When including horses and nature in human healthcare, questions frequently arise about scope of practice.

Scope of practice laws define the procedures, processes, and actions a licensed healthcare provider may perform. Scope of practice also explains the limits or extent to which a licensed healthcare provider is allowed to practice. 

In the United States, each state has specific stipulations related to scope of practice, and licensed healthcare professionals are responsible for remaining firmly within their legal boundaries, regardless of whether or not they include horses. If they act outside of their scope, they face legal action and could lose their license.

Bringing a patient to the farm and adding horse, animal, or nature activities to a counseling practice or a physical, occupational, or speech therapy therapy session is considered outside of the traditional scope of practice of most licensed healthcare professionals. This type of unique treatment is typically classified as a speciality area of practice or an emerging treatment technique, tool, or method. To provide any emerging treatment without prior education, training, and supervision is considered acting outside of one’s scope of practice and therefore unethical according the the following professional membership associations:

American Psychological Association Ethical Principles of Psychologists and Code of Conduct 2.01 Boundaries of Competence:

(a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.

(e) In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm.

American Counseling Association Code of Ethics C.2.b. New Specialty Areas of Practice:

Counselors practice in specialty areas new to them only after appropriate education, training, and supervised experience. While developing skills in new specialty areas, counselors take steps to ensure the competence of their work and protect others from possible harm.

American Occupational Therapy Association Code of Ethics, Beneficence: 

Principle 1: Occupational therapy personnel shall demonstrate a concern for the well-being and safety of all recipients of their services.

  1.  Provide occupational therapy services, including education and training, that are within each scope of practitioner’s level of competence and scope of practice.
  2.  Take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgement, and weigh potential harm when generally recognized standards do not exist in emerging technology or areas of practice.

American Speech-Language-Hearing Association Code of Ethics

Principles of Ethics II: Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.

  1. Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.

TO CLARIFY,  scope of practice is typically determined by the educational content provided during a professional’s graduate level course of study, and any different approach, treatment specialization, or treatment tool that falls outside of that course of study requires additional training, education, and supervision. Animal-assisted therapy, equine-assisted therapy, and nature-based therapies generally fall outside of the traditional scope of practice for most mental health professionals, occupational therapists, speech therapists, and physical therapists because content related to including animals and nature in clinical practice is not commonly provided by the educational institutes granting advanced degrees.

Therefore, if licensed professionals wish to offer any of these therapies, they are responsible for obtaining ADDITIONAL training, education, supervision, and experience to a level that would constitute competency.

For Non-Licensed Folks

Non-licensed providers of animal-assisted, equine-assisted, or nature-based activities do not have a scope of practice as their services are not regulated by law. Instead, these providers offer important services that are uniquely different than those offered by licensed healthcare professionals.

In the United States, it is actually illegal for non-licensed individuals to use protected terms and titles proprietary to licensed healthcare professionals, to offer services provided by a licensed healthcare professional, or to duplicate services using a different non-protected title (Glosoff, et. al., 1995; AOTA, 2007; APTA, 2016; Human Services Guide, 2016). These are serious offenses that can lead to legal action.

Understanding scope of practice, and taking the steps necessary to remain within one’s scope of practice, or to stay outside of the scope of practice of licensed healthcare professionals is an important step in legitimizing the inclusion of animals and nature in healthcare.

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