Steps to Establishing a Program (TX)

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Whether you plan to partner with an organization that provides animals and handlers as a “therapy team” to work with healthcare professionals in your organization or whether you want to start a program using animals that will be owned by the facility there are a lot of details to work through before the program can begin. This section of the course will go over the steps to consider when assessing the ability to sustain a program and administering the program. Bear in mind that the order in which you work through this process may be dictated by your individual organization and its specific needs. Each institution’s implementation plan will vary based on the persons served and goals of the program.

Organization Assessment

The first step in the process of establishing the feasibility of an animal-assisted therapy program will be designating an individual or group of individuals to be responsible for gathering and coordinating the information necessary to assess the needs and goals of the program. Their first task will be to assess the level of interest of the decision makers and stakeholders of the institution. Knowing who is involved in the decision allows the individual gathering the information to have a better understanding of the information they will need to present for final approval.

The type of program you are starting should be clearly defined. An Animal-Assisted Therapy (AAT) program versus Animal-Assisted Activity (AAA) program will have different components that need to be evaluated. The differences in programs should be clear to all parties involved so that the needs of the institution can be accurately assessed and the proper program is selected for evaluation. Although therapists may not specifically be involved in animal-assisted activities, an institution may choose to run both programs. The intent of each program needs to be clear up front to everyone so accurate goals, policies, and costs can be established. It is important to establish realistic measurable goals for any program to ensure the program accomplishes what it was set out to do.

A good way to work through this phase of the process is by performing a needs assessment. The Needs Assessment should include:

  • Is there a need for a pet therapy program?
  • What are the current needs of your residents/patients?
  • Would the residents/patients of your facility benefit from pet therapy?
  • How might they benefit from pet therapy?
  • What types of programs may be available in your area?
  • Assess community resources.
  • Perform a cost-benefit analysis
    • For the program on its own
    • In comparison with alternative therapies or activities
  • Get input
    • From staff and administration
    • From residents/patients

Evaluation of staff, cost and availability of animals to make sure the project is sustainable is one of the more important initial steps. Often the financial component is a key-limiting factor for any new program so establishing the costs and where the funds to cover the expenses will come from will be important for budgeting and reporting on the program.

Goal setting will ensure the ability to measure the outcomes of the program. Goal setting should include:

  1. Establish goals and objectives for the program
  2. Develop measurement indicators – increase in social interaction; lowering of blood pressure; improved function at discharge of therapy; or increased participation in other therapies
  3. Chart current participation in activities for comparison after implementation
  4. Write a protocol for the program
  5. Statement of goals and objectives
  6. Statement of commitment level and what the procedure will be upon termination of the program

 


 

Should you Partner with an Established Organization?

One of the benefits of partnering with an organization like Canine Assisted Therapy, Inc. (C.A.T.) to provide therapy teams for your facility is that C.A.T. assists a facility in setting up the program. They can assist a facility in the creation of policies and procedures for pet therapy that are specific to the facility; review infection control policies and procedures regarding pet therapy, and help to educate the staff on the benefits of pet therapy to the patients or residents in your facility.

Careful assessment is done by a C.A.T. staff member or trained C.A.T. volunteer to determine the needs of the facility. This assessment includes an overview of current policies and procedures for animal-assisted therapy; assessment of the environment where the therapy will take place; the scope of the pet therapy that will be provided and the population that the therapy will be provided for. This gives C.A.T. the information necessary to select a therapy team that will best meet the needs of the facility.

Physical Plant Assessment

The location or locations that will be visited by the animal-handler team will need to be assessed. Are there multiple locations involved? What type of access to enter and leave the building exists and is it conducive to a visit by a dog? What type of environment is the dog going to be in and does it require a specific set of behaviors that a dog must possess? Will that environment change or is it consistently the same?

Environments can range from quite simple to more involved. The amount of staff, type of patient, number of people in the setting at any given time and any barriers for access to a dog and/or it’s handler will change the complexity of the setting. Since not all animals are suitable for all environments, the physical plant assessment will better allow the program director to determine which dog or pet therapy team should be involved at each location and the number of dogs needed for the desired program.

Some of the physical plant questions to answer are:

1- Where is the designated break area for dogs?

2- When and where will visits occur?

