Students in the UAB/Engel Therapeutic Preschool Program are led to the walking trail by volunteers with Special Equestrians at Indian Springs School. This spring marks the third semester students have participated in the program.

The 3-year-old sits atop the light brown horse, her hair flapping gently with each step the large animal takes. The reins are tightly held as she carefully surveys her surroundings. As she makes the lap around the ring and passes a familiar face the corners of her mouth rise.

The smile reflects the face of her mother who stands nearby, watching.

"Since she has been in this class everything has become so much better for her," the  mother says. "It's really been fun and exciting for me because she's telling me new things. Now she even sings. It's so much fun."

It hasn't always been that way for this family or other families in the UAB/Engel Therapeutic Preschool Program. So when a child can demonstrate a positive emotion - even through something as simple as a smile - it is a resounding success.

The UAB/Engel Therapeutic Preschool program is housed in the Department of Psychiatry's Division of Child/Adolescent Psychiatry and is under the leadership of Lee Ascherman, M.D., director of the division. It focuses on early intervention and treatment of emotionally and behaviorally at-risk children ages 2 to 5. Children attend five days a week, receive individual and group therapy, speech and language services and occupational therapy.

The program began in 2003 and has since graduated more than 30 children. Nancy Labriola, a speech/
language pathologist and therapeutic preschool teacher, says the program emphasizes communications skills, social skills and group and individual therapy - each of which addresses behavior and emotional needs.

"Many of the children who come in this class may have as many as three or four disabilities," Labriola says. Some of the children have trouble communicating when they are happy, sad or hungry, she says. Some do not speak at all. "We have to teach them to express what they are feeling," Labriola says.

Children with specialized needs can place a tremendous amount of strain on a family, she adds, driving parents to do things that are not characteristic of them. One of Labriola's key goals is to help the families understand the child's needs, the issues they are facing and offer tips for facilitating learning and improvement. It's not an easy task, but it's one she and Liz Leinheiser, a psychiatric nurse, know is important to the future of the children and their families.

Children come to the class with a range of vulnerabilities. Some may have been adopted from a foreign country or hospitalized for months at a time and have attachment issues. Others could be autistic or a survivor of trauma.

"It takes a good bit for them to trust anyone," Labriola says. "Sometimes they will trust an animal before transitioning to trust an adult."

Special Equestrians

Labriola sought a therapeutic opportunity for the children with the Special Equestrians program at Indian Springs School. This spring marks the third semester her class has participated in the program.

The children learn to lead, mount, ride and trot their horses during the 12-week course. Volunteers come every week to lead the children on a sensory trail ride in the woods on a course designed by UAB occupational therapy students. The trail enables the children to integrate different sensory inputs using wind chimes, swim noodles and wood knockers.

The children are encouraged to touch, feel and guide their horse through the trail, an experience that is therapeutic on many levels.

"For these kids to be doing this, it's a feat; it's something special," Labriola says. "They feel unique. This gives them something to talk about and something that is special and strictly for them.

"Their self-esteem is boosted. It's a therapy in itself."

One parent commented that her son, who has specific developmental delays, is opening up in the therapeutic preschool and is making significant progress.

"He loves ‘Mrs. Lab,' and he is very, very happy with what he's been doing. For any parent that's the main concern," she says.

Kathleen Claybrook, executive director of Special Equestrians at Indian Springs, says she agreed to take Labriola's class even though they had never taken multiple children with emotional issues in a group setting. The results, she says, are astounding.

"They are so much more outgoing than when they first got here," she says. "The children talk to us and interact, answer questions, follow directions - things they didn't do well when they started.

"I see many more smiles and less intimidation from them. They've gotten beyond many of their fears."

Early intervention key

The preschool is part of the Engel Day Treatment Program that provides integrated education and treatment of children and adolescents from preschool through high school.

The preschool-age children may be referred by school systems that take responsibility for identifying needs as they approach school age. They also are referred by other agencies that work with very young children, including programs like Head Start and United Cerebral Palsy.

The children in the school all have had developmental difficulties or emotional issues that complicate development and, sometimes, learning. They may be related to chronic illness or other factors. Ascherman, director of the Child and Adolescent Psychiatry Division, says the earlier the intervention can take place the greater likelihood of future success for the child.

He says the school strives to identify and address emerging problems of significance at a young age to give the children a greater opportunity for school-age learning and overall better functioning. The equestrian program helps in addressing those issues, he says.

"The equestrian program is one of a number of components we are trying to provide that help them overcome fears, gain confidence, work on motor development and assist with normal aspects of their development while also trying to help them with any particular vulnerabilities they may have," Ascherman says.

Some of the children in Labriola's class are fortunate enough to be a part of Special Equestrians because of scholarship donations. Others have to pay their child's way. It's not always an easy road for the parents to travel, but the journey is worth their time and investment.

One parent commented that his child was "in a shell" when she started. "She wouldn't tell you if she was hurting, sick or feeling bad. She's like a completely different child now.

"To me, what UAB and Mrs. Labriola do with the program is worth its weight in gold. They work with the children and the parents, giving us techniques that enable us to carry the instruction home and put it into practice," he says. "The results we've had are amazing. It's helped give my child a better life."

If you are interested in finding out more about the Engel Day Treatment Program or other programs within the Department of Psychiatry or in learning about giving opportunities, contact Eve Rhea at 975-7298 or erhea@uab.edu. You can also learn more online at www.uab.edu/psychiatry.