when I hope that they give me. An answer that aligns with what we were talking about, and they don't gimme something that's like wildly inappropriate. And I'm like, W what were you thinking?

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 33:55

Yeah.

Track 1 33:56

you listening? Do you know this kid is nine years old? This was, so then we have that debrief afterwards, which I think when we look at some of the more mental health models where we're incorporating horses, that debrief piece is really important and certainly we can see it in other sessions where we're incorporating the horses, where we kinda have to say and say, yeah, we did have an a little incident there where maybe your handling wasn't as good or, we were getting ready and that kid was starting to escalate and I just wanted to, to have a quiet lap around and you were continuing to talk. And so that was too much sensory feedback. And I feel like those scenarios are pretty straightforward, but with our clients with mental health issues where I'm not disclosing As much information about what their challenges are, the volunteer team, the therapy team, they're seeing, pretty much an able-bodied kid. They may not exactly understand why they're getting OT services. And that's, again, it's a need to know sort of situation. But then afterwards, Stopping and saying like, that wasn't appropriate to share. Like, we don't really need to know your scary movie that you like heard over the weekend or saw over the week. Like that, that what did you do over the weekend that, was enjoyable. A horror movie is not what I wanna that was not appropriate. Not appropriate. I, I think we. Maybe see that a little more with this population than we would see in some of our other settings where people sort of clearly know, oh, this child has special needs and I'm going to change, the way I interact. As opposed to what I found with, with some of the therapy teams here they see one thing and so they react in a less filtered way shall we see a say. And I think really having those support protocols in place for our therapy teams as they come in and to understand that they are working in a different setting. And when I think back to my equine specialist and mental health training, being that equine specialist in mental health, you were there. As the equine advocate and monitoring kind of what's going on with that whole situation. And it's almost bringing a little bit of that level of awareness into our sessions with our team members when we have clients that have a more mental health based diagnosis that our volunteers just may not be perceptive enough, I think, to pick up on. In the same way that they do for a child with autism, where although there may not be a physical thing that they can see, they can tell that this child is is different, as opposed to a kid with depression. I.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 36:55

Yeah. I think that is just a, a huge and important complexity about mental health is that you can't see it. and you don't know how severe it is for someone. And I think you know, there's, there's certainly, like we've kind of alluded to, I feel like, an importance to have that kind of preemptive education and planning, even if it's five minutes before that child gets on the horse and you're just touching base with your team. Or like we talked about modeling.Through yourself. I can remember when I felt scared when I did X, Y, and Z. Giving really structured examples and then volleying it to one of your team, hoping that they share something that's, relevant and Appropriate, but. knowing full well that you can stop that conversation if you need to, and you can just reengage in an activity. I mean, there's definitely those situations that sort of do happen. And it is unique. I think you raise a really good point in that, you know, there's multiple people in that situation and so how do you kind of handle that and that confidentiality piece. And it is, it is even though it's amazing in that kids can open up to it, it is a really unique circumstance. And I find too in practice, one of the other things that I tend to see a lot too is sometimes an attempt to have a casual conversation around the child.

Track 1 38:13

Mm-hmm.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 38:14

so you're doing the session, but you might get off on a tangent when you're talking about the weather outside So he'll gonna be talking about something that has nothing to do with the child, but the child is sitting there and, and they're still receiving that service. But I think conversations, stations in a session are hugely important and really, I think a very overlooked aspect of Of care. I think within the whole context of hippotherapy kind, assisted therapies,

Track 1 38:46

Yeah, I think.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 38:47

it's natural for us to wanna be social, You know?

Track 1 38:49

Yeah. And we're, we are relying on the horse for part of that social piece. And then we have the team aspect and so there's, I think as the therapist who's leading that, that session, we have a lot more to manage. I. then we do, if we're in a clinic or even in our nature-based sessions where it's pretty much one-on-one, although the parent is usually nearby. And, and like you said, that can be a real advantage because we can check in with mom or dad who's there and, and confirm Sometimes if the child is telling us a story, we kind of look at mom and dad and mom and dad gives that nod like, yes, that's an accurate story, or they might add in a little bit more details. And our nature-based sessions tend to be very private. even when they're in a public park or something like that. It's a very, we have our own kind of bubble, whereas we're at the stable and just the necessity of the safety aspect of having the horse handler there adds, one more component in and I've made some requests and changes depending on clients. If I have a young girl who we might be dealing with menstruation and sexuality, I don't want the, 65 year old man who's an excellent horse handler to be the horse handler for that particular session. I might switch him out, you know, and bring in a teenager, maybe even who Is going to be more of a peer and give some more peer-based feedback to that client who is dealing with like, oh, I have my period today. I don't, I don't like, I don't really feel like participating, but I'm here. So I'm always thinking okay, now that we have, multiple dynamics and my clientele is very tuned into the whole therapeutic setting, I need to tailor that based on, what I have available to me. in each setting. And I think that's something that's under, under-discussed when we're thinking about this population in particular. I think it has a much bigger impact on our clients. And I think we've talked about definitely some of the benefits that we would expect to see. When we're incorporating horses into mental health, some of the different approaches that we would take, some of the challenges, certainly. How did you, how did you get here? What's your horse background? Give us kind of a recap. We, we know where we're at, but how did you get here?

