**6. Results**

#### **6.1 Acceptability**

The charity beneficiaries are now 600 individuals every year, out of those around 160 undertake the Restart intervention which is evaluated here, the rest benefit from lighter touch support over a longer period, volunteer activities to support the course and/or accredited training through a local college. Over the period of data collection for this study (2016–2018/19) 326 had completed the intervention with an evaluation tool (before they start the program and then two months after they finished the program) completed by their referrer. Completion rates for those who start the Restart intervention are 95%. Referrals are increasing year on year with referrers from multiple agencies as outlined sending those people for whom talk based interventions are not working. Referrers report that between 10 and 15% of their clients do not respond well to talk based interventions. During the COVID – 19 pandemic numbers did drop however the charity stayed open to support individuals with acute mental health and behavioural issues. The charity has been running for ten years and has consistently grown throughout this period.

#### **6.2 Demand**

Since the establishment of this intervention different agencies are becoming aware of it and now the demand is outstripping supply with overall more than 1000 people having completed the course and over 160 per year now being referred just for the Restart intervention.

#### **6.3 Implementation**

The intervention which we are focusing on in this paper forms the majority of the activity undertaken by this charity. The lighter touch work with a wider group has now also picked up momentum and is benefitting more individuals, with less acute needs. This variety of offer from the charity has been developed in response to need with many individuals experiencing poor mental health and cuts in mental health services on the NHS in the UK causing wide spread need and little support in many areas.

#### **6.4 Practicality**

The main resource issues are the highly trained instructors in natural horsemanship (individuals with typically 10+ years of training). In addition, these individuals need further development to facilitate this intervention from the charity. A physical site for the intervention is needed, and having a yard and an indoor school with a special soft surface is required in order for the charity to function all year round plus ancillary buildings for administration rest rooms etc. In addition, the site for the charity needs to be both accessible to local people in the areas from which the referrals mainly originate which is primarily areas of deprivation and able to house horses in a natural environment which needs safely fenced outdoor space for grazing and social interaction for them.

## **6.5 Adaptation**

According to the charity CEO the intervention has not substantially changed since the first month, however the relationships within the family of those who are referred and the resilience skills within the family as a whole (where appropriate) have been identified as very important by the participants, course facilitators and the referrers. Therefore, the charity is now undertaking work with troubled families, foster families and the teams around the family to try to positively impact on these processes. This is being done both through the Restart intervention and as part of the 'lighter touch' support offered which includes longer term support for those who need it after completing the intervention and educational opportunities with local colleges to develop social skills as well as volunteering opportunities. All these have been developed through local networking and identification of local need.

### **6.6 Integration**

This intervention is now recognised as a professional partner by Social Care, Community Mental Health Teams, Child and Adolescent Mental Health Services, Domestic Violence and Drug & Alcohol Services. It is now part of the landscape of care for schools, General Practitioners and social prescribing 'navigators'. Working across so many sectors however is demanding on the time of the charity staff and requires excellent networking and communication skills. It is interesting that all these agencies are seeing some individuals and families many times however as their 'offer' is primarily talk based there is a consistent group for whom their services are not working. Indeed, it would appear that individuals tend to get referred to this charity when they are stuck in 'treatment' being 'bounced' between services over and over again. They then do this intervention which is intended to positively influence their engagement with services, family, relationships and education.

#### **6.7 Expansion**

This charity has now replicated its programmes across eight sites in the UK. With two international sites also launched. Additional facilitators have been trained by the charity to aid replication, recruited primarily from those who already hold instructor status with Parelli Natural Horsemanship.

### **6.8 Limited-efficacy testing**

In this study before and after measures were completed by the person's referrer to the course 326 completed scales were included in the analysis (see **Figure 1**).

*The Embodied Nature of Horse Human Communication: A Feasibility Study of an Equine… DOI: http://dx.doi.org/10.5772/intechopen.98848*
