Now that is has become commonplace practice to use animals in a variety of ways in our society it is important to identify programs and their goals with consistent terminology to avoid confusion or misconceptions. Some of the common terms we hear include: service dogs, emotional support dogs, animal-assisted therapy dogs, animal-assisted activity dogs, and pet therapy dogs. The wide variety of uses for dogs have caused a great deal of confusion for the average person trying to understand the role of the dogs with their owners or handlers.
Often terms are used interchangeably, even by owners, which adds to the confusion. Business owners struggle to identify which animals they must allow in public places. It has occasionally led to animosity in public places between dog owners/handlers and people who don’t necessarily believe dogs should be allowed in public places. The confusion in terminology has pitted both animal lovers and human benefactors of animal relationships against the general public at restaurants, grocery stores and other public places. Understanding and using the correct terminology will accomplish three main goals:
- The person in the healthcare field will be able to distinguish among the various roles animals play in healthcare.
- The general public will become more informed and more tolerant of the animals that serve humans in various capacities.
- The person who tries to gain entry into a public place by misrepresenting their dog will become less commonplace and the legitimacy of the qualified programs will not be compromised by these situations.
Americans with Disabilities Act (ADA)
The American with Disabilities Act, specifically Titles II & III, dictate rights and responsibilities of individuals with service dogs to state and local government services (Title II) and public and commercial entities (Title III). With the advent of some other animal designations, confusion arose over the past decade and the need for further clarification of the Act became evident. The Department of Justice published final revisions to the Act in 2010 to add clarity to some of the issues that have come up since the Act was first put in place in 1990.
According to the ADA, a service dog is typically allowed to accompany a person with a disability almost anywhere the general public is allowed including: restaurants, businesses and cabins of airplanes. It is the expectation that the animal is well maintained, housebroken, healthy and not disruptive. According to the ADA, service dogs must be under control and leashed or harnessed unless it specifically interferes with the work they are doing for the disabled individual.
There are some exceptions to this rule of access, but those exceptions are very few and far between. For example, a service dog can access most areas of a hospital but it would not be appropriate for them to access operating rooms or burn units where there is a sterile environment that the animal may compromise.
Allergies or being afraid of dogs are not valid reasons to deny access. Instead, the expectation is that reasonable accommodations should be made to both parties in this situation as best as possible. For example, increasing the space between the two parties and placing them as far away as possible from one another is a reasonable accommodation. Service dogs must be allowed in places that serve or sell food, so even if local or state codes prohibit animals in this setting, this is not an acceptable reason to deny access to an individual with a service dog.
The ADA makes very specific provisions for inquiring about the legitimacy of service animals accompanying individuals. If it is not clear why the animal is accompanying an individual only limited inquiries are allowed. “Staff may ask two questions: (1) is the service animal required because of a disability, and (2) what work or task has the dog been trained to perform?” Staff cannot require any proof of disability or documentation for the dog, nor can they require the individual to have the dog demonstrate the kind of work it performs.
According to the Department of Justice, “A service animal is a dog that is individually trained to do work or perform tasks for a person with a disability.” Examples of a “working dog” would be dogs that guide people who are visually impaired or dogs that alert people with hearing impairments. Service dogs can be used to remind patients to take medications, provide mobility assistance to individuals with those needs, calm individuals with Post Traumatic Stress Disorder (PTSD) during an anxiety attack, or alert and protect a person experiencing a seizure. Service dogs are considered working animals and are not considered pets. A working dog is trained to provide the assistance directly related to the limitations of the disabled individual. Therefore, a dog whose sole function is to provide emotional support or comfort is not a service dog and is not afforded all the same rights as a service dog under the ADA.
Emotional Support Animal (ESA)
Also commonly referred to as a “comfort animal”, an emotional support animal is a pet that provides therapeutic support to a person with a mental illness. Emotional support animals must be prescribed by a licensed mental health professional for a person with a mental illness. The mental health professional must specifically state what the impairment is that substantially limits the person from one or more major life activities for a valid prescription. Further, they must state that the presence of the animal is necessary for the individual’s mental health status.
As discussed in the ADA section, individuals with emotional support animals do not have the same rights to public access as do individuals with a service dog. Emotional support animals may only accompany their owners in public areas if permission is granted from the individual establishment and/or facility management. ESAs may travel with their owner on an airplane and may live with their owner in locations covered by the Fair Housing Amendments Act (FHAA) regardless of a ‘“no pet” policy being in place.
Delta Society/Pet Partners has been instrumental in providing clarification on terminology to reduce the confusion of the roles animals play and the expectations based on the defined roles. It is important to be familiar with the different terms and use them properly in your healthcare setting to avoid confusion among staff, patients and visitors. Below is a summary of terminology that the Delta Society/Pet Partners has published for clarification on their website: www.petpartners.org.
A therapy animal provides affection, support, and comfort in a variety of settings. These settings may include: hospitals, outpatient and inpatient rehabilitation centers, skilled nursing facilities, assisted living facilities, retirement communities and homes, medical offices and schools. A therapy animal has no special rights of access, except in those facilities they have established a relationship and have been granted access. They are not entitled to enter businesses with “no pets” policies or accompany their handler in the cabin of airplanes regardless of their therapy animal designation.
Resident Animal (RA)
This term describes an animal that lives in a facility full time and is owned by the facility. The animal is cared for by staff, volunteers, and residents of the facility in any combination deemed appropriate by the facility. Resident animals may be part of a formal goal oriented program, may be involved in meet and greet activities or a combination of both. It is important to remember that based on the intent of the program the animal is involved with, this will determine whether it is an animal-assisted activity or animal-assisted therapy. One animal can be involved in multiple programs within the same facility.
