Atlas›Domain XV · Nature, philosophy, social & rites of passage›Guide 013
Guide XV-013

Care farming

A 32 · L 57 · M 1120 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: UK care farming as defined in Natural England Commissioned Reports NECR155 (2014) and NECR194 (2015) and the Care Farming UK Code of Practice now held by Social Farms & Gardens. The Dutch zorgboerderij (care farm) model and Norwegian Inn på tunet are noted as national variants where they differ.

Care farming, also called social farming, is "the therapeutic use of farming practices" [source: NHS Forest / Social Farms & Gardens]. Natural England's working definition is: "A care farm utilises the whole or part of a farm to provide health, social or educational care services" for one or more vulnerable groups. This is delivered through structured programmes of farming-related activity, not one-off visits [source: NECR155]. It is one form of "green care", the umbrella term for nature-based interventions. Others are social and therapeutic horticulture, animal-assisted interventions, green exercise, ecotherapy, facilitated environmental conservation and wilderness therapy [source: NECR155; NECR194].

Care farming is not a psychotherapy. It is a health, social-care, educational or welfare service run by farmers and their staff. On UK farms, specialist health or social-care knowledge is not required of every person delivering it [source: Farmers Weekly 2019]. The psychotherapist's usual roles are to assess fit, evaluate and refer to a farm, prepare and debrief the client, collaborate with the farm, and work in therapy with what the farm means to the client. Less often, a therapist who is trained and insured for it delivers sessions on a farm.

How change is thought to happen, as providers and participants describe it:

  • Meaningful work. Real tasks with plants and animals give directly visible results.
  • Structure. The farm gives shape to the day and the week.
  • Being treated as an ordinary person. Participants work as a worker or deelnemer (participant), not as a patient.
  • A small, safe group and shared meals.
  • Bonds with animals.
  • A calm, low-stimulus green setting.

[source: Hassink, WUR / Federatie Landbouw en Zorg factsheet]. Care farms in England report social, educational and health outcomes. The benefits they report include wellbeing, social inclusion, self-efficacy, reduced anxiety and depression symptoms, and life skills [source: NECR155]. Evidence status in one line: a Campbell systematic review "found no evidence that care farms improved people's quality of life" and "some evidence that they might improve depression and anxiety", and called for larger studies with validated measures [source: Murray et al. 2019, Campbell Systematic Reviews].

2. Framework

Care farming has no manualised phase model. The structure below combines the programme features published by Natural England with the therapist-side stages, which are [synthesis].

Programme format, as published for England [source: NECR155]:

  • Sessions. 82% of care farms run full-day sessions and 51% run half-days. A typical day runs about 10am to 3pm [source: Farmers Weekly 2019].
  • Attendance. Most clients (90%) attend one to three times a week.
  • Programme length. Programmes average about 30 weeks, and 98% last a year or less. Length is tailored to the individual.
  • Occasional care farms. These are farms or nature reserves that offer care farm services only some of the time. They mostly run half-days, and their programmes average about 12 weeks.
  • Client groups. Care farms serve people with learning difficulties, autism, mental ill-health or physical disabilities, young people at risk, older people and people with dementia. They also serve people with drug and alcohol problems, adult offenders and ex-service personnel. An average farm serves five groups.
  • Referral. Most referrals come from social services, community mental health teams and education services. Self-referral, family referral and GP referral also occur.
  • Funding. Places are funded by personal budgets, local authorities, education commissioners, charities and other sources [source: NECR155; NECR194; Farmers Weekly 2019].

National variants.

  • Norway. Inn på tunet is defined as "tilrettelagte og kvalitetssikrede velferdstjenester på gårdsbruk": adapted, quality-assured welfare services on farms that aim at coping (mestring), development and wellbeing. It covers education and childhood, work training (arbeidstrening), health and care (substance use, disability, mental health, dementia), integration, and criminal justice. Services are purchased by municipalities, the labour and welfare service NAV, or the child welfare agency Bufetat, and the purchaser holds responsibility toward the user [source: Nasjonal strategi for Inn på tunet 2012].
  • Netherlands. On a Dutch zorgboerderij, participants value a "real farm" and a "real farmer" (echte boer), who acts as a role model with natural authority [source: Hassink factsheet].

