You will remember from previous chapters that animal-assisted activities (AAA) include therapy dog visitation and are referred to as AAT by many in the media and scholarly journals. However, there is a distinct difference between the two. AAA may mean any range of activities, and are often unstructured and serve to provide enjoyment, entertainment, and distraction from medical conditions and the medical environment. Although associated with many positive outcomes, including reductions in stress, anxiety, loneliness, depression, and pain in some patients, AAA is not delivered as part of a patient’s care plan to reach treatment goals (see Figure 15). Below are examples of actual facility patient case experiences.
Figure 15 A physical rehabilitation patient pets a therapy dog after completing a task during treatment. (Photo by Rebecca A. Vokes.)
7.1Animal-Assisted Therapy (AAT)
A relatively new complementary therapy, AAT is structured to produce a desired outcome for a particular patient through interaction with the therapy dog. AAT is typically delivered by a health care professional and incorporated into a patient’s care plan. AAT has the potential to contribute to many positive patient outcomes; however, more research is needed to identify what outcomes can be impacted in what settings and for which patients. AAT should have a documented treatment goal and be included with traditional interventions in the patient’s medical record, along with the patient’s response to the intervention and progress toward goal achievement. As an administrator you should consult with health care information technology staff and clinicians in order to determine how best to record AAT in the patient’s electronic health record (EHR).
7.2AAT Case Examples
B. V. is a 29-year-old male with multiple fractures to both hands as the result of a fall while skiing. He underwent an operation to mend metacarpals and proximal phalanges in both hands, and is now undergoing regular physical therapy at the orthopedic rehabilitation unit. He is having trouble regaining the use of his dominant hand in particular, and often becomes visibly frustrated, sometimes even refusing to continue with a session. After discussing the case with the patient’s care team, the physical therapist arranges for AAT at an upcoming session and incorporates the dog into exercises that encourage the use of patient’s dominant hand. The patient shows increased motivation to use his dominant hand to toss a tennis ball across the room to the dog. The dog’s retrieval of the ball, returning it to the patient and waiting for it to be thrown again, encourages the patient to repeat the exercise multiple times. After the AAT session, B. V. is asked for feedback on the exercise with the dog and expresses the desire to work with the dog again. The physical therapist schedules further AAT sessions. The goal is to increase the patient’s participation in physical rehabilitation exercises, and to improve hand function by using the hand to pet the dog, brush the dog, and throw toys for the dog. The sessions are recorded in the provider notes section of B. V.’s EHR.
S. H. is a 56-year-old female diagnosed with major depression and hospitalized after a suicide attempt. A dog lover, the patient is isolating herself in her room and interacting little with staff or other patients. Her psychiatrist requests AAT to encourage the patient to leave her room and interact more with other patients and staff. A licensed professional counselor in the facility’s AAI program meets with the treatment team to discuss the AAT plan. She subsequently brings her therapy dog to the unit and encourages the patient to walk the dog in the hallway with her. As the patient walks the dog, holding one end of a double leash also held by the counselor, other patients and staff approach her to pet the dog and talk with the patient about the dog. The interaction is noted by the psychiatrist in her client notes.
Some health care facilities are interested in having a more constant presence of a dog on a particular service for longer periods of time than the hour or two typical for AAT or AAI. The intensive health care environment with high stimuli, unpredictability, multiple staff and patients, and unusual sounds and smells creates an unnatural and stressful environment for dogs. Advanced training is needed for dogs to work comfortably in such a setting for long periods of time. Some service dog organizations (e.g., Canine Companions for Independence) train facility dogs for this purpose. Facility dogs are expertly trained to work with a handler/facilitator in a setting specific to the handler’s qualifications. Facility dogs are highly trained to reliably respond to numerous commands to facilitate a professional working with populations with special needs (see Figure 16).
Figure 16 This facility dog serves at an inpatient psychiatric unit for children. A facility dog can provide valuable animal-assisted interventions for an inpatient or residential population. (Photo by Lindy Rodman, VCU University Relations.)