Responsible Person (RP)
The designated person or persons responsible for the health, welfare, and behavior of the animal or animals on a daily basis has a critical role in well being of the animal. The RP may be the owner, a handler, or may be a staff member(s) who has been delegated these responsibilities. This person or persons are responsible for caring for the animal and coordinating all the services they need from grooming to veterinary care. They are ultimately responsible for the well-being of the animal.
One of the most common phrases used when referring to animals working with humans and healthcare workers is “pet therapy”. This is a “catch all” phrase that incorporates a lot of different interactions but perhaps doesn’t describe any of them accurately. The term “pet therapy” can be misleading. Because it is a more global term, it does not refer to specific programs. Since there are various types of programs using animals, handlers and healthcare providers in any combination with the intent of improving the health or function of human beings, identifying those programs and using more specific terminology can decrease some of the confusion around all of these programs.
By definition “pet therapy” is a term that is used to refer to therapy provided to a pet, including animal behavior training programs. Today we use the terms “animal-assisted activities” or “animal-assisted therapy” or “animal-assisted interventions” to describe the programs that hospitals, skilled nursing homes, assisted living facilities, schools and outpatient clinical settings typically participate in with animals. Pet Partners defines these terms as “the involvement of animals in human treatment programs”. Animal-assisted therapy involves working with a licensed healthcare provider to help a patient meet specific goals. Animal-assisted activities are defined as more informal interactions between pets and people without specific goals. Animal-assisted interventions incorporates a broader range of programs.
Pet Therapy Team
This team consists of a dog and their handler. The handler is typically the owner, but does not necessarily have to be the owner. The dog must be responsive to the handler and consistently obey basic commands. The person handling the dog must have a strong relationship with the dog and know the dog’s threshold for work so they maintain a safe environment for patients and the dog. The pet therapy team can be involved in animal- assisted activities or animal-assisted therapy depending on the intent of the activity.
Pet Therapy Dog
This is the dog that is a member of the pet therapy team.
All activities that use an animal-human team to provide services to any variety of facilities is an animal assisted intervention. These interventions include everything from “meet and greet” activities to goal specific therapy activities. This term has become the popular alternative to “pet therapy” because it reduces the confusion regarding whether the therapy is being performed “by a pet” or “on a pet”.
Animal-Assisted Activities (AAA)
According to Pet Partners, “Animal-Assisted Activities are the casual meet and greet activities that involve pets visiting people. The same activity can be repeated with many people, unlike a therapy program that is tailored to a particular person or medical condition.” These activities provide opportunities for people to interact with pets in ways that will enhance the quality of their lives. These animal interactions can motivate an individual to do something by giving them confidence they need to complete the activity. AAA may provide an animal to someone who doesn’t have their own animal or whose own animal does not possess the necessary behaviors to drive the desired results.
Animal-assisted activities can occur in a wide array of settings and can include licensed healthcare workers, handlers, family members and volunteers in any combination interacting with a qualified animal. Visits can be scheduled or spontaneous and can be with individuals or in a group setting. It is not necessary for an underlying medical condition to exist in order for this interaction to occur. There is not a specific goal, time frame or documentation that needs to occur with animal-assisted activities. Although there is no established goal for these activities it does not mean there is no benefit.
An example of AAA would be a handler bringing their dog to a nursing home to visit residents. There are no set treatment goals of the visits. There is no documentation in a patient note and outside of signing in and out there is no record of the visit required.
Animal-Assisted Therapy (AAT)
“AAT is a goal-directed intervention directed and/or delivered by a health/human service professional with specialized expertise, and within the scope of practice of his/her profession” according to Pet Partners. “AAT is designed to promote improvement in human physical, social, emotional, behavioral, and/or cognitive functioning.”
These programs are usually directed and delivered by human health or services professionals with expertise in a particular focused area and within the scope of their professional practice act. Healthcare providers engaged in animal-assisted therapy most commonly include physical and occupational therapists but may also include nurses, speech therapists and recreational therapists.
These therapy programs may be provided in a variety of settings. In AAT, specified goals and objectives are determined for each patient and their progress is evaluated and documented. AAT can be, and often is, integrated into other therapy activities to accentuate positive results of the therapy plan. The expectation is that for the duration of the interaction with the animal there will be short term benefits. When a benefit is noticed it is typically noticed in more than one of the aspects listed and is documented so the goal that it is addressing is apparent.
Example of AAT:
A man has been placed in a rehab hospital recovering from a stroke and has limited use of his right upper extremity. Family members have mentioned to the physical therapist that the man is depressed because he misses his two dogs at home. The therapist utilizes the presence of a dog to motivate the patient to use his right arm by placing the dog on his right side in a sitting position and asking the client to pet, stroke or brush the dog’s back and head.
Below is a list of key points for AAA and AAT that Pet Partners has provided as a summary on their website:
* Casual “meet and greet” activities that involve pets visiting people
* No specific treatment goals
* Same activity can be used for one person or a group
* Documentation is not required
* Visit does not require a specific plan
* Length of visit is not important
* Treatment plan is established for a person with an identified impairment
* Goals must be established for each session
* Treatment must be on an individual basis
* Documentation is required for each visit or session
* Visit and visit frequency is established with the healthcare provider and are scheduled with the patient for compliance.
* Duration of treatment is based on patient’s tolerance