3- How will you accommodate others when a dog is visiting if someone is not comfortable with an animal on premises with them? Will there be a dedicated area or time that remains animal free?

Staffing Requirements

With any new program the more stable the staff is at a facility or in a department the easier it is to implement a new program. The same can be said for beginning an animal-assisted therapy program. To get “buy-in” from the staff, the person(s) spearheading the project need to be able to address the benefits of the program as well as the concerns and liabilities. They need to be able to speak to all the phases of the program from animal selection, policies and procedures, liability, costs, patient issues, patient safety, and efficacy.

If you are going to use an outside organization they may be able to provide guidance on policy and procedures, animal selection and training for the pet therapy team. This may reduce the need to add staff or add responsibilities to current staff. If you plan on running the program without a partner organization the process will be more labor intensive and more staff involvement will be needed to establish policies and run the program.

Staff Education and Training Needs Assessment

All staff at a facility need to be trained on an animal-assisted program and what it entails. If you are partnering with an organization to support your program by providing animals they should be able to provide you with useful training programs for all employees. If you choose to take on the responsibility for educating your staff on the programs you will need to decide what the goals are of your training program, length of the training, how to administer it, and whether it is live or self-paced training.

Some of the staff requirements and training elements to consider are:

  1. Who will be the point person for the program?
  2. Who will be responsible for training the staff?
  3. Who will need to go through orientation? Who is involved? What is involved?
  4. Are there additional background checks needed for handlers?
  5. Is the training for handlers different from your employees?
  6. How often will there be retraining or updates provided?
  7. How will you document and measure successful completion of training?

Patient Population Assessment

Animal-assisted interventions may benefit patients of all ages in areas such as improvement of measurable physical goals, improved mood, increased motivation, and enhanced self-esteem. The potential patients should have all pertinent precautions and risks addressed.

We have spent a great deal of time talking about the benefits of the animal-human bond and the impact dogs have on the health of patients, but we also need to address the fact that not all people in a facility will be “animal lovers”. Some people have a fear of animals and these individuals would not likely be motivated by the presence of an animal, so there would be no real benefit of adding the animal to their therapy program in this case. Combative patients or patients who are unable to treat an animal in a gentle or humane manner are also not candidates for animal interventions.

Another potential issue for some patients is the fear of “catching something” from the animal. If a patient has a compromised immune system or they have a medical condition that could potentially worsen due to exposure to the animal this would be a contraindication to using animals as part of their treatment. This may include people with open wounds or sores, people who are immune-compromised, or people who are allergic to certain animals.

Something to take into consideration is the ability to place people who have requested no contact with animals or have a contraindication to animal-assisted therapy in an area “free of animals”. The ability to schedule the animal visits at a specific time will allow people in the facility that do not want or should not have contact with the animals to choose an alternate time to come and limit their exposure to the animals.

One of the ways to predict if the experience of an animal intervention is appropriate for a patient would be to include questions on intake to screen for the issues outlined above pertaining to health issues and interest in animals. You can also add questions to post care surveys to see if your execution of the plan meets the program’s expectations. These processes should be addressed in the facility’s policies and procedures.

Questions to answer in this section of your assessment of patients include:

  1. How do you determine who will get a visit or have a dog involved in their therapy?
  2. How will you screen for allergies or fear of animals?
  3. How will you screen for behavioral issues that may preclude a patient from safely handling an animal?
  4. How will you schedule different types of animals to minimize the risk of conflicts? For example, who will be in charge of making sure a cat and dog are not scheduled at the same time if there is no history on the animal’s behavior with the other?

Animal & Team Selection

As we discussed earlier in this course, a variety of animals can be used for animal-assisted therapy and animal-assisted activities. Dogs are typically used, but if it is determined that other animals will be used, what special considerations are needed to accommodate these animals?

One of the benefits of partnering with a reputable organization that has experience in animal-assisted therapy programs is that they have the knowledge and resources to offer the best demonstrated practices in selecting a dog that is right for your setting. The stringent guidelines that organizations like Canine Assisted Therapy and Pet Partners offer to any organization are a key component in a successful program.

