20 | mup 1|2010|20 - 25|© Ernst Reinhardt Verlag München Basel, DOI 10.2378 / mup2010.art03e Marianne Gäng, Rita Hölscher-Regener, Christian Robier Already in MuP issue 3 / 2009 our series on financing horse-assisted therapy has started off with the topic of “Hippotherapy”. Now we are going to turn to the next big issue in the area of special education and therapy with horses: horse-assisted therapeutic pedagogical special education, also known as therapeutic pedagogical vaulting and riding. Under the generic term “horse-assisted therapeutic pedagogical special education” one can find many different types of horse-assisted pedagogical work varying significantly in terms of target groups and goals, whereas some have things in common with other areas of education and therapy such as hippotherapy or the deployment of horses in psychotherapy. Horse-assisted therapeutic pedagogical special education takes place for clients of many age-groups, so the authors make distinctions between three big age-groups in terms of providing an overview of financing possibilities: pre-school aged children, school children and teenagers and adults. The large area of horse-assisted therapeutic pedagogical special education at (special) schools has been knowingly omitted. This topic is scheduled to be taken a closer look at in another issue dealing with financing. Generally speaking, we can say that also in the area of horse-assisted therapeutic pedagogical special education laws and thus financing models and possibilities vary to a great extent in Germany, Austria and Switzerland. In many areas the pedagogues in charge are the ones to give advice to clients, institutions or parents in terms of financing possibilities in order to find suitable solutions. The following table contains information on the financing situation of horse-assisted therapeutic pedagogical special education in Germany, Austria and Switzerland. Based on central questions pedagogues trained by three big associations in their respective countries (Switzerland: Schweizer Gruppe Therapeutisches Reiten - SG- TR, Austria: Österreichisches Kuratorium für Therapeutisches Reiten - ÖKTR and Germany: Deutsches Kuratorium für Therapeutisches Reiten - DKThR) talk about the financing situation in their countries. The table does not claim to be complete and is only able to give information about the status-quo at the beginning of 2010, of course. It is thus required to check the information provided here for possible changes. In case we haven‘t listed all possible financing options for horse-assisted therapeutic pedagogical special education we would like to ask our readers to contribute by sending in letters to the editor to create a broad information pool. R.H. Forum Financing horse-assisted therapy Part 2: Financing horse-assisted special education in Germany, Austria and Switzerland Gäng, Hölscher-Regener, Robier - Financing horse-assisted therapy mup 1|2010 | 21 Marianne Gäng, Rita Hölscher-Regener, Christian Robier Financing therapeutic pedagogical special education Question Germany - Rita Hölscher-Regener, Riding and Vaulting Pedagogue, DKThR Switzerland - Marianne Gäng, Graduate Social Pedagogue, Training Manager, SG-TR Austria - Mag. Christian Robier Vaulting Therapist, ÖKTR Which form of horse-assisted therapeutic pedagogical special education is offered by pedagogues trained by your association? How is it defined? Horse-assisted therapeutic pedagogical special education takes place in various settings (vaulting, riding, lead types, floor work etc.). The term “Horse-assisted therapeutic pedagogical special education“ summarises pedagogical, psychological, psychotherapeutic, rehabilitation and social-integrative horse-assisted courses for children, teenagers and young adults with different handicaps or disorders. The main thing here is not the equestrian training, but the individual education in communication skills and social competence via the medium horse, i.e. mainly the positive impact on motor skills, perception, learning, well-being and behaviour (also see: www.dkthr.de). The Swiss Therapeutic Riding group defines horse-assisted therapeutic special education as an individual attendance and special education in a close relationship with the horse and as shaping the encounter between the client and the horse. With the help of an evolving human-horse relationship a relationship to oneself and others is supposed to be found and shaped (also see: www. sg-tr.ch and the books “Heilpädagogisches Reiten und Voltigieren“ and “Ausbildung und Praxisfelder im Heilpädagogischen Reiten und Voltigieren“, published by Marianne Gäng). The HPVR section (therapeutic pedagogical riding and vaulting) of the Austrian “Kuratorium für Therapeutisches Reiten“ defines horse-assisted therapeutic pedagogical special education as follows: The term “Horse-assisted therapeutic pedagogical special education“ summarises pedagogical, psychological, psychotherapeutic, rehabilitation and social-integrative horse-assisted courses for children, teenagers and young adults with different handicaps or disorders. The main thing here is not the equestrian training, but the individual education in communication skills and social competence via the medium