Farm-animal work within care farming

1. Introduction

Version followed: IAHAIO White Paper definitions (2014, updated 2018) and the IAHAIO international guidelines for farm animals in animal-assisted services (version 1.1, 2021); UK care farming as Social Farms & Gardens describes it; the Norwegian farm-animal therapy model as Berget and Braastad (2011) summarise their trials; UK HSE and UKHSA hygiene guidance for animal contact.

Farm-animal work within care farming is not a single psychotherapy. Care farming is described by Social Farms & Gardens as "the therapeutic use of farming practices", giving people "real activity with purpose and meaning", with tasks ranging from sowing seeds to feeding animals, and referrals usually coming from health, social care and education professionals [source: NHS Forest page produced by Social Farms & Gardens; Farmers Weekly 2019]. Animal husbandry (livestock, small animals, poultry) is one strand of that work [source: Care Farming Network, US]. Where the farm-animal work is a planned, goal-oriented intervention with measured and documented progress, led by a licensed professional within their scope of practice, IAHAIO calls it animal-assisted therapy (AAT); informal motivational or recreational contact is an animal-assisted activity (AAA); goal-oriented educational work led by educators is animal-assisted education (AAE) [source: IAHAIO White Paper 2018]. Most UK care-farm placements are supervised farm work rather than AAT; the clinician needs to know which one a given placement is [synthesis].

Core idea of change, as the Norwegian trial authors propose it: mastering graded, real farm tasks builds self-efficacy; contact with animals may lower arousal and anxiety; the animals and the farmer offer social support; and caring for animals gives people who usually receive care a caregiving role. In their trials, frequent complex work (such as milking) was linked to reduced depression and anxiety, and effects often appeared only at follow-up [source: Berget and Braastad 2011]. Evidence status in one line: small RCTs and quasi-experimental studies with mixed depression results and stronger self-efficacy and anxiety findings, mainly at six-month follow-up [source: Berget and Braastad 2011]. The broader IAHAIO framing is One Health and One Welfare: human health, animal welfare and environment are linked, and an intervention must not compromise the animal to help the person [source: IAHAIO White Paper 2018]. Cross-refer 013 (care farming) for the farm setting as a whole, and the other animal-assisted guides in this family for equine work; hippotherapy (where a horse's movement is used as a treatment tool) is delivered by licensed physical, occupational or speech therapists, not by care-farm staff or psychotherapists [uncertain: not verified].

2. Framework

There is no single manualised protocol. The phases below combine what the sources describe with standard therapist-side procedure; the phase structure itself is [synthesis].

Phase A: referral and suitability. Goal: decide whether farm-animal work fits the client's goals and whether it is safe for the client and the animals. Covers goals, animal history, fears and phobias, allergies, immune status, pregnancy, any history of animal abuse or unsafe handling, mobility and access, transport and funding. Care farms receive clients through GPs, community mental health teams, social services and education commissioners, and sessions are funded by individuals, local authorities, charities or education budgets [source: Farmers Weekly 2019]. IAHAIO asks programmes to screen or monitor clients who handle animals unsafely, have a history of animal abuse, or are young children interacting unsupervised, and to apply exclusion criteria for high-risk groups [source: IAHAIO farm-animal guidelines 2021; IAHAIO White Paper 2018]. Move on when risks are identified and managed and the client consents.

Phase B: choosing and checking the farm. Goal: confirm the provider runs safeguarding, risk assessment, health and safety, staff recruitment, farming activities and evaluation to a recognised standard. Social Farms & Gardens publishes a care-farming Code of Practice covering these areas [source: Farmers Weekly 2019; contents beyond that report: uncertain: not verified]. Check the animal side against the IAHAIO farm-animal guidelines (veterinary oversight, species-specific welfare and safety protocol, positive-reinforcement training, retirement plan) and the hygiene side against HSE guidance [source: IAHAIO 2021; HSE]. Move on when you would be content for the client to be there unaccompanied.

Phase C: contracting and goals. Goal: an individual plan with measurable goals, roles (therapist, farmer or stockperson, client), information-sharing rules, confidentiality outdoors, weather and travel plans, and what happens after an incident. IAHAIO requires AAT to have measured and documented progress [source: IAHAIO White Paper 2018].