Therapist-side stages [synthesis]:

  1. Assessment and fit. Goal: decide whether farm-based activity fits the client's needs, goals and risks. Move on when the client is interested, has no unmanaged contraindication, and has agreed goals.
  2. Finding and evaluating a farm. Goal: identify a farm whose quality assurance, client mix, safety and access suit the client. Move on when the evaluation checklist (intervention 4) is satisfied and funding is agreed.
  3. Referral, consent and preparation. Goal: complete the referral, agree what information may be shared, and prepare the client for the first day. Move on when the client has had a taster or first visit.
  4. Participation with parallel therapy. Goal: sustain attendance and use the experiences in sessions. Agree a review interval with the farm and the referrer.
  5. Review. Goal: check progress against goals using validated measures. Continue, adapt, step down or end according to the goals and measures.
  6. Ending and transition. Goal: plan the next step, such as volunteering, work, education or another community setting. Plan this from the start, because most programmes are time-limited [source for time limits: NECR155].

3. Guiding principles

  • The farm is a real working farm, not a clinic. Do not ask the farm to act like a treatment ward. Help the client value ordinary work and ordinary relationships [source: Hassink factsheet; NECR155].
  • Participant, not patient. Use the farm's language (participant, volunteer, worker). Avoid clinical framing on site unless the client wants it [source: Hassink factsheet].
  • Meaningful work with visible results. In sessions, tie progress to concrete tasks done and things the client cares for [source: Hassink factsheet].
  • Own pace and choice. Agree that the client can work at their own tempo, rest on a bad day, and choose among activities [source: Hassink factsheet].
  • Structure is part of the intervention. Protect regular attendance and fixed daily routines, such as animal care, when planning the week [source: Hassink factsheet].
  • Small, safe groups. Check group size and client mix. Some groups need to be kept apart; for example, a person sensitive to noise should not be placed with a boisterous group [source: Farmers Weekly 2019].
  • Quality assurance before referral. Prefer farms that work to a published code or approval scheme:
    • the Care Farming UK / Social Farms & Gardens Code of Practice [source: NECR194; Farmers Weekly 2019];
    • CEVAS therapeutic accreditation [source: Farmers Weekly 2019];
    • Norway's KSL standard 11 with Matmerk approval [source: Nasjonal strategi 2012].
  • Safety is non-negotiable and qualitative. Every activity needs a risk assessment, safeguarding and hygiene controls. A farm visit can never be entirely risk-free [source: Farmers Weekly 2019; HSE].
  • Collaboration with clear roles. The care farmer runs the farm programme. The therapist runs therapy. The referrer or commissioner holds the placement. Write down who does what [synthesis].
  • Confidentiality has a different boundary on a farm. Farm staff and other participants are not bound by the therapy contract. Agree in advance what is shared and with whom [synthesis].
  • Competence and dual roles. Deliver farm-based sessions yourself only within your training, licence and insurance. Manage multiple relationships under APA Ethics Code Standard 3.05 [source: APA Ethics Code; synthesis].
  • Evidence humility. Present care farming to clients and referrers as promising for some outcomes, not as a proven treatment. Commissioners describe it as "relatively unproven" [source: NECR194; Murray et al. 2019].
  • Plan the ending from the start. Programmes are mostly time-limited, so a planned next step guards against loss and relapse when the placement ends [source: NECR155; synthesis].

4. Intervention inventory

Published care-farming sources describe the farm's own activities: animal care, egg collection, crop and horticultural work, and land or forest management [source: NECR155]. They describe almost no therapist procedures. The therapist-side procedures below are therefore marked [synthesis] unless a source is given. They are built around the published programme features.