horse, i.e. mainly the positive impact on motor skills, perception, learning, well-being and behaviour. When dealing with a horse and during vaulting / riding the human is trained in a holistic way: physically, emotionally, mentally and socially (see: www.oktr.at). Is this type of special education officially approved in your country? If so, by which institution? There is no official approval, but local benefactors take over the costs with out-patient providers within the scope of an official order; basic contracts are made with these providers, the costs are checked individually on a case-by-case basis. Yes, this kind of special education is approved by individual health insurance companies (e. g. Helsana, Sanitas). ASCA (foundation for acknowledging and developing alternative and complementary medicine) approves horse-assisted therapeutic pedagogical special education without any restrictions, when it is supervised by graduate riding pedagogues and riding therapists SG-TR. EMR (Experience Medical Register) approves horse-assisted therapeutic pedagogical special education, supervised by graduate riding pedagogues and riding therapists SG-TR. EMR is a department of the Eskamed AG (www. eskamed.ch) and is an independent pan-Swiss institution awarding a quality label for trainings and further education of therapists dealing with complementary and alternative medicine and keeping lists of therapists. But since 2008 riding pedagogues are only listed when they have gone through extra medical courses apart from other qualifications. In the whole of Austria there is no official approval of horse-assisted therapeutic pedagogical special education, but there are various agreements allowing for financing possibilities. Here, the only relevant agreements are made with the respective federal state governments (federal state law). Health insurances generally don‘t pay, the only exception being the insurances of civil servants and additional mother-child insurances, but even then only parts of the total sum. 22 | mup 1|2010 Gäng, Hölscher-Regener, Robier - Financing horse-assisted therapy Question Germany - Rita Hölscher-Regener, Riding and Vaulting Pedagogue, DKThR Switzerland - Marianne Gäng, Graduate Social Pedagogue, Training Manager, SG-TR Austria - Mag. Christian Robier Vaulting Therapist, ÖKTR Is horse-assisted therapeutic pedagogical special education approved in general or are there any special conditions to be considered (e. g. requirements for the type of training the pedagogues have to go through, certain target groups / types of disorders…)? Due to the large number of “horse-assisted therapeutic“ courses and providers selecting and assessing facilities is often too much for local authorities. It would be certainly helpful if the various further education courses had similar standards in terms of pedagogical education, coaching licences etc. . Quality labels are certainly important assessment criteria as well. The lawful financing possibilities refer to various types of disorders, so a distinction is made between youth and social assistance services. Measures are generally approved. This applies to all types of disorders and target groups. The pre-condition for health insurances paying for horse-assisted therapeutic pedagogical special education courses is that the riding pedagogue / riding therapist in charge is enlisted with the ASCA, the EMR or directly with the respective health insurance company. However, since 2008 the EMR wants to make sure that riding pedagogues have gone through an additional medical course apart from their SG-TR diploma (Swiss Therapeutic Riding group) and also want proof of practical experience. Riding therapists are approved without the additional medical course. Diplomas from abroad are generally not accepted. The clients don‘t need a medical prescription or the like in order to be allowed to make use of horse-assisted therapeutic pedagogical special education courses. The approved riding pedagogue / riding therapist makes out an invoice for the client who in turn forwards that invoice to his or her health insurance company. The refund percentage depends on the respective health insurance company and the client‘s insurance conditions (e. g. on whether the client has an additional insurance covering alternative medicine or not). Currently the basic profession of our colleagues is not bound to any pre-condition or additional trainings, however, there are conditions regarding the clientel. There are federal states which support horse-assisted therapeutic pedagogical special education for handicapped people, other federal states rather tend to support measures for children and teenagers under the supervision of approved youth assistance centres. What are the consequences arising from approval / nonapproval? A facility approved by a local benefactor within the scope of a basic contract certainly has much more “planning reliability“ and will be able to provide a high-quality horse-assisted education since also things that are affecting the participant directly will be financed (e. g. anamnesis and consulting talks with the psychological parent). In case the measure is not officially approved sponsoring will certainly make sense. For projects with a