Phase D: orientation. Goal: hygiene routine, farm rules, introduction to the animals and their body language, and simple first tasks. Clients take part as much or as little as the provider considers appropriate, with activities tailored to the individual [source: Farmers Weekly 2019].

Phase E: graded work and relationship. Goal: progression from simple to more complex tasks, flexible to the client's daily state, with ongoing therapeutic processing. Berget and Braastad advise encouraging progression to more complex work adapted to each person, allowing more time with the animals on a bad day, and not stopping the intervention early because effects may appear late [source: Berget and Braastad 2011].

Phase F: review, ending and transfer. Goal: measure change against goals, plan the ending, and carry gains into everyday life (work, volunteering, education) [synthesis].

Format and duration. Sources describe, rather than prescribe: UK care-farm sessions often run across a working day [source: Farmers Weekly 2019]; the Norwegian trials used interventions of about twelve weeks or three months with six-month follow-up [source: Berget and Braastad 2011]. IAHAIO sets species-specific limits on how long and how often each animal works and how long direct contact per animal may last, with breaks back in the herd; use the guidelines themselves for those limits [source: IAHAIO 2021]. No session count is established for psychotherapy integrated with care farming [uncertain]. Farm work is physical; do not set activity targets. Questions about physical capacity go to the client's physician or a qualified exercise professional, and the activity is best framed in behavioural-activation terms (cross-refer II 040) [synthesis].

3. Guiding principles

Goal-oriented and documented, or else call it something else. If there are no stated goals and measurement, it is an activity, not therapy [source: IAHAIO White Paper 2018].
Work within your scope and licence. AAT is led by a licensed or degree-qualified professional within their scope; a separate animal handler works under that professional's supervision and must understand animal behaviour, health and stress [source: IAHAIO White Paper 2018].
The animal is a partner, not a tool. Only domesticated animals; healthy, suitable temperament, not overworked; never made to do strained or stressful tasks; recipients supervised so they do not tease or mishandle animals [source: IAHAIO White Paper 2018]. In practice: stop or change the task when the animal shows stress.
One Health and One Welfare. Plan the programme with human health, animal welfare and the environment together; no gain for the client justifies harm to the animal [source: IAHAIO White Paper 2018].
Positive reinforcement only. Training of farm animals is to use strictly positive reinforcement [source: IAHAIO 2021]. Model the same with clients.
Real work, real meaning. The therapeutic ingredient is purposeful participation in genuine farm tasks [source: Social Farms & Gardens via NHS Forest]. Avoid make-work.
Grade by mastery, adapt by the day. Move towards complex tasks as the client masters simple ones; give latitude on bad days [source: Berget and Braastad 2011].
The farmer matters. Clients in the Norwegian studies valued the farmer's understanding and support; the farmer is a working colleague in the client's care [source: Berget and Braastad 2011].
Interdisciplinary oversight. Easy access to a vet or ethologist, on-site monitoring of interactions, and an advisory group with clear lines of authority and quality control [source: IAHAIO 2021; Berget and Braastad 2011].
Hygiene is non-negotiable. Soap and running water after contact; hand gels and wipes are not a substitute on farms; no eating in animal-contact areas [source: HSE; UKHSA West Midlands 2024].
Respect beliefs about animals. Where a client's religious, cultural or other beliefs conflict with the intervention, discuss alternatives with the client or family [source: IAHAIO White Paper 2018].
Consent is ongoing, for the client and, in its own way, the animal. The client may decline any task or animal; the animal's avoidance or stress ends that contact [synthesis, built on IAHAIO handler duties].
Confidentiality is harder outdoors. Farm staff, volunteers and other clients see who attends; agree in advance what is shared and with whom [synthesis].
Avoid unmanaged dual roles. A therapist who also owns or runs the farm, employs the client, or sells the farm's produce to them holds multiple relationships; assess these against APA Ethics Code Standard 3.05 (Multiple Relationships) and your own code [source: APA Ethics Code; application synthesis].
Insure for the setting. Check that your professional indemnity covers outdoor and animal-assisted work and that the farm holds its own liability cover; Farmers Weekly lists insurance among the areas providers take professional advice on [source: Farmers Weekly 2019; synthesis].

