The Carl E. Dahl House

Men who seek treatment at the Dahl House have co-occurring substance use disorder (SUD) and mental health conditions, and in many cases, they have spent years cycling through programs that treated one issue but not the other. GAAMHA’s original 1972 program (Pathway House) graduates participants at roughly a 50% rate, well above the Massachusetts statewide average of 28–32%. But that success rate stirred a question within the agency: what about the other 50%? 

Staff recognized that residents with more significant co-occurring mental health needs were the least likely to succeed in a standard, cohort-paced program. The Dahl House was built specifically for them: a person-centered model rather than a cohort model, with a much more robust staffing ratio (roughly three or four clients per clinician). This allows residents to move at their own pace between good days and bad ones.

Residents typically stay 6 to 9 months at no cost to them, covered by a benefit through MassHealth, the state Medicaid program. Participation in animal care is voluntary but strongly encouraged; nearly everyone chooses to take part. When a rare resident opts out, it’s typically a sign that the program isn’t the right fit for them.

R.O.O.T.S.

R.O.O.T.S. is a free outpatient program for young people ages 12–24. Participants typically attend one session per week over a 24-week curriculum that includes Equine Assisted Learning, barn work, building projects, arts and crafts, and hikes through Evergreen Grove’s forest.

The program grew out of a call from the Massachusetts Department of Public Health’s Office of Youth and Young Adult Services, which was looking for more effective interventions for young people struggling with substance use and mental health. GAAMHA partnered with the department to help write the funding solicitation its program would ultimately be awarded. They received up to nine years of pilot funding toward two goals: prove the intervention works, and build a case–with data–for care farming as a reimbursable, diversionary alternative to emergency departments and inpatient psychiatric care.

Clinically, R.O.O.T.S. runs like other outpatient programs–with biopsychosocial assessments, PHQ-9 and GAD-7 screenings, an individualized treatment plan–but sessions happen outdoors, with no clinical building or clinical attire. Therapists build session plans around each young person’s interests, whether that’s horses, goats, or pigs. Many participants, particularly youth from urban settings, have no prior experience with farms or animals at all. 

National data on outpatient treatment retention for young people is poor, with most participants dropping out within two to four sessions. At R.O.O.T.S., the average length of stay exceeds the full 24-week curriculum — young people, as staff put it, simply don’t want to leave.

The farm setting also changes how difficult conversations happen. For example, rather than asking a young person to describe painful family dynamics directly, clinicians can start with observing herd dynamics together and asking what feels familiar. Many R.O.O.T.S. participants have lost a parent to overdose, and because GAAMHA cares for elderly and sick rescue animals, loss is something the farm experiences regularly, too. This gives clinicians a metaphorical, lower-stakes way to open conversations about grief before approaching it directly.

The Farm and the Herd

At Evergreen Grove, two barns anchor daily operations: a “small barn” that houses goats, pigs, alpaca, sheep, and chickens, and a “big barn,” used mainly for hay storage and as shelter during severe weather. Horses live on 24/7 turnout (in an outdoor setting) with access to run-in sheds rather than being stalled–a decision the farm made after learning that horses do best outdoors.

The herd includes miniature horses, two full-size horses, and 11 Newfoundland ponies — a rare breed with only around 500–600 remaining worldwide. GAAMHA formed a partnership with the Newfoundland Pony Conservancy Center after learning the conservancy was at risk of losing its own farm around the same time GAAMHA’s care farm was opening its doors. GAAMHA now hosts what may be the largest herd of Newfoundland ponies in the United States. Their manageable size and famously friendly temperament make them especially well suited to participants with no prior equine experience.

Animal care groups and chores rotate roughly every two weeks, but assignments aren’t one-size-fits-all. Someone with prior riding experience might work with horses from day one, while someone with no farm background often starts with smaller animals like goats or pigs. Staff work with the clinical team to match residents to animal groups–and sometimes to specific peers–based on individual recovery goals: e.g. building patience by pairing someone with an animal or peer that challenges them, or building confidence by starting with a lower-stakes animal group and working up.

Staffing

Between the two programs, Evergreen Grove employs about 29 staff members. The Dahl House team includes a program director, a clinical supervisor, three clinicians, a care coordinator, a psychiatric nurse practitioner who visits several times a week, an RN on-site five days a week, and a rotating team of recovery specialists providing 24/7 coverage. R.O.O.T.S. has its own program director, clinical supervisor, and clinicians.

The animal care team runs separately from clinical staff,a lesson GAAMHA learned the hard way after early attempts to have case managers split time between client work and barn chores led to burnout. Today, dedicated animal care staff work full-time on the farm and collaborate closely with clinicians rather than filling both roles themselves. That team includes a human-animal interaction specialist and Dahl House program graduate, who runs one-on-one sessions helping current residents build animal-handling skills. Weekend farm support comes from a staff member (also a program graduate) who volunteers additional hours simply because he enjoys being there. 

Staff turnover on the farm programs runs well below what GAAMHA typically sees across its programs agency-wide.