4.1 Assessing fit and goals [synthesis]

  • Purpose: decide whether a care farm placement serves the client's goals. Typical goals are structure, meaningful activity, social connection, work readiness, mood, or a calmer setting. Use it when a client is isolated, unoccupied, stuck after hospital or addiction treatment, at risk of school exclusion, or seeking a route back to work. All of these are among the groups farms serve [source for client groups: NECR155].
  • Steps:
    1. Ask what a good week would look like and what has been missing, for example routine, purpose, people or being outdoors.
    2. Explore the client's history with farms, animals, rural life, manual work and being outdoors, including positive and negative memories.
    3. Name the published offer: structured farm tasks, a small group, regular days, and a time-limited programme.
    4. Agree two or three concrete goals. Choose an outcome measure you already use routinely.
    5. Decide whether the placement sits alongside therapy or follows it.
  • Example language (illustrative): "Some farms take people for regular days to do real work: feeding animals, growing things, mending fences. It isn't therapy in the room, but people often say it gives their week a backbone. Does any part of that appeal to you, or put you off?"
  • Watch for: the client agreeing to please you or a referrer, idealising farm life, or seeing a placement as a sign they are being "sent away". Fit is likely when the client shows curiosity, names a task they would like to try, and can state a goal in their own words.

4.2 Health, safety and contraindication screening [synthesis, with source points]

  • Purpose: identify risks that a farm must plan for, or that rule out a placement. Use it before every referral.
  • Steps:
    1. Ask about allergies (animal dander, hay and dust, pollen, insect stings) and asthma. Ask about mobility, balance and sensory needs, such as sensitivity to noise [source for noise: Farmers Weekly 2019].
    2. Ask about weakened immunity and pregnancy. Some farm animals can carry infections, notably E. coli O157 and Cryptosporidium, without looking ill. Young children and older people are at greatest risk [source: HSE]. Pregnant women need warning about risks such as lambing ewes [source: Lycetts guide].
    3. Ask about fear, phobia or trauma involving animals, dogs, livestock, machinery, rural settings or physical labour.
    4. Ask about current substance use, risk to self or others, and any recent changes in mental state.
    5. Ask about eating and food. Many farms share meals, and some produce food. Screen briefly for disordered eating. If you find it, refer to a registered dietitian or an eating-disorder service; the support line to give is the National Alliance for Eating Disorders. Give no diet, weight or supplement advice.
    6. Ask about weather tolerance, heat and cold, hydration, sun protection, and medicines that affect these. Route any medicine question to the prescriber, and never advise changing a medicine.
    7. Ask the client's physician to advise where a physical condition is uncertain.
  • Example language (illustrative): "Farms are outdoors, muddy and full of animals, so I need to ask some practical health questions. Nothing here is a test you can fail. It just tells the farm what to plan for."
  • Watch for: under-reporting by clients who are keen to go. Most risks are manageable with planning. Unmanaged immunosuppression, an active animal phobia the client does not want to work with, or acute risk needs a decision with the client's medical team before going ahead.

4.3 Animal-specific consent and history [synthesis, IAHAIO framework]

  • Purpose: clarify where animal contact sits. Under IAHAIO definitions, informal farm animal contact is closer to animal-assisted activity ("planned and goal oriented informal interactions"). Animal-assisted therapy is "a goal oriented, planned and structured therapeutic intervention" delivered or directed by a formally trained professional within their scope of practice [source: IAHAIO definitions via HABRI]. Use this procedure whenever animal contact is part of the placement. For structured animal-assisted work, cross-refer guide 035 in this domain.
  • Steps:
    1. Ask whether the client wants animal contact at all, and with which species.
    2. Explore any bites, falls, fear, or past cruelty to or by animals.
    3. Agree with the farm how the client can opt out of animal tasks without losing their place.
    4. Check that the farm has handwashing with soap and running water, and keeps eating away from animal-contact areas [source: HSE].
    5. Teach the client to respect the animal's signals of stress or withdrawal, and to let staff handle animals that are unsettled [synthesis].
  • Example language (illustrative): "You never have to handle an animal you don't want to. If you'd like to work up to it, the farm staff can show you how the animals tell you they've had enough."
  • Watch for: rough handling, which can signal frustration or a risk to animal welfare and should be raised with farm staff. Watch also for avoidance that the client wants to overcome. That calls for a planned, consented, graded approach with farm staff, not pressure. Dalton et al. 2020 on zoonoses is relevant [uncertain: not verified].