4. Intervention inventory

The sources describe farm tasks, welfare rules and hygiene controls, not therapist scripts. The therapist-side procedures below are built on those sources; where a step is the clinician's own practice it is marked [synthesis]. Example language throughout is illustrative.

4.1 Suitability and referral assessment

Purpose / when: Before any referral or AAT plan, to match goals to what a care farm offers and to screen out avoidable risk [source: IAHAIO White Paper 2018; IAHAIO 2021; synthesis for structure].
Steps: (1) Clarify the goal the client wants from the farm (routine, confidence, social contact, work skills, calm). (2) Ask about past and present contact with animals, including fear, bites, phobias (IAHAIO specifically names screening for bird phobias where chickens are used). (3) Ask about allergies to particular species. (4) Ask about conditions or treatments that weaken immunity, and about pregnancy; route these to the client's GP or physician before contact [source: HSE; IAHAIO White Paper 2018]. (5) Ask directly and neutrally about any history of hurting animals or of unsafe handling, which IAHAIO lists as a screening point [source: IAHAIO 2021]. (6) Check mobility, access, transport and funding, which Farmers Weekly identifies as practical barriers [source: Farmers Weekly 2019]. (7) Record the decision and reasons.
Example language (illustrative): "The farm work is real work with real animals, so I need to ask some practical questions first: how you are around animals, any allergies, and anything about your health that a farm visit could affect."
Watch for: Over-eagerness that hides fear; a client who wants the animals mainly to escape people (useful, but name it); undisclosed immune suppression. Working: the client can say what they want from the farm and risks are written down with a plan for each.

4.2 Animal history and animal-related trauma interview

Purpose / when: When any animal history is reported, or routinely, because animals can carry attachment, loss or trauma meanings [synthesis].
Steps: (1) Ask about animals in childhood and now, losses, and any attacks or injuries. (2) Ask whether animals were used to threaten or hurt the client or someone they cared about, and screen for domestic abuse where that appears [synthesis]. (3) Note species-specific triggers (size, horns, sudden movement, smell of a cowshed). (4) Decide with the client: avoid that species, start at a distance, or work on the fear deliberately with consent (cross-refer exposure-based guides; no exposure without a separate plan and consent).
Example language (illustrative): "Some people find animals easy and people hard, and some the other way round. What has your life with animals been like?"
Watch for: Disclosures of abuse that need safeguarding action; dissociation when describing an attack. Working: a clear map of which animals and tasks are safe starting points.

4.3 Evaluating a care farm before referral

Purpose / when: Before the first referral to a provider, and when circumstances change [synthesis].
Steps: Ask the provider, and visit if you can: (1) Have you adopted the Social Farms & Gardens Code of Practice, and how do you cover safeguarding, risk assessment, health and safety, staff recruitment, farming activities and evaluation? [source: Farmers Weekly 2019] (2) Are staff and volunteers vetted (in England and Wales, Disclosure and Barring Service checks), and who is the safeguarding lead? [source: Farmers Weekly 2019 lists DBS checks among areas for professional advice] (3) Is there a vet overseeing animal health, a species-specific welfare and safety protocol, positive-reinforcement training and a retirement plan for the animals? [source: IAHAIO 2021] (4) Are there handwashing stations with soap, running water and paper towels near animal areas, separate eating areas, and visitor information on hygiene? [source: HSE visitor-attractions guidance] (5) Who supervises clients with animals, and what training do they have? Berget and Braastad recommend skilled stockpersons supervise [source: Berget and Braastad 2011]. (6) What insurance does the farm hold? (7) How does the farm report incidents and share information with referrers?
Example language (illustrative, to the farm): "Before I refer anyone, could you walk me through how you handle safeguarding, animal welfare and hand hygiene, and who would be with my client in the animal areas?"
Watch for: Hand gel offered in place of washing; animals visibly stressed, tied up for long periods or housed alone where the species is social [source: IAHAIO 2021]; vague safeguarding answers. Working: written answers you can attach to the referral record.