Why is all this important? The American Veterinary Medical Association sums it up in their definition of the human-animal bond. As you may recall, “The human-animal bond is a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors that are essential to the health and well-being of both. This includes, but is not limited to, emotional, psychological, and physical interactions of people, animals, and the environment.” A key factor here is the interactions being “mutually beneficial”. To make pet therapy mutually beneficial, it is critical that a therapy team be suitable for a facility and vise versa. If “the dog is safe and happy, those they are serving will be safe and happy”. To place a therapy team into a facility where there are stressors to the dog makes the environment less than ideal for that dog. When a dog is stressed, he or she is not able to fully focus on the interaction resulting in a less than optimal experience for the recipient. In addition, a stressed animal is more likely to behave in ways that may not necessarily be the “norm” for that animal. Most importantly, placing a dog or any other therapy animal in a situation that is not conductive to his or her strengths and comfort level, it not fair to the animal. It can result in rapid “burn out” for the therapy dog causing the dog to no longer enjoy performing therapy work. Therapy work must be enjoyable for the animal so that it is beneficial to the people receiving the therapy.

According to Canine Assisted Therapy (C.A.T.) there should be clear and consistent guidelines to evaluate a pet therapy team. If there is not an organization or organized group of pet therapy volunteers in your area that will help with the placement of teams into your facility, it is important to know how to evaluate and determine if a therapy team is suitable for your facility. Here is a four-step process to evaluate the dog and the team to determine if they are a good fit for your facility or department and the patients and/or residents.

Step 1. Assess the environment where the animal interactions will take place.

  • How much activity is taking place?
  • Are individuals sitting in wheelchairs or chairs?
  • Will the interactions take place in a busy waiting room or a quiet area?
  • Will this take place in a therapy room where there will be lots of noise and equipment?
  • What kind of distractions might there be?
  • Are there medical machines that turn on and off intermittently?
  • Are patients moving around in wheelchairs?
  • Is there equipment present that may create noise or otherwise be disturbing to a dog?
  • Do the participants have the potential for outbursts or behavioral issues?

Step 2. Establish the purpose of the interactions.

  • Are the interactions geared toward socialization of the patients or residents with no specific goals to be achieved from the interaction?
  • Will the team be visiting individuals in their rooms, common areas or waiting rooms to ease stress or provide comfort?
  • Are the interactions goal driven and include assistance in PT, OT, or Speech Therapy?

Step 3. Determine the type of team that is best suited for your needs.

  • Hospitals, nursing homes or assisted living facilities: These types of environments are conducive to most therapy teams. There are no specific goals involved other than to improve the mood of the patients or residents. The handler should exhibit good interactive people skills. The dog should be comfortable around most medical equipment and actively seek out the attention of most everyone he or she comes into contact with. The handler should have good control of the dog. The dog should be able to perform basic commands of sit, down, stay and walk on a loose leash next to the handler without pulling.
  • Physical/Occupational/Speech or other “therapy” environments: Teams that work in a “goal oriented” interaction must be more experienced in providing not only the animal-assisted activities as listed above, but should also have some additional traits. The handler should have exceptional control of the dog. The dog should react to their handler’s commands without hesitation. It is important to note that the handler should always use positive reinforcement when interacting with their dog. No leash corrections or harsh tones should be used.
  • The dog should be able to focus attention on one individual (patient) despite the presence of numerous people. The dog should be comfortable being handled on all parts of their body and with activities like brushing. The handler should be focused on the dog and should not attempt to control the therapy session except to offer input regarding the capabilities, comfort, and safety of the dog.
  • Most importantly the handler must be the advocate for their dog.
  • Teams working with children or individuals with special needs must exhibit all of the traits listed above, be very comfortable in the environment, actively seek out the attention of children, and be stable around unpredictable behaviors.

Step 4. Assessment of the Therapy Team

Indicators of a suitable therapy team can vary, but generally speaking, both the handler and the dog should walk into the facility or treatment room with confidence. The handler should be approachable and engaging with staff and patients. The dog should appear happy with their tail wagging or in a neutral position (i.e. – tail is not tucked). The dog should actively seek out the attention of those present in the room. The handler should be very attentive to the dog and concerned about the proper placement of the dog for interactions. The handler should have the dog well under control and the dog should not pull on the leash, jump, or act overly excited.