4.4 Evaluating a care farm before referral [synthesis, with source points]

  • Purpose: choose a safe, suitable farm. Use it for every new farm.
  • Steps:
    1. Ask which code or standard the farm follows. In the UK this may be the Care Farming UK / Social Farms & Gardens Code of Practice, which covers safeguarding, risk assessment, health and safety, staff recruitment, farming activities and evaluation [source: Farmers Weekly 2019]. The Code was a self-assessment reviewed by an expert panel [source: NECR194]. Ask also about CEVAS therapeutic training [source: Farmers Weekly 2019]. In Norway, ask whether the farm holds Inn på tunet approval, which is audited at least every second year [source: Nasjonal strategi 2012].
    2. Check safeguarding and vetting: DBS checks in the UK, and staff training [source: Farmers Weekly 2019; Lycetts guide].
    3. Check public and employers' liability insurance [source: Lycetts guide].
    4. Check risk assessments for activities, and COSHH hygiene assessments.
    5. Check that machinery and chemicals are locked away, sick or newly calved animals are kept separate, there are first aiders, and there is an emergency plan [source: Lycetts guide].
    6. Check basic facilities: shelter, somewhere to sit, handwashing, toilets, and a site that is not too remote [source: Farmers Weekly 2019].
    7. Ask about the client mix and group size, the staff on site, transport, accessibility, and wet-weather plans.
    8. Ask how the farm records attendance and outcomes, and how it reports concerns.
    9. Visit, with the client if possible.
  • Example language (illustrative), to the farmer: "Before I suggest your farm to a client, could you walk me through how you'd handle a first day, a bad day, and an accident?"
  • Watch for: vague answers on safeguarding, no written risk assessment, gel-only hand hygiene, or an unclear person in charge. HSE states that alcohol gels and wipes are not a substitute for handwashing on farms [source: HSE]. One insurer's guide mentions sanitiser, but HSE guidance takes precedence [source: Lycetts guide].

4.5 Referral and commissioning pathway [source: NECR155; NECR194; synthesis]

  • Purpose: secure a funded place through the right route. Use it once fit and the farm are agreed.
  • Steps:
    1. Identify the route. In the UK this may be social services, a community mental health team, education, a GP or social prescribing scheme (cross-refer guide 015 on green social prescribing and pointer 081), a personal budget, or self-funding [source: NECR155; NECR194]. In Norway, the purchaser is the municipality, NAV or Bufetat [source: Nasjonal strategi 2012].
    2. Agree the goals, the number of days, and the review dates with the purchaser and the farm.
    3. Send only the information the client has agreed to share.
  • Example language (illustrative): "The farm is usually paid through social care, a personal budget or the school. Let's work out which route applies to you before you set your heart on a place."
  • Watch for: funding that ends abruptly, as some GP referral schemes have needed constant reminders [source: NECR194]. Watch also for gaps between referral and start, which can erode motivation.

4.6 Information-sharing and confidentiality agreement [synthesis]

  • Purpose: set clear limits on what passes between the therapist, the farm and the referrer. Use it before the start.
  • Steps:
    1. List what the farm needs to know: risks, health needs, emergency contacts, and what helps on a bad day.
    2. List what stays in therapy.
    3. Agree how and when you will speak with the farm.
    4. Explain that other participants and farm staff are not bound by your confidentiality, and that a rural community may know the client.
    5. Record the client's written consent and the safeguarding exceptions.
  • Example language (illustrative): "The farm will know you're coming through me and what to do if you feel unwell. What we talk about in here stays here unless there's a safety reason, and you'll always know what I've passed on."
  • Watch for: the client avoiding the farm because of fears of being known, and the farm passing on gossip. Revisit the agreement after any incident.