4.4 Medical and infection-risk routing

Purpose / when: For clients who are pregnant, immunocompromised, very young or elderly, or have relevant medical conditions [source: HSE; UKHSA West Midlands 2024].
Steps: (1) Explain plainly that farm animals can carry infections transmissible to people; HSE lists many, including E. coli O157, cryptosporidiosis, ringworm, orf, Q fever, salmonella, toxoplasmosis and ovine chlamydiosis [source: HSE zoonoses]. (2) For pregnancy, note that HSE describes ovine chlamydiosis as a cause of serious illness, miscarriage or stillbirth, and toxoplasmosis as serious in pregnancy; UKHSA advises particular care and links separate guidance on animals giving birth [source: HSE; UKHSA 2024]. Route the decision to the client's midwife or physician and the farm's risk assessment. (3) For immunosuppression, ask the treating team; IAHAIO notes that some settings require animal screening tests [source: IAHAIO White Paper 2018]. (4) Never advise on starting, stopping or changing a medicine. (5) Document the medical advice received.
Example language (illustrative): "This is not about putting you off. Farms are safe with the right precautions, and your doctor or midwife is the right person to say which precautions you need."
Watch for: Clients who conceal pregnancy or treatment to keep a placement. Working: medical advice is on file and matched by the farm's arrangements.

4.5 Informed consent and contracting

Purpose / when: Before the first session; revisit when tasks, animals or settings change [synthesis].
Steps: (1) Explain what kind of intervention this is (AAT, AAA or supervised farm work) and who leads it [source: IAHAIO White Paper 2018]. (2) Agree what the farmer or stockperson will know about the client and what will be reported back to you, in writing. (3) Discuss being seen: other clients, volunteers, visitors and neighbours may see the client; agree how to answer "what are you here for?". (4) Touch: animal handling may involve staff showing the client how to hold or guide an animal; agree that any human touch is explained first, can be refused, and is never sexual. (5) Weather, travel and cancellation plans. (6) The client's right to decline any animal or task at any time. (7) Incident and illness plan (see 4.17). For children and young people, obtain parental consent and the young person's own assent, and confirm safeguarding arrangements.
Example language (illustrative): "You can say no to any task or any animal, any time, without needing a reason. The farmer will know you're here for support, and we've agreed what she or he will tell me."
Watch for: Clients who feel they cannot refuse a farmer's request; information flowing informally. Working: the client can state the rules back and uses the right to decline at least once without fuss.

4.6 Individual goal plan and measurement

Purpose / when: At start, reviewed regularly; required for anything called AAT [source: IAHAIO White Paper 2018].
Steps: (1) Set two or three goals in the client's words (for example, attend reliably, complete a task without help, manage anxiety in a group). (2) Choose measures the client and team can track; the Norwegian trials measured self-efficacy, anxiety and depression with standard scales [source: Berget and Braastad 2011]. (3) Record task level and attendance at each session. (4) Review at agreed points and share a summary with the client.
Example language (illustrative): "Let's write down what would tell us, a few months from now, that the farm is helping, so we're not just guessing."
Watch for: Goals set by the referrer rather than the client; measuring only attendance. Working: goals change as mastery grows.

4.7 Hygiene routine as session structure

Purpose / when: Every session, before and after animal contact and before eating [source: HSE; UKHSA 2024].
Steps: (1) Show where washing facilities are on arrival. (2) Wash with soap and running water after touching animals, fences or surfaces in animal areas and before eating or drinking; gels and wipes do not replace washing [source: HSE; UKHSA 2024]. (3) No eating, drinking, hand-to-mouth contact or kissing animals in contact areas [source: UKHSA 2024]. (4) Remind nail biters, thumb suckers and pen chewers specifically [source: HSE visitor-attractions guidance]. (5) Supervise children's handwashing [source: UKHSA 2024]. (6) Use the routine as a predictable opening and closing ritual [synthesis].
Example language (illustrative): "Same as always: hands first, then the animals, then hands again before tea."
Watch for: Compulsive washing in clients with OCD (agree a standard, do not reinforce extra rituals) [synthesis]; skipping washing when rushed. Working: the routine happens without prompting.