Teams should be observed from the time they walk into the front door of the facility for any indication of stress from the dog. These indicators may be:

  • Hesitation to enter the facility or a specific room.
  • Tail tucked and body position low to the ground.
  • Hesitation to approach people. Hesitation may be specific, i.e.- does not want to approach the patient in a wheelchair or with crutches.
  • Dog is anxious or appears uncomfortable.
  • Dog shows two or more of the following behaviors can indicate stress. NOTE: These are just a few of the known behaviors that may indicate stress in a dog. A good handler will know what stress signals their dog exhibits.
  • Excessive lip licking
  • Yawning
  • Panting
  • Looking away or sniffing at the ground or objects to avoid making contact with a person
  • Ears pinned back
  • Low body posture
  • Tense movement
  • Sitting out of reach of the person receiving interaction

Liability Assessment

Any program must be assessed for its risk to patients. The institution must determine the necessary steps to reduce or eliminate potential dangers. Along with infection due to exposure to an animal, the concern of a bite or scratch from an animal is also considered a liability. The risk of a bite can be minimized with strict adherence to animal selection and making sure the animal is the right fit for the program with the right temperament. Behavioral assessment of the animal can reduce the risk of scratches as well. The handler plays a key role in reducing the liability of bites or scratches by knowing their animal, reading signs of stress, deciding when it’s time to give the animal a break or end a session, and maintaining control over the animal at all times.

A question that often arises is whether or not it is advisable to use one’s own pet that is certified or registered for therapy work when simultaneously acting as the clinician. There are few standardized guidelines for pet therapy and virtually none for therapists using their own dogs when providing services. There are numerous issues if a therapist chooses to use their personal dog for therapy work, but here are certainly the most important to consider according to Canine Assisted Therapy (C.A.T.):

  • The vast majority of therapy organizations that register or certify therapy animals are “volunteer”. The liability insurance for the organization that the team is registered or certified through only covers the dog and handler when they are acting in the capacity of a volunteer for the organization. As soon as a therapist is “working” at their profession, i.e. – providing therapy whether it is physical, occupational, speech, etc., they are no longer working in the capacity of a volunteer and therefore are not covered by the insurance provided by the organization.
  • Professional liability insurance may provide coverage for using a personal animal for therapy. It is important with your own professional liability insurance carrier to determine if this is covered on your policy or can be added to your policy.
  • There is potential liability of working with your own dog while simultaneously acting as a therapist with a patient. As a therapist you must determine if it is truly possible to handle your dog and provide quality therapy to a patient while dividing your attention between the dog and the person. For example, if you are the handler and the physical therapist working with a patient and you and the patient are walking down the hallway with a double loop leash, although you have control of the dog with the patient, what happens if the patient starts to fall and you need both hands to protect the patient? You either put the patient at risk for falling because you are unable to use proper assistive techniques or you put your dog at risk for injury in an unpredictable situation. Either way you may compromise the safety of the person and/or the dog in this situation. While it is possible to have another therapist or support personnel assisting they would need to be able to take control of the patient since you are the primary handler for the dog and would likely have the greatest control over the animal. You have to make the decision if this set up works for your facility or institution. It is important to remember that you could cause a dog to never be able to work as a therapy dog again with one unfortunate incident. As the owner, you would have to determine if that risk is one worth taking.
  • If you are playing dual roles of handler and therapist simultaneously your institution will need to determine if there are any concerns with billing practices that need to be addressed. Federally funded programs have specific guidelines regarding supervision of more than one patient at one time. Your institution would need to determine if there were any concerns about you acting as handler and therapist while billing for therapy.
  • Although the risk of infectious diseases, bites and scratches is not remarkable based on the information gathered through the CDC, insurance coverage for this program is imperative. Partnering with organizations like Canine Assisted Therapy or Pet Partners that carry liability insurance may be a benefit to some smaller institutions to help defray some of the cost of the program. If the organization chooses to carry their own insurance they should be certain the program is adequately covered. As we discussed earlier, a therapist using their own dog through a volunteer organization may not be covered by the liability insurance of the organization if they are acting as both the handler and the therapist, so this should be clear to avoid having any potential claims denied.