special clientel, but also for individual clients, financing through charity organisations (Lions Club, Rotarier, foundations etc.) can be made possible. Since 2008 the SG-TR diploma for riding pedagogues is not accepted anymore by the EMR. All riding pedagogues who have made their diploma before 2008 are still approved! The SG-TR council is currently negotiating with the EMR to get rid of this imbalance regarding the approval of riding pedagogues and riding therapists. Currently there is no standardised and nationwide financing model for horse-assisted therapeutic pedagogical special education. However, the following benefactors / financing possibilities may come into consideration for individual federal states: Financing via the Youth Welfare Act (JWG) Financing via the Disabled Persons Act (BHG) Donations / Foundations / Sponsors etc. Private financing The latter should be particularly considered when there are no other options in the respective federal state. Gäng, Hölscher-Regener, Robier - Financing horse-assisted therapy mup 1|2010 | 23 Question Germany - Rita Hölscher-Regener, Riding and Vaulting Pedagogue, DKThR Switzerland - Marianne Gäng, Graduate Social Pedagogue, Training Manager, SG-TR Austria - Mag. Christian Robier Vaulting Therapist, ÖKTR Apart from that there is still always financing on a private basis to be considered, even though many parents only have limited financial leeway. In case of combined costing, however, parents with low income may be able to take advantage of such measures. What are the general financing models for the pre-school area / area of early horse-assisted education? Are there any special steps required? Are there any specific regulations / special regulations? If so, what are these? Via §§ 30 and 56 SGB IX (Social Security Code) within the scope of early recognition and early education handicapped children or children threatened to become handicapped have access to therapeutic pedagogical complex benefits. The important thing here is the cooperation between a facility providing horse-assisted therapeutic pedagogical special education and an interdisciplinary early education facility, especially when a child receives multiple benefits from social assistance authorities. Applicant is always the child or its parents, respectively. Usually, the local health authorities investigate. Expert opinions by other facilities (e. g. paediatricians, kindergartens), a letter of rejection from the respective health insurance company are required for processing. Financing via individual health insurance companies (when the EMR has given approval of an expert) private financing via the parents Financing via donations, foundations, service clubs (Rotary a. o.) There are no specific regulations. When a federal state finances via the JWG (Youth Welfare Act) or the BHG (Disabled Persons Act), this is also possible in the pre-school area. Carinthia has a special financing within the scope of special kindergartens. There are facilities in many federal states which can give expert opinions. In Tyrol, for instance, this would be the university hospital, in Styria this used to be the social assistance office until May 2009, since then financing via the BHG is not possible anymore. What are the general financing models for school children and teenagers? Are there any special steps required? Are there any specific regulations / special regulations? If so, what are these? Via § 27 SGB VIII in combination with § 35a KJHG (Children and Teenager Assistance Act) parents can apply for “education support“ when there is a high probability that their child‘s mental health does not comply with the typical condition for the age in question for more than six months. This support can be given in an out-patient form, e. g. via the HFP. Usually the local child guidance centres (EB) decide on which form of support is required and would make sense. A recommendation given by the EB to the local youth assistance benefactor may result in the costs being met. Also mentally retarted children have access to horse-assisted therapeutic pedagogical special education as therapeutic pedagogical measures via §§ 39, 40 BSHG (Federal Social Security Act), especially when the special education school emphasises this measure to be taken in order for the child to attend school (in the sense of an appropriate school education) . Financing via individual health insurance companies (when the EMR has given approval of an expert) private financing via the parents Financing via donations, foundations, service clubs (Rotary a. o.) Partially, horse-assisted therapeutic pedagogical special education is carried through at special homes or on behalf of special homes. Here, there is a wide choice of financing models which are mainly based on donations. The Burgenland pays via the youth welfare, Lower Austria via the Disabled Persons Act, Upper Austria via the Disabled Persons Act, Tyrol via the Disabled Persons Act, Styria is currently negotiating since financing has been cancelled since May 2009. 