4.8 Orientation to the animals and their body language

Purpose / when: First sessions, and whenever a new species is introduced [source: IAHAIO 2021].
Steps: (1) The stockperson introduces each animal and its temperament. (2) Teach species-specific approach as IAHAIO describes it: approach goats and cattle from the side (or front for cattle) and stand where a kick cannot reach; goats prefer stroking behind the ears and on the neck and resist restraint; do not lean over rabbits or make sudden movements; approach chickens from the front and never chase them; sheep may sniff intensely on first contact and are stressed by shouting, sudden noise and impatience; respect each animal's preferred distance [source: IAHAIO 2021]. (3) Point out freezing and fleeing as stress signs (named for donkeys) and how the herd is used for rest [source: IAHAIO 2021]. (4) Note particular hazards: horns on cattle, bites from pigs, sudden running of cattle which cannot be stopped, so a familiar person stays beside the animal [source: IAHAIO 2021].
Example language (illustrative): "Watch her ears and feet. If she moves away, that's her answer for now, and we give her space."
Watch for: Clients who grab, chase or hold on after an animal pulls away; fear that spikes with size. Working: the client reads and respects signals without prompting.

4.9 Graded work-task progression

Purpose / when: The main active component, for self-efficacy and mood [source: Berget and Braastad 2011].
Steps: (1) Start with a simple, completable task (feeding, cleaning a pen), shown and then done alongside the stockperson. (2) Move towards more complex, responsible tasks as competence grows; in the Norwegian studies, frequent complex work such as milking was linked with reduced depression and anxiety [source: Berget and Braastad 2011]. (3) Agree each step with the client and farmer. (4) Note completion and the client's own rating of difficulty. (5) Link each step to the client's goals in therapy.
Example language (illustrative): "Last month you were watching the milking. Now you're doing a whole side on your own. What does that tell you about what you can learn?"
Watch for: Being kept on low-skill tasks indefinitely (one study linked the most frequent animal contact, among participants who did not acquire complex skills, with increased depression) [source: Berget and Braastad 2011]; pushing too fast. Working: rising task complexity with stable or falling distress.

4.10 Flexible "bad day" adaptation

Purpose / when: On days when the client arrives low, anxious or exhausted [source: Berget and Braastad 2011].
Steps: (1) Brief check-in on arrival. (2) Offer a lighter task or more time with a calm animal, as the Norwegian authors recommend [source: Berget and Braastad 2011]. (3) Keep attendance itself as the success. (4) Return to the usual level next time unless a pattern emerges.
Example language (illustrative): "Today can be a quieter day. Would you rather brush the calves or help with feeding?"
Watch for: A bad day becoming the norm (review the plan); risk indicators needing assessment. Working: the client keeps coming on bad days.

4.11 Caregiving-role work

Purpose / when: For clients whose identity has become "the one who is cared for" (long-term mental illness, disability, addiction recovery) [source: Berget and Braastad 2011 propose the caregiving role as a mechanism; therapeutic use synthesis].
Steps: (1) Give the client ongoing responsibility for named animals' daily needs within the farm's routine. (2) In therapy, explore what it is like to be relied on. (3) Link to the client's wider relationships and roles. (4) Keep a stockperson accountable for the animals so welfare never depends on the client alone [synthesis; IAHAIO 2021 on on-site monitoring].
Example language (illustrative): "The goats look for you now when you come in. What's it like to be the one someone depends on?"
Watch for: Guilt or panic when the client misses a day; over-identification with an animal's suffering. Working: the client describes themselves in more capable terms.

