H.I.T.S. Founder
Sarah Kennerly Lustig and Thor
“Equine-Facilitated Learning and Nurse Life Care Coaching motivates and assists survivors of PTSD and TBI ‘get out of their head’ through meaningful equine and farm life emersion services, on the ground and in the saddle, unleash potential to improve independence, interpersonal skills, post trauma syndrome, and post concussive sequela. Through short-term or long-term therapy, survivors regain their footing, strengthen their pride, manage their symptoms, and rediscover their purpose again with their family, friends, relationships, coworkers, and community - key in maintaining a purpose driven independent life.” – Sarah Lustig R.N., Certified Nurse Life Care Planner and Brain Injury Specialist
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The Inspiration to Start an Equine Therapy Program
In February 2021 Sarah Lustig, a registered nurse and expert in traumatic brain injury, opened an equine program and trail riding sanctuary at Saltaire Stables and Farm for the sole purpose of serving adults silently suffering from post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), especially our Veterans. Survivors of this trauma often struggle to readjust to life, and due to lack of knowledge about rehabilitation resources or being to told ‘your on a waiting list’ or ‘just wait and see’, they are left feeling isolated, weak, and detached from society and many experience worsening symptoms or relapse of symptoms.
After seeing so many TBI and PTSD survivors silently suffering and not being given the chance for readily available care, Lustig and her partner Taylor, also a registered nurse and expert in traumatic brain injury, decided to combine their nursing background with her lifelong love for horses to provide the community with a therapeutic retreat offering Equine Assisted Activities and Therapies (EAAT). They acquired the farm’s horses from Grace Farm, a nonprofit rescue group dedicated to the rescuing and care of neglected animals. Sarah decided to locate the best horse rescue in the state in order to acquire horses to give them a much larger purpose: to rescue humans.
Background on the Program and Its Clinicians
In May of 2022 Sarah founded Hoofprints in the Sand, INC a nonprofit with these goals in mind,
Treat and research immediate and long-term EQUINE-ASSISTED ACTIVITIES & THERAPIES (EAAT) as a model method of treatments and improvements in systems of care, including access to and delivery of healthcare services, personalized model center approaches, length, durability of treatment, rehab, relapse, relapse prevention.
Interventions that promote sustained functional recovery especially administered during post-acute or chronic phase of injury. Research of interest includes interventions and the delivery of the healthcare service known as EAAT to improve the ability to treat co-occurring TBI and psychological health conditions.
Implementation, follow-up, and services research to increase provider adoption and availability of evidence-based treatments, treatment engagement, follow-up care, and understanding of long-term outcomes. Research of interest includes clinical effectiveness studies comparing new/novel capabilities to existing evidence-based treatments.
Provide patient centered EAAT model interventions, routine assessments utilizing established, valid, and reliable VA wellness assessments, collect focused research data targeting how EAAT impacts patient care longitudinally, and publish results demonstrating immediate and long-term treatment results to improvements in systems, access, and delivery of care relevant to the sustainable, objectifiable, and longitudinally positive effects of the patient’s physical, social-behavioral, psychosocial, health, wellbeing, and relapse prevention.
The focus and goal for HOOFPRINTS IN THE SAND, INC (HITS) is provide exploratory studies to demonstrate that EAAT can affect functional and structured changes of brains of patients of TBI especially those suffering from PTSD and in turn improve psychological health conditions.
Through exploratory studies in recent literature (Xi Zhe October 2020), published research demonstrated that Equine Assisted Therapy (EAT) can affect functional and structural changes in the brains of PTSD. The findings suggests EAT may target reward circuity responsiveness and produce increased caudate brain connectivity effect from pre- to post-treatment with associated greater symptom reduction of depression, substance abuse, anhedonia, fear, anxiety, cognitive control, and self-regulation of behavior and emotion. The treatment consisted of 19 Veterans with PTSD completed 8 weekly 90 minute group sessions led by licensed mental health and equine specialist with ground work only, no riding.