24 | mup 1|2010 Gäng, Hölscher-Regener, Robier - Financing horse-assisted therapy Question Germany - Rita Hölscher-Regener, Riding and Vaulting Pedagogue, DKThR Switzerland - Marianne Gäng, Graduate Social Pedagogue, Training Manager, SG-TR Austria - Mag. Christian Robier Vaulting Therapist, ÖKTR Financing children living in public facilities an additional financing of horse-assisted therapeutic pedagogical special education by public authorities is hard to accomplish since one assumes the children to be “perfectly“ taken care of, yet sometimes services are charged via the hospital per diem charge or the hourly rates of specialists. Foster children may get access to a financing as an “additional aid for support“ in compliance with § 33 SGB VIII (full-time care). In general, there are more and more institutions that provide horse-assisted therapeutic pedagogical special education with their own horses and facilities and have fully integrated this concept and thus the financing in their overall concept. What are the general financing models for adults? Are there any special steps required? Are there any specific regulations / special regulations? If so, what are these? § 13 KJHG (Youth Social Work) lays down that young people (which means adults up to 27 years), who are depending on support to a greater extent to keep social disadvantages at bay or to overcome individual shortcomings, shall be offered social pedagogical support (e.g. in the form of horse-assisted therapeutic pedagogical special education). However, there is no legal claim to this, this is just a “can be“. Generally speaking, any social assistance authority can grant persons (without any age restrictions), who are physically, emotionally or mentally handicapped not only on a temporarily basis, rehabilitation support via §§ 39, 40 BSHG. The goal is to “participate in community life“. Visitors of workshops are entitled to receive so-called “accompanying offers“ horse-assisted therapeutic pedagogical special education can be part of. Sometimes the latter is financed via the “pocket money fund“ which may also apply to people living in residential homes. Financing via individual health insurance companies (if an expert is accepted by the EMR) private financing Financing via donations, foundations, service clubs (Rotary a. o.) Financing via the general budget of residential homes and workshops for mentally retarted people if horse-assisted therapeutic pedagogical special education has been integrated in the list of accepted therapies. For adults financing is currently only possible via the Disabled Persons Act in Lower Austria. Until May 2009 financing used to be possible via the BHG in Styria. Gäng, Hölscher-Regener, Robier - Financing horse-assisted therapy mup 1|2010 | 25 Question Germany - Rita Hölscher-Regener, Riding and Vaulting Pedagogue, DKThR Switzerland - Marianne Gäng, Graduate Social Pedagogue, Training Manager, SG-TR Austria - Mag. Christian Robier Vaulting Therapist, ÖKTR Are there currently any attempts to change the financing situation of horse-assisted therapeutic pedagogical special education? In times of very limited financial ressources of public benefactors every provider of horseassisted therapeutic pedagogical special education is right now probably only interested in keeping the status quo. The SG-TR concil is currently negotiating with the EMR to make an arrangement concerning approval. The ÖKTR is attempting to get an approval by the Ministry of Health in order to be able to negotiate with the federal states (the application was handed in in 2006 but has not been processed yet by the Ministry). In Styria the ÖKTR is currently attempting along with a parents‘ initiative to be allowed to negotiate with the state to get a new possibility for getting costs reimbursed. Which attempts would be of particular importance according to your point of view? Covering the range of horse-assisted therapeutic pedagogical special education within the scope of prevention, e.g. for obese children. Here, coopereations and support given by health insurance companies could be made possible. Of particular importance would be agreements with health insurance companies under the aspect of preventing and accompanying measures in the mental and physical area. Further notes: Horse-assisted therapeutic pedagogical special education is often offered at (special) schools. For many years now the Ministry of Education recommends horse-assisted therapeutic pedagogical special education by decree as a subject taught at special schools! Rita Hölscher-Regener Social pedagogue, riding and vaulting pedagogue DKThR, freelancer since 1993 with her own surgery for therapeutic riding, workshop supervisor and horseassisted therapeutic pedagogical special education work group supervisor with the DKThR Address: Rita Hölscher-Regener · Leierweg 24 D-44137 Dortmund, Germany e-mail: hoelscher-regener@web.de Marianne Gäng Social pedagogue, riding pedagogue SG-TR, founder and training supervisor SG-TR, publisher and co-author of many books on therapeutic riding Address: Marianne Gäng · Hofackerstraße 6 CH-4118 Rodersdorf, Switzerland e-mail: hpg@intergga.ch Mag. Christian Robier Clinical psychologist and health psychologist, vaulting therapist ÖKTR, president of the ÖKTRs, freelancer with his own surgery for therapeutic riding Address: Mag. Christian Robier · Gossendorf 52 A-8330 Feldbach, Austria e-mail: robierc@gmx.at The authors