4.12 Free contact and calming time with animals

Purpose / when: For de-arousal, comfort and rapport; participants in the Norwegian studies could pet and interact with animals as much as they liked [source: Berget and Braastad 2011].
Steps: (1) Choose a calm, suitable animal approved by the stockperson [source: IAHAIO 2021]. (2) Let the animal approach, or not. (3) Keep within the farm's contact limits for that species and return the animal to its group for breaks [source: IAHAIO 2021]. (4) Invite the client to notice breathing, warmth, the animal's rhythm [synthesis]. (5) Balance with active tasks (see 4.9).
Example language (illustrative): "Let him come to you. Just notice what happens in your body while you wait."
Watch for: Contact replacing all task work; the animal showing stress or trying to leave. Evidence status: proposed physiological de-arousal is a hypothesis in the source, not established for farm animals [source: Berget and Braastad 2011]. Working: the client can settle and then move on to work.

4.13 Reading the animal's signals as relational practice

Purpose / when: For clients who struggle to read others, respect boundaries or tolerate refusal [synthesis, built on IAHAIO's requirement that handlers recognise stress and that animals not be overwhelmed].
Steps: (1) Before approaching, ask the client to predict the animal's state from posture and movement. (2) Approach as taught (4.8) and check the prediction. (3) When the animal moves away, pause and process: what did the client feel, what did they want to do? (4) Link to human relationships in therapy.
Example language (illustrative): "She stepped back. You looked disappointed and then you waited. That's a skill a lot of people never learn."
Watch for: Anthropomorphising that loads the client's distress onto the animal; the client pressing on after refusal. Working: the client respects "no" from animals and starts noticing it in people.

4.14 Three-way collaboration with farmer or stockperson

Purpose / when: Throughout; the farmer's informational, emotional and appraisal support was valued by participants [source: Berget and Braastad 2011]. IAHAIO calls for interdisciplinary work involving people who know both the people and the animals [source: IAHAIO White Paper 2018].
Steps: (1) Agree roles: the stockperson leads on animals and safety; the therapist leads on clinical goals and risk. (2) Agree a short handover routine (what to note about each session) and keep it within the information-sharing consent (4.5). (3) Hold periodic reviews with the client present where possible. (4) Offer the farmer guidance on responding to distress, without making them a therapist [synthesis]. (5) Join an advisory group or set lines of authority and quality control for the programme [source: Berget and Braastad 2011].
Example language (illustrative, to the farmer): "You know the animals and the farm; I know the clinical side. Can we agree what each of us does if Sam has a hard day?"
Watch for: The farmer drawn into a quasi-therapist role or told more than the client agreed; splitting between farm and therapist. Working: consistent messages and a client who talks about "the team".

4.15 Processing alongside the work

Purpose / when: When the therapist is present on the farm; side-by-side activity may make talking easier for some clients [synthesis].
Steps: (1) Agree beforehand whether you will talk during tasks and where private conversation can happen out of earshot. (2) Use brief reflections on what the client is doing and feeling. (3) Leave longer or sensitive material for a private space or the next office session. (4) Stop talking if it distracts from animal safety.
Example language (illustrative): "We can talk while we work, or just work. Tell me if anything comes up that you'd rather keep for our session indoors."
Watch for: Disclosures overheard by others; attention drifting from a large animal. Working: the client raises material naturally and safely.

4.16 Preparing and debriefing a client who attends a care farm

Purpose / when: When the therapist is not on the farm and the client attends a placement separately [synthesis].
Steps: (1) Before the first visit: rehearse what to expect, the hygiene routine, how to say no, and how to ask for help. (2) After each period: ask what the client did, what was hard, what they were proud of, and how they felt with the animals and people. (3) Link experiences to therapy goals (mastery, social anxiety, routine). (4) Watch for illness after visits (4.17) and for safeguarding concerns.
Example language (illustrative): "Tell me about the week on the farm. What did you do with your hands, and what did your head do while you did it?"
Watch for: The farm becoming a place to avoid therapy work; idealisation of the placement. Working: farm experiences feed new material and practice into sessions.