4.7 Preparing the client for the first day [synthesis]

  • Purpose: reduce anticipatory anxiety and early dropout.
  • Steps:
    1. Go over the day's shape. Days often run from mid-morning to mid-afternoon, with a shared break or meal [source: Farmers Weekly 2019; Hassink factsheet].
    2. Plan clothing, footwear and weather protection, and what PPE the farm provides [source: NECR155].
    3. Plan transport.
    4. Rehearse handwashing before eating and after animal contact [source: HSE].
    5. Agree a "bad day" plan: who to tell, where to rest, how to leave safely.
    6. Arrange a taster visit if the farm offers one.
  • Example language (illustrative): "What would make the first morning easier? Knowing who'll meet you, what you'll do first, or where you can take a breather?"
  • Watch for: catastrophic predictions, such as "they'll think I'm useless". Treat these as material for cognitive work. Readiness shows when the client can describe the plan back to you.

4.8 Pacing, choice and graded engagement [source for principle: Hassink factsheet; synthesis]

  • Purpose: keep participation at the client's own tempo, with choice among tasks. Use it with depressed, anxious or fatigued clients, and with people with dementia.
  • Steps:
    1. With the client, map which farm tasks feel easy, medium and stretching.
    2. Agree a starting task, and how the client will signal a need to rest or switch.
    3. Review each week what was done and how it felt.
    4. Shift tasks or roles collaboratively.
    5. Frame this as behavioural activation: activity is chosen for mastery and pleasure, not prescribed (cross-refer II 040). Set no exertion or exercise targets. Route physical capacity questions to the client's physician or a qualified exercise professional.
  • Example language (illustrative): "Last week you said mucking out wiped you out but feeding the hens felt good. What would you like to ask for this week?"
  • Watch for: overexertion to prove worth, and shame on low-energy days. It is working when the client starts choosing tasks and reports a sense of achievement.

4.9 Debriefing farm experience in sessions [synthesis]

  • Purpose: turn the week's farm experience into therapeutic material. Use it in every session during the placement.
  • Steps:
    1. Open with a concrete account of what the client did, who was there, and what they noticed.
    2. Draw out moments of achievement, belonging, frustration or avoidance. The Campbell review names achievement, fulfilment and belonging as what participants valued [source: Murray et al. 2019].
    3. Link these to the client's goals and beliefs.
    4. Identify one thing to try or notice next time.
  • Example language (illustrative): "You said the lambs knew your voice by Thursday. What was that like, being someone they count on?"
  • Watch for: reports that stay at the level of tasks only. Gently ask about feelings and relationships. Progress shows as richer accounts, and the client bringing the farm into conversation without prompting.

4.10 Meaning-making: worker, not patient [source for theme: Hassink factsheet; synthesis]

  • Purpose: use the experience of being treated as "een normaal iemand" (an ordinary person) and "niet als een patiënt" (not as a patient) to rework identity and self-stigma [source: Hassink factsheet].
  • Steps:
    1. Ask how people on the farm treat the client, compared with services, family or work.
    2. Explore what it means to be relied on.
    3. Help the client name skills and qualities shown, and carry them into other settings.
  • Example language (illustrative): "On the farm you're the person who knows how the gate latch works. How does that version of you differ from the one who sits in waiting rooms?"
  • Watch for: this identity collapsing when the client leaves the farm, or splitting between the "good farm" and "bad services". It is working when the client uses farm skills in their self-description and in other places.

4.11 Working with relationships to animals, including loss and slaughter [source for bonds: Hassink factsheet; synthesis]

  • Purpose: participants describe close bonds with animals that bring warmth, comfort and confidence, and they find caring for living beings meaningful [source: Hassink factsheet]. Farm animals also fall ill, die, are culled or go to slaughter. Use this procedure to work with attachment, care-giving and loss.
  • Steps:
    1. Ask which animals matter to the client and why.
    2. Before the placement, find out the farm's practice on slaughter and sale, so the client is not surprised.
    3. When an animal dies or leaves, make room for grief, anger, or relief. Link this to the client's other losses where relevant.
    4. Agree with the farm whether the client is told in advance, and whether they take part in any marking of the loss.
  • Example language (illustrative): "It sounds as if Bramble was the one you looked for first every morning. Losing her may stir up more than the farm."
  • Watch for: distress that persists, and links to bereavement, especially suicide bereavement. Use safe messaging, and give crisis resources where needed: 988 in the US, Samaritans 116 123 in the UK and Ireland. Watch also for moral conflict about meat production, and for the client withdrawing from the farm altogether.