HITS is now an organized and operated EAAT program, operated by Registered Nurses with combined experience in brain injury rehabilitation of greater than 30 years’ experience actively assessing and researching the TBI/PTSD population. HITS delivers outpatient equine services on it’s 18-acre farm.
Oftentimes survivors fall through the cracks, losing interest in office psychologist, psychiatric medication, put on a ‘wait list’, or told to ‘wait and see’ if symptoms dissipate. Ultimately, they struggle at home ‘losing their purpose’ in life, suffering with progressive symptoms adversely affecting their activities of daily living (ADLs).
HITS program fills the gap during ‘wait lists’ and ‘wait and see’ periods by providing new/improved more efficacious and longer treatment. HITS offers 8, 3-hour morning sessions 9am-12pm of horsemanship and lifemanship on the ground and on horseback, also combined with mindfulness therapies geared towards PTSD; and 8, 3-hour afternoon sessions 1pm-4pm of life skills remediation activities in the educational room, also combined with mindfulness therapies and outdoor eco-activities geared for co-occurring TBI with PTSD/psychological health conditions.
Treatment is patient-tailored offering 8 consecutive days or 2x weekly for 8 weeks and coordinated housing arranged to improve access to and from delivery of service to sustain treatment engagement, motivation, and outcomes. Participants also enjoy the oasis atmosphere of 18 acres of green pastures, completely surrounded by the Francis Marion National Forest with 100s of acres of trails, fresh lake, three stables, 24 horse stalls, sandy bottom horse arena, EAAT trained horses (of varying sizes equipped to carry small to large adults safely), and educational clinic geared at re-training/remediating life-skills.
HITS Research components:
1) Referrals/Collaboration: Primary source through VA CCN Networks; other private health insurance; as well as concierge
2) Admission Criteria: ADLs/IADLs FIM Scores 4 – 7 & Cognition/Comprehension/Expression/ Social Interaction/Problem Solving/ Memory FIM Scores 3 – 7, Stable non-complex medical conditions, Non-serious/threatening inappropriate behavioral symptoms, Not a danger to themselves or others, Adults only
3) Assess/Re-Assess/Track longitudinal patient’s physical, social-behavioral, psychosocial, health, wellbeing, and relapse prevention utilizing VA Optum adult wellness assessments (routinely monthly/yearly), and diagnostics scheduled (*and less routinely fMRI neural changes and oxytocin levels) taken at *initial, *d/c, 3 month, *6, 9, *12, 18, *24 mth, 3 YR,*4 , 5 , *6 , *8, *10YR
4) Maintain per diem staff of clinicians, nurses, equine specialists, trainers and volunteers trained in EAAT
5) Increase and optimize with longer periods of dose-response relationships with horse as healers with goal to ride, motivation is key to decrease factors contributing to attrition
6) Offer ongoing case management of potential confounding variables, such as concurrent mental treatment and comorbidities
7) Implement safety protocols and policies of patient care, horse care, volunteer assistance, and protecting human / horse interactions with special observation of impact of work on equines & follow guidelines laid out in the grant guidelines.
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Sarah Kennerly Lustig R.N., CNLCP, CBIS, CDP, Rehab Nurse
Founder, President, and Program Director
HOOFPRINTS IN THE SAND, INC. (HITS)
501 (c)(3) Nonprofit Equine Therapy Program
Equine Specialist | Certified Nurse Life Care Planner | Brain Injury Specialist | Nurse Coach
O 843.884.4618 - C 843.364.4918 - F 843.884.4607
Farm: 1131 Wando Rd., Charleston SC, 29492
Corporate: 1270 Ben Sawyer Blvd., Mt. Pleasant, SC 29464
H.I.T.S. in the News
Horsemanship, Healing and Hope by Elizabeth Horton
www.thedanielislandnews.com/news/horsemanship-healing-and-hope