Infections are a major concern in any healthcare facility. One of the questions that frequently arise when implementing animal-assisted programs is “what is the risk of transmission of pathogens from animals to humans?” This process is called “zoonoses”. This risk of zoonotic diseases, diseases that can be transferred from human to animal or vice versa, can be a barrier to an institution or facility wanting to pursue a program. However, the Centers for Disease Control and Prevention Guidelines that address animal-assisted interventions states that of the known diseases that can be transmitted between human to dog has limited data that suggests that an infectious outbreak has occurred as a result of an animal-human interaction in a facility using animals as part of a program. According to Fine, “cats and dogs carry human pathogens which, along with those carried by other animals, have been associated with more than 150 zoonotic diseases.” However, Fine also noted that very few cases of transmission in any animal-assisted program have been reported. So, while although the risk exists it is very unlikely that a disease will be passed between an animal and a human in the course on an animal-assisted intervention.

According to C.A.T., the goal of infection control policies is to ensure that Animal-Assisted Activities and Animal-Assisted Therapy programs and animal handler teams (volunteer and dog) visiting healthcare facilities are to follow appropriate infection prevention and control procedures.

The procedures to mitigate injury and allergic responses to animals include:

A. Each animal visiting a healthcare facility must:

  1. Be clean in order to minimize shedding of dander and odor;
  2. Be groomed to remove loose hair before each visit;
  3. Have short nails with no rough edges
  4. Be free of parasites, and
  5. Be provided the opportunity to eliminate prior to entering any facility

B. Handlers must:

  1. Ask each client/patient if he or she would like to interact with the animal before proceeding with the animal (make sure to confirm that the patient/client is not allergic to animals);
  2.  Use care to see that patients/clients avoid contact with animal feces, saliva or urine;
  3. Discourage clients/patients from feeding any animal (if an exception is made, make sure no treats are raw);
  4. Never leave animal alone with a patient/client;
  5. Keep animal on a short leash to provide for strict control at all times;
  6. Take all reasonable precautions to prevent animal bites or scratches;
  7. Clean up animal accidents of urine, stool, saliva etc. (see requirements below):
    a) Handlers shall carry a “spill” kit at all times to immediately take action.
    b) Clean-up of substances from environmental surfaces requires gloves and the use of a leak-resistant plastic bag.
    c) Handlers shall notify medical personnel of the occurrence of any “accident,” and complete an Incident Report.

Visits will be Cancelled or Terminated If:

A. Animal (i) is ill due to diarrhea, vomiting, running nose or eyes, skin lesions, excessive scratching/chewing, open sores or cuts, etc. [In such event, C.A.T. has authority to require an updated Certificate of Health from a veterinarian prior to resuming visits] or (ii) eliminates inside the facility.

B. Handler is ill.

C. Facility limits access to people due to a community outbreak of influenza or other communicable disease.

Health Requirements of Animal – Each Animal Must:

A. Be current on its rabies vaccination;

B. Have all recommended immunizations and prophylactic medications;

C. Be evaluated regularly for health and behavior;

D. Have a certificate of veterinary inspection from an accredited veterinarian (which shall be kept current);

E. Be free of fleas & ticks;

F. Have routine screening for enteric parasites, and if positive, must be treated for it.

General Restrictions.

A. Volunteer teams are not to enter a room where the patient/client is on infection control precautions or isolation.

B. Animals are restricted from access to the following areas: food-preparation, laundry, central sterile supply and clean supply storage, medication preparation, operating rooms, and general treatment areas.

C. Handlers shall not eat, drink, apply make-up or contact lenses in patient care areas, nurses work stations or any other open common area of the facility.


 

Assessment of Wellness Guidelines for Animals

Regardless of how low the risk is, animals should be monitored for signs of illness which includes, but is not limited to: wounds, hot spots, ear infections. The facility policy and procedures manual should always include proof from a veterinarian that the animal has had a routine check up and all shots are current. In states where dog licenses are required the animal should have a tag that clearly displays their compliance with these vaccines. To meet the requirements of infectious control for any program it is important to consult with a veterinarian to ensure the safety of both patients and animals.

The following information is provided by the AVMA on their website at https.ebusiness.avma.org. The information was most recently revised in 2011 and is taken directly from the website. It is titled “Wellness Guidelines for Animals in Animal-Assisted Activity, Animal-Assisted Therapy and Resident Animal Programs” (Oversight: CHAB; EB 04/01; Revised 11/01, 11/05, 11/06, 04/11).