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 41:14

Yeah, so. I back when I was in kindergarten, I, one of my best friends rode a horse. She actually had a, a disability as well, but I, we were the best of friends and I wanted to be just like her. I wanted to ride a horse and, you know, I just knew that that's something I was in my blood really young. I actually grew up in a, a very blue collar family, so, it was something that I couldn't really afford to do as a leisure kind of adventure. But it was something that I was told that I could always do when I got older someday. So, when I fast forward to college, when I was looking at filling some general education requirements for my degree U n H, the University of New Hampshire had a program where you could learn as a beginner horsemanship classes. And I thought to myself, no way, There's no way I'm gonna learn to ride a horse here. This has gotta be, now I'm gonna read that description again, And that was, that was a point where I, so I registered for that class and my life changed forever. And so that's really my horse experience started in college. And so I rode On the equestrian team for U N H I worked a work study at the barn for several years volunteered with a therapeutic riding program and also did another work study where I would take in autistic client to her riding lessons and got to assist in some of those. And so once all of these pieces started fitting together and I realized I could combine OT with all of these things, I thought to myself, Wow, This is definitely for me in some capacity of whatever I do with my career. And I've been riding ever since. Hunter Jumper Eastern balance seat riding, and got to learn from some phenomenal faculty. Uh, Christina. K I don't know if you have heard of her. She is, Okay. Yeah. she is phenomenal. She is a an author. She has submitted publications through different books and equine journals and magazines. And she taught me a lot and I feel so honored to have learned from her in the time that I had her. So, um, she was phenomenal. And, uh, Cindy Burke, she was the therapeutic riding Program director at the university for several years, and I got to learn from her as well. So some really amazing U n H faculty kind of, uh, also kind of helped to foster and facilitate that interest in knowing that, okay, yeah, there's, there's bigger things here, you know, that we can do with, with this kind of work. So,

Track 1 43:52

Well, that is definitely an exciting kind of pathway of having that very early interest and. I think for so many of our kids who ride, who do have special needs to hear that maybe somebody looked up to them or is looking up to them right now, and wants to be just like them because it may not be an experience they have as often as maybe some other kids. So I think that's an exciting thing for parents to hear and. For our equine programs out there. That's my undergraduate degree is in equine studies. And, you know, it was, it was a, a fabulous experience. And the fact that my parents said, when I said, they said to me like, you know, what do you wanna go to college for? And I said, horses, I. they didn't say, oh, choose something that you can make a career out of. They said, okay, like if, if you think that that's what you wanna do, we support you completely. And so that was a very instruction based curriculum from with eventing as the basis. And it was, a phenomenal experience. And I got to do some of my initial Path certification through there. I trained a horse for the world Special Olympics. So, some of that foundation and our equine programs out there do have a really important role to play, I think, in introducing people to horses and to also the professional opportunities that are out there because, We often think that, horse people come from childhood and that's the only way to get there. But you know, there are many wonderful clinic clinicians that come to horses later in life, whether that's college or or beyond. And for all those people out there that are like, I love horses and I think this is something that I want to do, like. It's not too late. It's nice to, it's nice to think it's not too late. You can learn, you can learn the basics of horsemanship. There are many ways, many pathways to get there. Um, as we get ready to wrap up, what's one thing that you could use more of in your professional life right now? I,

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 45:56

So I would say, I think as I'm closing in on my dissertation with Boston University and, and looking at. How can equine assisted occupational therapy really impact children and their mental health? I think that, you probably wouldn't be surprised to hear that, you know, using some kind of help from money sponsorship to develop these programs as well as fund research opportunities. I've learned recently there's a lot of limitations with grants. There's a lot of criteria to meet. So yeah, I think that there are a lot of opportunities to really help, uh, continue to support the very increased, steadily increasing need in pediatric mental health right now. And then to be able to use horses. So I would say that would be more, more that along lines.

Track 1 46:44

Yeah. Yeah. Funding is important and I think funding also implies two things. It's, it's the financial. piece, but it's also support. It's the, the feeling that you are supported in what you're doing and the path that you're taking and the information that that's going to lead to. So when should we be looking for your finished dissertation? How much longer do you have to go?

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 47:11

So, yeah, I'll be wrapping up this December, and I'll actually also be presenting at the American Occupational Therapy Association Conference in Orlando this coming spring.

Track 1 47:21

So we might meet in person then.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 47:24

Okay, great. That sounds awesome. I would love that. Um, yeah, I, I really I've done a lot of research on the theoretical components and kind of higher level thinking around this idea. And so I really wanna share what you know, is obviously trending for pediatric mental health, but also really pushing to advocate occupational therapy in, in this role.

Track 1 47:47

Yeah.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 47:48

So I am really excited to share what I've learned and yeah, I hope we can keep in touch and connect.

Track 1 47:54

Absolutely. Is there any questions that you wanted to ask me that we haven't covered?

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 48:00

Oh, geez. I feel like I'll think of some after I um, process all of this. It's been an amazing conversation. I can't think of any at the moment, but. I hope we can keep the conversation going and I continue to learn from your work and all that you're doing too.'cause it's, it's amazing, it's so needed and, um, you have just such a wealth of knowledge to contribute. So thank you so much for the opportunity.

Track 1 48:24

All right. Awesome. It was wonderful talking with you.

natalie-saccoccia--ms--otr-l_1_09-27-2023_195400 48:29

Yeah, you.