4.17 Incident and illness response

Purpose / when: After a bite, kick, fall, crush or illness following a visit [source: UKHSA 2024; HSE; IAHAIO 2021].
Steps: (1) First aid and medical care through the farm's procedures. (2) For sickness or diarrhoea within two weeks of a farm visit, UKHSA advises contacting the GP or NHS 111; bloody diarrhoea needs emergency attention; stay off school, childcare or work until free of symptoms for two days [source: UKHSA West Midlands 2024]. (3) The farm records and reports as its health and safety duties require (HSE refers to RIDDOR) [source: HSE]. (4) Check on the animal too, and whether it should be rested or reassessed [source: IAHAIO 2021]. (5) In therapy, process fear, shame or anger, and decide together whether and how to return.
Example language (illustrative): "That frightened you, and it makes sense that it did. Before deciding anything about going back, let's go through what happened."
Watch for: Avoidance spreading beyond the incident; blaming the animal or self. Working: an informed decision about returning.

4.18 Safeguarding in farm settings

Purpose / when: Throughout, especially with children, young people and adults at risk [source: Farmers Weekly 2019; IAHAIO 2021].
Steps: (1) Confirm the farm's safeguarding lead and procedure. (2) Agree how concerns are reported between farm and therapist. (3) Young children are not to interact unsupervised with animals [source: IAHAIO 2021]; follow species age guidance in the IAHAIO document and HSE guidance on preventing accidents to children on farms [source: IAHAIO 2021; HSE]. (4) Where a client harms an animal, stop the contact, assess the meaning and risk, and act on welfare and safeguarding duties [synthesis; IAHAIO 2021 on screening for animal abuse history]. (5) Never name minors in records shared with the farm beyond what is needed.
Example language (illustrative): "If anything on the farm ever makes you feel unsafe, with a person or an animal, you can tell me or the farm lead and we'll act on it."
Watch for: Unsupervised one-to-one time with unvetted volunteers; cruelty to animals as a sign of other harm. Working: concerns are raised and handled through clear channels.

4.19 Meaning-making around animal illness, death, sale and slaughter

Purpose / when: Working farms raise, sell and slaughter animals, and animals fall ill or die; clients may be affected [synthesis].
Steps: (1) Ask the farm, before referral, how this is handled and what clients see. (2) Prepare the client honestly. (3) When a loss occurs, make space for grief and moral feelings; connect with the client's own losses where relevant. (4) Respect vegetarian, vegan, religious or cultural views and offer alternatives [source: IAHAIO White Paper 2018 on beliefs; synthesis].
Example language (illustrative): "The lambs you fed are going to market next week. How are you with that?"
Watch for: Grief reactions linked to prior bereavement (cross-refer the death and mourning guides); moral distress. Working: the client can hold the farm's realities without leaving or shutting down.

4.20 Review, ending and transfer

Purpose / when: At planned review points and before ending; Berget and Braastad caution against stopping early because gains may appear late [source: Berget and Braastad 2011].
Steps: (1) Review goals and measures (4.6). (2) Plan the ending with the client and farm: last tasks, saying goodbye to animals and people. (3) Identify where gains transfer: volunteering, education, employment, other green-care settings (cross-refer 013 and green social prescribing 015). (4) Continue follow-up where possible, since the Norwegian trials found many effects at six-month follow-up [source: Berget and Braastad 2011].
Example language (illustrative): "You've learned to turn up, learn a job and work with others. Where else could you use that?"
Watch for: Loss reactions to ending; relapse when routine stops. Working: a concrete next step in place before the last session.

5. Handling problems

The sources address welfare, hygiene and task grading; most of the clinical problem-handling below is [synthesis] unless tagged.