“Some of the most common concerns facing veterinarians involved in animal-assisted activity (AAA), animal-assisted therapy (AAT), and resident animal (RA) programs are zoonotic disease risks and behavioral problems. These guidelines are not intended to address these complex issues in detail. Instead, they were developed to provide veterinarians with a platform on which to build a knowledge base, to help ensure that the animals involved are protected, and to maximize the therapeutic applications of the human-animal bond.

Wellness programs should be designed to provide reasonable assurance that animals used in AAA, AAT, and RA programs are: 1) healthy, so as to reduce the bi-directional risk of transmission of zoonoses; 2) behaviorally appropriate for the program, and: 3) protected from being harmed by participation in the program. A wellness program goes beyond annual physical examinations and associated vaccinations and medications. Rather, it involves continuous monitoring by the RP (responsible person) and periodic monitoring by the veterinarian for the purpose of developing preventive care strategies that will enhance the health and welfare of the animal. Total wellness encompasses the physical and behavioral attributes of the animal, as well as the characteristics of interaction between people and animals participating in the program.

Specifically, to ensure the welfare of human and animal participants, a veterinarian should be actively involved in all AAA, AAT, and RA programs. Positive human and animal outcomes are dependent on a close partnership and frequent communication between the veterinarian and the RP, as well as good communication with licensed therapists (e.g., occupational and physical therapists) and a qualified animal behaviorist.

The attending veterinarian should be familiar with the types of tasks that will be expected of the animal(s) and have experience with the physical and behavioral characteristics of the species to be used in the program. This is particularly important when physical or behavioral changes are detected in animals, because this information, in addition to good communication between the veterinarian and the RP, will help the veterinarian assess whether changes are caused by participation in the AAA, AAT, or RA program.

A mechanism should be in place to permit the veterinarian to periodically assess the physical and behavioral health and well being of the animal(s) involved. The wellness program should proactively enhance the health and well being of the animal(s) and should include regularly scheduled examinations and preventive care.

Wellness programs should be tailored to fit the needs of individual animals. Species, age, breed, and any risk factors that could jeopardize an animal’s health and welfare should be considered. Dogs and cats should not be used in these programs until they are at least six months old and are prepared for participation, and the special needs of elderly animals should be addressed. Appropriate ages for other species should also be considered, taking into account physical and zoonotic risks, behavioral appropriateness, and stressors that may adversely affect young or elderly animals in these programs.

Wellness programs should include regular vaccination; parasite prevention and control; selected screening for common diseases and conditions; behavioral evaluation; preventive medical, dental, nutritional, and behavioral care, including environmental enrichment; and an assessment of genetic health when appropriate.

A decline in animal wellness may manifest itself as a physical or behavioral change. Because wellness is dynamic, wellness programs should be flexible and modified to accommodate the changing needs of animals as they age or as a result of participation in AAA, AAT, or RA programs.

The RP must be willing to share the results of an animal’s medical and behavioral evaluations (usually in summary format) with regulatory agencies that have legal oversight for the target populations of AAA, AAT, and RA programs.

Daily recommendations concerning animal wellness must be readily available to all members of a household or facility so that everyone can be involved in maintaining the health and welfare of animal(s) involved in AAA, AAT, and RA programs. However, sharing recommendations and encouraging others to promote animal wellness does not eliminate the need for, or duties of, a RP.

Wellness visits should include a thorough physical examination that includes assessment of nutritional and oral health, screening for selected infectious and parasitic diseases, evaluation of behavior and lifestyle factors related to the animal and others in the household or facility, a reproductive health assessment, and an evaluation for congenital diseases and/or conditions. Preexisting medical conditions or potential behavior problems that might be worsened by AAA, AAT, or RA activities should be documented and the RP informed about associated risks and medical or behavioral changes that might indicate worsening of the condition.

Animals should be vaccinated for rabies (if appropriate for that species) in accordance with local and state ordinances or regulations. Other vaccinations should be given at appropriate intervals, as determined by the veterinarian, to be in the best interest of the animal, its RP, and the individuals with whom the animal will be in contact.

Internal and external parasite prevention and control programs should be implemented in accordance with local risks and the life stage of the animal. The practitioner should keep in mind that these animals may not be candidates for certain topical insecticides because of the degree of handling and petting associated with AAA, AAT, and RA programs.