4.12 Working with the group and shared meals [source for themes: Hassink factsheet; synthesis]

  • Purpose: participants want contact with others in a small, safe group, and eating together is often "een ankerpunt in de dag" (an anchor in the day) [source: Hassink factsheet]. Use this procedure to build social confidence and to work with conflict.
  • Steps:
    1. Map who the client works and eats with.
    2. Rehearse small social steps, such as asking for help or joining the break.
    3. Process friction with other participants in sessions.
    4. Where meals are a source of distress (eating in front of others, food rules), assess for disordered eating and refer as in 4.2. Do not set food goals.
  • Example language (illustrative): "Sitting down for lunch with the others seems to be the hardest part of the day. What happens for you right before you go in?"
  • Watch for: isolation within the group, bullying, and difficulties from mixing client groups [source for mixing: Farmers Weekly 2019]. Raise these with the farm through the agreed channel.

4.13 Collaboration with the care farmer and staff [synthesis, with source points]

  • Purpose: keep the placement coordinated. The farmer is the person participants see as having knowledge and natural authority [source: Hassink factsheet]. Many farms pair a farm manager with a care service provider [source: Farmers Weekly 2019]. Use this procedure throughout the placement.
  • Steps:
    1. Name one contact on each side.
    2. Agree a brief check-in rhythm that fits farm work.
    3. Share agreed risk information and what helps.
    4. Agree how safeguarding concerns are reported in both directions.
    5. Invite the farm's observations to reviews, with the client's consent and preferably with the client present.
  • Example language (illustrative), to the farmer: "You'll see things on the farm I never will. What would be useful for you to hear from me, and what's the easiest way to reach you that doesn't pull you off the yard?"
  • Watch for: the therapist directing farm practice beyond their competence, and the farm being asked to carry clinical risk it is not equipped for. Staffing is a known pressure on care farms [source: NECR155].

4.14 Outcome monitoring and review [source for need: Murray et al. 2019; NECR194; synthesis]

  • Purpose: show whether the placement helps. Commissioners want evidence on health, wellbeing, social functioning and service use [source: NECR194]. The Campbell review calls for validated measures [source: Murray et al. 2019].
  • Steps:
    1. Take a baseline on a validated measure you already use, such as a depression, anxiety or wellbeing scale. Licensed instruments are used under their own terms.
    2. Re-measure at agreed review points.
    3. Add the client's own goal ratings and farm attendance.
    4. Discuss the results with the client, then with the referrer.
  • Example language (illustrative): "Let's look at these scores alongside how you feel the farm is going. Do they match?"
  • Watch for: improvements in attendance and mood that are not matched by social or functional gains, or the reverse. Adjust goals or setting accordingly.

4.15 Work training and vocational transition [source: Nasjonal strategi 2012; NECR155; synthesis]

  • Purpose: use the farm as a step toward work, education or volunteering. Norway's arbeidstrening (work training) is a named service area, and NAV is a purchaser [source: Nasjonal strategi 2012]. Use this procedure with clients whose goals include employment.
  • Steps:
    1. Identify transferable skills with the client and the farm, such as reliability, teamwork, machinery under supervision, and animal husbandry.
    2. Link the client to employment support.
    3. Plan a graded handover to the next setting.
  • Example language (illustrative): "You haven't missed a Tuesday in two months. That's exactly what an employer asks about. Shall we put it into words for your CV?"
  • Watch for: fear that losing benefits or the farm place will follow success, and unpaid work drifting into exploitation [synthesis].