Stuck client (no progress in task level or mood). Check whether the client has been left on simple tasks; the Norwegian authors link complex work with better mood outcomes and advise individual progression [source: Berget and Braastad 2011]. Agree a next task with the farmer. Check for undiagnosed depression, medication changes (route to prescriber), or a poor fit between client and farm. Do not end early solely for lack of early change, since effects may appear late [source: Berget and Braastad 2011].
Resistance or refusal to take part. Treat refusal of a task or animal as a legitimate use of consent, not failure. Explore what it protects (fear, shame at not knowing how, past trauma). Offer an observer role, a different species or an indoor task [synthesis].
Overwhelm on the farm (noise, crowds, large animals, smells). Farmers Weekly notes some groups need keeping apart, for example people sensitive to excess noise [source: Farmers Weekly 2019]. Agree a quiet retreat place and a signal to step out; reduce group size or exposure to large animals; use grounding with a calm small animal (4.12). If panic recurs, consider a planned graded-exposure approach with separate consent (cross-refer exposure guides) [synthesis].
Non-attendance. Explore barriers: transport (Farmers Weekly notes some providers run minibuses because transport can be a barrier), cost and funding, weather, energy [source: Farmers Weekly 2019]. Use the caregiving role (4.11) and the farmer's welcome as motivators, without guilt-tripping. Review whether the placement still fits [synthesis].
Ruptures with the farmer, staff or other clients. Hear the client's account first; seek the farm's account with consent; hold a three-way meeting if needed (4.14). Repair is itself therapeutic material. If the farm's conduct falls short on safeguarding, raise it formally [synthesis].
Rupture with the therapist over the farm. Clients may feel "sent away" to a farm instead of being helped. Name it, explain the rationale, and keep regular therapy contact [synthesis].
Animal stress or welfare concerns. Stop the contact and inform the stockperson. IAHAIO requires that animals not be overworked or overwhelmed, that animals in pain or discomfort be reassessed and possibly removed, and that interventions not compromise animal welfare to help a client [source: IAHAIO White Paper 2018; IAHAIO 2021]. If concerns persist, do not refer further and report through the appropriate animal-welfare route [synthesis].
Rough handling or cruelty by a client. Stop the interaction, ensure the animal's safety, and assess meaning and risk, including possible links to abuse at home. IAHAIO lists screening or monitoring of clients with a history of animal abuse [source: IAHAIO 2021]. Decide with the farm whether contact can resume under closer supervision [synthesis].
Fear becoming phobia, or a past attack resurfacing. Pause animal contact; assess for trauma symptoms; offer trauma-focused work in therapy before any return; return only with a plan and consent [synthesis].
Allergy reactions. Stop exposure and follow the farm's first-aid plan; the client's physician decides on future exposure. IAHAIO asks providers to check species-specific allergies [source: IAHAIO White Paper 2018].
Illness after a visit. Follow UKHSA advice (GP or NHS 111; emergency care for bloody diarrhoea) and tell the farm so it can review its controls [source: UKHSA 2024; HSE]. Re-check the hygiene routine (4.7).
Outdoor conditions. Weather (heat, cold, rain, wind), uneven or muddy terrain, ticks (HSE lists Lyme disease among farm zoonoses), plant and insect allergies, hydration and access for wheelchair users or people with limited mobility: plan these qualitatively with the farm and follow its risk assessment and safety guidance; have an indoor or cancellation plan [source: HSE for Lyme disease; synthesis].
Confidentiality breaches outdoors. If another client, volunteer or a neighbour learns sensitive information, address it with the client, review what the farm shares, and tighten agreements (4.5) [synthesis].
Dual-role tension. A therapist who runs a care farm, employs volunteers who are clients, or sells produce to clients should assess the relationship under APA Ethics Code Standard 3.05 and their own professional code, and use supervision; refer on if the roles cannot be kept clear [source: APA Ethics Code; synthesis].
Competence gaps. A psychotherapist without farm-animal training should not handle livestock in sessions; IAHAIO expects handlers to be trained in animal behaviour, appropriate interaction and species needs, and to work under the professional's supervision where roles are split [source: IAHAIO White Paper 2018]. Seek training and supervision from people experienced in AAI and in the species involved. Check that your indemnity covers outdoor and animal-assisted work [synthesis].
Belief or cultural conflicts (species taboos, objections to slaughter or animal use). Discuss alternatives with the client or family, as IAHAIO advises; offer horticultural or other non-animal care-farm work (cross-refer 013) [source: IAHAIO White Paper 2018].
Physical over-exertion or injury from farm work. Do not set activity targets; route questions about physical limits to the client's physician or a qualified exercise professional; ask the farm to adapt tasks [synthesis].
Request for riding. Riding farm animals is governed by species-specific weight and age guidance in the IAHAIO document [source: IAHAIO 2021]; therapeutic riding and hippotherapy are separate disciplines with their own standards bodies (cross-refer the equine guides in this family) [uncertain: not verified].

Sources

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