Disabilities should not necessarily eliminate an animal from participation in AAA, AAT, or RA programs. Amputees or deaf animals, if otherwise healthy, can have a positive impact on special populations, providing their activities do not exacerbate their disabilities and that the ability that is lacking is not necessary for safe and effective interaction with the target population. Participation of animals having conditions that may affect their mobility should be evaluated in light of the physical facilities of the AAA, AAT, or RA program (e.g., a dog with hip dysplasia may have difficulty maneuvering stairs or long hallways). Disabled animals must be monitored closely by the RP and the attending veterinarian to ensure that the animal’s participation does not exacerbate an existing medical condition or adversely affect its ability to provide needed services.

Screening tests should be selected on the basis of their ability to identify medical problems in these animals and to reduce bi-directional risks of transmission of potential pathogens between animals and humans. Results of screening tests should be evaluated with regard to realistic risks to humans and animals. Appropriate treatment and risk management should be instituted if needed. Interactions of animals with immunocompromised individuals may justify use of certain screening tests that would not be necessary if those animals were only interacting with immunocompetent populations.

The RP should be provided with information on maintaining the animal’s hair coat and nail quality, and should be taught to do a basic assessment of their animal’s skin condition. Excessive grooming or bathing (including the use of harsh products) in preparation for AAA or AAT or as part of a maintenance protocol for a RA may be deleterious.

Medications administered to participating animals should be reviewed for their appropriateness (e.g., animals treated with immunosuppressive medications may be at greater risk of contracting infectious agents).


 

Selected Preventive Behavioral Strategies

During wellness visits, the attending veterinarian should specifically address behavioral health. Questions about the appropriateness or inappropriateness of elimination can reveal information that may relate to other training and health issues. Reports of inappropriate elimination should be probed to determine their possible association with participation in AAA, AAT, or RA programs. Behavioral changes may occur more frequently as animal’s age or if medical conditions cause discomfort or pain.

Behaviors that could be considered inappropriate must be assessed in the context of RP expectations and tolerances. For example, some RP expect dogs to chew and cats to scratch. Behaviors tolerated in the home may not be acceptable in hospital or long-term care facilities and the RP should be counseled to this effect.

Behaviors should be evaluated in the context of the general physical and behavioral health of the animal, as well as with respect to the animal’s age and any pre-existing conditions. For example, aggression may be a consequence of irritability associated with a medical condition. Changes in elimination frequency or volume may be associated with an underlying medical cause or be an effect of aging.

The RP must ensure that resident animals are provided regular opportunities for play, quiet time, and rest separate from activities involving contacts with residents and staff. Similar consideration must be afforded animals used for AAA and AAT.

The RP and facility residents should be educated about behavioral signs that might indicate that an animal is not enjoying an activity associated with AAA, AAT, or its residence in the facility. The RP and residents must carefully observe the animal’s body language to detect signs of stress, discomfort, anxiety, or fear. They must also be aware of changes in sleep and eating patterns that could reflect excess stress or lack of proper care associated with the AAA, AAT, or RA program. The appearance of such signs should be discussed with a veterinarian to determine appropriate interventions. Interventions could include more frequent breaks, a “vacation” for the animal, or discontinuing its participation depending on the factors associated with stress. Intervention options may need to be explored with a person knowledgeable in animal behavior and the operation of AAA, AAT, and RA programs to determine what is reasonable.”


 

Other Considerations

Animals should be trained not to pick things off the floor unless instructed by the RP. In some facilities, powerful human medications may accidentally fall to the floor or be intentionally offered to these animals.

There should be a coding system to alert the RP to rooms that should not be entered because their occupants do not want to interact with animals or because of a greater risk of contracting or transmitting an infectious disease.

The RP, veterinarian, and other involved parties must be aware that working animals may need to be retired because of their age, reduced enthusiasm for their job, or physical or behavioral concerns. One of the hardest decisions to make in any of these programs may very well be deciding when it is time to call it “quits”.

These considerations will help provide a healthy and safe environment for both the animals and people that are part of, or come in contact with an animal-assisted program. The AVMA website https.ebusiness.avma.org is a good resource for all parties interested in starting an animal-assisted intervention program. The above information was taken directly from the site and provides answers to many of the questions on behavioral and zoonotic diseases.

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