4.16 Planned ending and transition [source for time limits: NECR155; synthesis]

  • Purpose: prepare for the end of a time-limited programme. Most last a year or less [source: NECR155].
  • Steps:
    1. Name the end date early and revisit it at reviews.
    2. Identify what the client wants to keep: routine, people, outdoor work.
    3. Plan replacements, such as volunteering, a community garden, or work.
    4. Mark the ending with the farm in a way the client chooses.
    5. Increase therapy contact around the ending if needed.
  • Example language (illustrative): "The farm place runs until spring. What would you like to have in your week when it ends?"
  • Watch for: low mood, relapse or crisis as the end nears, and the client asking for an indefinite extension. These are signs to slow the ending and plan more support.

4.17 Delivering therapy on a farm [synthesis; APA Ethics Code]

  • Purpose: for a therapist who holds sessions on a farm or works there in another role. Use it only within your training, licence and insurance.
  • Steps:
    1. Confirm with your insurer and the farm whose liability covers the activity and the site.
    2. Agree a private space and a wet-weather alternative.
    3. Explain the limits of confidentiality where you may be seen.
    4. Agree touch and physical-help rules: consent before and during, a right to stop, and never sexual.
    5. Manage any multiple relationship, for example if you also volunteer at or own the farm, under APA Ethics Code Standard 3.05.
    6. Follow the farm's risk assessment and safety briefing.
  • Example language (illustrative): "We can talk while we walk the field edge, but if anyone comes within earshot we'll pause. If the weather turns, we have the barn office."
  • Watch for: role blur between therapist and farm staff, clients saying more than they meant to in an informal setting, and safety lapses while you are attending to the conversation.

4.18 Children and young people in education placements [source for groups: NECR155; Farmers Weekly 2019; synthesis]

  • Purpose: support placements for young people at risk, excluded pupils or children with special educational needs [source: Farmers Weekly 2019; NECR155].
  • Steps:
    1. Obtain consent from those with parental responsibility, and the young person's own assent.
    2. Check the farm's safeguarding and child protection policy and staff vetting.
    3. Liaise with the school on attendance and on learning goals.
    4. Agree who is responsible for supervision during the day.
    5. Keep any assessment of learning or developmental needs moving, rather than letting the placement delay it.
  • Example language (illustrative), to a young person: "You get a say in whether this happens. What would make it worth trying?"
  • Watch for: the placement being used to keep a young person out of school without a plan, and safeguarding disclosures made to farm staff. Agree in advance how those reach the designated safeguarding lead.

4.19 Older adults and people with dementia [source: Hassink factsheet; NECR155; synthesis]

  • Purpose: support people with dementia and their carers. People with dementia want to choose among activities rather than follow a fixed programme [source: Hassink factsheet].
  • Steps:
    1. Involve the person and family carers in choosing the farm.
    2. Share what the person likes and any history of farm work.
    3. Plan for falls, weather, hydration and toileting with the farm.
    4. Use the carer's respite and the person's reports from the farm in your work with the family.
  • Example language (illustrative), to a carer: "What did your father's working life look like? It may tell the farm which jobs will feel familiar."
  • Watch for: distress on arrival or leaving, and changes in health. Signs that it is working include the person speaking of the farm with recognition or pleasure.

4.20 Responding to an incident, illness or injury on the farm [source: HSE; Lycetts guide; synthesis]

  • Purpose: support the client and the placement after an accident, an animal bite, a fall, or a suspected infection. HSE notes that E. coli O157 illness can range from diarrhoea to kidney failure [source: HSE]. Insurer guidance says to halt operations if an illness outbreak is linked to a farm [source: Lycetts guide].
  • Steps:
    1. Ensure medical care is sought.
    2. Confirm the farm has recorded the incident in its accident book.
    3. Debrief the client's emotional response.
    4. Review the risk plan with the farm and the referrer.
    5. Decide with the client whether and how to return.
  • Example language (illustrative): "That bite gave you a real fright. Before we decide anything about going back, let's go through what happened and what you'd need to feel safe again."
  • Watch for: new fear or avoidance generalising beyond the farm, and any pattern of incidents that suggests the farm is unsafe. Consider a safeguarding referral or ending the placement.

