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There is a lot of variation in health outcomes when it comes to individual states in America. Some states, such as Hawaii, have the life expectancy equivalent to that of developed countries, whereas states like Mississippi have the life expectancy equivalent to that of third world countries. This raised the questions of which states are doing well in health and why, and if their health has to do with their performance in the primary, secondary, tertiary, and/or quaternary prevention levels. The purpose of this research was to investigate if there is a correlation between performance in any of the prevention levels and the overall health status of a state, and if there is, which prevention level would be most beneficial for states to prioritize. The hypothesis of this research was: states that prioritized primary and secondary levels of prevention would have better health than states that prioritized tertiary and quaternary levels of prevention, since basic health measures contribute more to health outcomes than advanced medicine. To investigate this question, indicators were chosen to derive the ranking of each state in health and each of the four prevention levels. Six states were then chosen to represent the high, average, and low health statuses respectively. The six states were ranked for all indicators, and the data was analyzed and compared to determine a potential relationship between the prevention level rankings and the overarching health ranking. It was found that there is a correlation between performance in the primary and secondary prevention levels and a state’s overall health status, whereas there was no such correlation for the tertiary and quaternary levels. A model for health was proposed for states looking to improve their health status, which was to invest in primary prevention, followed by secondary, tertiary, then quaternary prevention and only moving to the next prevention level once the previous level reached a satisfactory threshold.
Method: Twenty families with children 10 years and older were recruited to participate in a 3-week equine assisted learning program at a therapeutic riding center in Phoenix, Arizona. Sessions included groundwork activities with horses used to promote life skills using experiential learning theory. The study design included a mixed-method quasi-experimental one-group pretest posttest design using the following mental health instruments: Devereaux Student Strengths Assessment, Brief Family Assessment Measure (3 dimensions), and Family Satisfaction Scale to measure child social-emotional competence, family function, and family satisfaction, respectively. Acceptability was determined using a Likert-type questionnaire with open-ended questions to gain a qualitative thematic perspective of the experience.
Results: Preliminary pretest and posttest comparisons were statistically significant for improvements in family satisfaction (p = 0.001, M = -5.84, SD = 5.63), all three domains of family function (General Scale: p = 0.005, M = 6.84, SD = 9.20; Self-Rating Scale: p = 0.050, M = 6.53, SD = 12.89; and Dyadic Relationship Scale: p = 0.028, M = 3.47, SD = 7.18), and child social-emotional competence (p = 0.015, M = -4.05, SD 5.95). Effect sizes were moderate to large (d > 0.5) for all but one instrument (Self-Rating Scale), suggesting a considerable magnitude of change over the three-week period. The intervention was highly accepted among both children and adults. Themes of proximity, self-discovery, and regard for others emerged during evaluation of qualitative findings. Longitudinal comparisons of baseline and 3-month follow-up remain in-progress, a topic available for future discussion.
Discussion: Results help to validate equine assisted learning as a valuable tool in the promotion of child social-emotional intelligence strengthened in part by the promotion of family function and family satisfaction. For mental health professionals, these results serve as a reminder of the alternatives that are available, as well as the importance of partnerships within the community. For therapeutic riding centers, these results help equine professionals validate their programs and gain a foothold within the scientific community. Additionally, they invite future riding centers to follow course in incorporating evidence into their programs and examining new directions for growth within the mental health community.