5. Handling problems

The published sources name only a few problems: staffing, weather, muddy sites, access, client mix, commissioner doubt and funding [source: NECR155; NECR194; Farmers Weekly 2019]. The responses below are [synthesis] unless a source is given.

  • Client stops attending or attends erratically.
    • Explore practical barriers first: transport, weather, cost and timing.
    • Then look at emotional barriers: shame after a bad day, conflict, boredom.
    • Offer a reduced or different task and re-agree goals.
    • If attendance does not recover, review whether a different green care setting fits better, such as social and therapeutic horticulture or conservation volunteering [source for the range of options: NECR155].
  • "It's just unpaid labour."
    • Take the concern seriously.
    • Clarify with the client and the farm how tasks are chosen for the participant's benefit, and what the client gains in skills, structure and references.
    • Raise it with the purchaser if work appears to serve the farm rather than the client.
  • Overwhelm on site (noise, animals, crowds, sensory load).
    • Agree a retreat space and exit signal. The green setting is valued for "rust en ruimte" (rest and space), and participants value being able to withdraw [source: Hassink factsheet].
    • Reduce days or group size.
    • Ask the farm to keep clients sensitive to noise apart from boisterous groups [source: Farmers Weekly 2019].
  • Stuck or flat.
    • Review whether the tasks still give visible results and choice [source: Hassink factsheet].
    • Rotate to a new role, such as care of a particular animal or teaching a newer participant.
    • Revisit goals and measures (4.14).
  • Rupture with the farmer or staff.
    • Help the client describe the episode.
    • Separate it from older patterns with authority figures.
    • With consent, facilitate a repair conversation through the agreed contact. Do not take sides on farm practice outside your competence.
  • Rupture with the therapist over the farm. A client may feel "sent away", or feel the therapist sides with the farm.
    • Name it and invite the complaint.
    • Re-affirm that the placement is voluntary.
    • Restore the client's choice.
  • Idealising the farm and devaluing other services. Validate what the farm provides. Then work on carrying it into other settings (4.10) and plan the ending early (4.16).
  • Deterioration, relapse or risk on site.
    • Agree in advance how farm staff contact you and emergency services.
    • Review risk at once.
    • Suspend the placement if needed.
    • For suicidal crisis, follow standard risk assessment and safety planning, and give crisis resources: 988 in the US, Samaritans 116 123 in the UK and Ireland.
  • Substance use or offending histories. Drug and alcohol services and probation are among the referrers [source: NECR155; NECR194]. Share risk information only as agreed and as the law requires, and make sure the farm's safeguarding covers the other client groups present.
  • Zoonotic illness, allergy flare or injury. Seek medical care. Follow the farm's incident procedure and review hygiene against HSE guidance: handwashing with soap and running water, gels not a substitute, no eating in animal-contact areas [source: HSE]. Then work through any fear that results (4.20).
  • Bad weather or seasonal gaps. Weather and mud are known challenges [source: NECR155]. Agree indoor tasks or a seasonal plan in advance, and use slow seasons to consolidate gains.
  • Animal death, cull or slaughter distress. See 4.11. Prepare clients in advance and offer to support a client's own way of marking the loss.
  • Disordered eating surfacing around shared meals or food production. Assess, then refer to a registered dietitian or an eating-disorder service; the support line is the National Alliance for Eating Disorders. Give no food, weight or supplement advice.
  • Funding ends early.
    • Plan a short, protected ending.
    • Explore personal budgets or other routes [source: NECR155; NECR194].
    • Protect the client from experiencing the loss as personal failure.
  • Rural dual relationships.
    • Where the therapist, client and farm share a small community, discuss boundaries openly.
    • Avoid business or social entanglements.
    • Document how you manage unavoidable overlaps, guided by APA Ethics Code Standard 3.05.
  • Safeguarding concern about the farm itself. Follow your own safeguarding duties. Inform the purchaser and, where relevant, the body that approves the farm, such as Matmerk in Norway [source: Nasjonal strategi 2012] or the UK code holder. Support the client's choice about continuing.

Sources

Programme, government and research sources:

Also cited:

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