Animal-Assisted

InterventionsBeki Dellow

Occupational Therapist

May 2013

Learning Outcomes• How do animals make us feel?

• Definitions

• Case study – Dorothy – Pets as therapy

• Evidence-base

• Implications

• Local and National Guidelines

• Summary

• Day Hospital – Meet Tia and Eunice

• Questions

• References

‘Those of you who know the power of a wet, cold nose, a

loving look that melts your heart, or a wagging tail that

makes you smile, you can readily imagine the potential of

uncovering that power to heal the pain that often floods our

clients’ (Pichot and Coulter, 2007 p6)

How do animals make

us feel?

‘He makes me feel relaxed and

unconditionally loved when he curls up on

my lap; he makes me feel invigorated

when I take him out for a long walk on a

fresh day; he makes me feel safe when I'm

home alone; he exasperates me when he

molts all over my clothes and furniture!

The list is endless! But I wouldn't change

him for the world cos the pros outweigh

the cons! ‘ :-)

‘My pets make me feel happy and wanted,

especially after a bad day, coming home to

the affection (purring) of my cat and my

dogs wagging tail being excited to see me

gives me a buzz!!! But in a phrase

probably "happy and content"!!’ :)

‘Accepted and always have

someone to talk to. Company

and external focus - you can't let

your animals get hungry just

because you feel down or

fatigued’

‘Awww, well I would not be

without my boys, they are good

company, know when I am

unhappy or poorly, they are

loving, faithful and just love

their mum lol (Simba &

Sweetie)’

Definitions

Animal-Assisted

Interventions (AAI)

‘A broad term that includes what is traditionally

known as Animal-Assisted Therapy or Animal-

Assisted Activities’Society for Companion Animal Studies (2010)

Animal-Assisted Activities

(AAA)

‘The casual meet and greet activities that

involve pets visiting people. The same activity

can be repeated with many people, unlike a

therapy programme that is tailored to a

particular person or medical condition’Delta Society (2009a p1)

Animal-Assisted Therapy

(AAT)

‘A goal-directed intervention directed and/or

delivered by a health/human service or professional

with specialised expertise, and within the scope of

practice of his/her profession. AAT is designed to

promote improvement in human physical, social,

emotional, and/or cognitive functioning’Delta Society (2009a p1)

Case Study

Meet Dorothy• Recovering from a stroke on the

rehabilitation ward (Left-sided weakness)

• Lived alone but had a supportive family

• Difficult to engage in traditional

occupational therapy interventions (e.g.

personal care) despite encouragement .

Nurses bed-bathing

• Had remained in bed recently, hoist

transfers onto the commode/wheelchair.

Not participating in physiotherapy

• Lost hope and given up on life

Thinking Outside the Box• What could I do differently to

motivate Dorothy?

• What was meaningful to her?

• What did her loved-ones think?

• Policy/procedures/team

thoughts?

• How? When? Where?

Meet Holly• Photograph of Holly on the windowsill

• Smiled when she talked about Holly and missed her

• Initially didn’t want to see her, ‘it will be too painful’,

‘she might jump up on me’, ‘it wouldn’t be fair to

Holly’

• Family on board and staff – gentle encouragement

• Meetings arranged with Holly and Dorothy’s daughter

in the hospital grounds

• Dorothy reported feeling happy during these

emotional interactions with Holly and her mood

appeared to lift

Special Study

Thinking Outside the

Box

An Exploratory Study into Occupational

Therapy Staff Views of Animal-Assisted

Interventions: Opportunities and

Implications for Occupational Therapy

Practice with Patients in a Hospital

Setting

Research Question

What do occupational therapists and

occupational therapy assistants

understand about Animal-Assisted

Interventions, and how do they

consider this service can be

integrated into their practice with

patients in a hospital setting?

Evidence-Base

Recent Studies

Animal-assisted interventions for elderly patients affected

by dementia or psychiatric disorders: A review (Bernabei

et al 2013)

•Literature review: 18 articles on dementia, 5 on psychiatric disorders

•AAI were found to have positive influences on demented patients by

reducing the degree of agitation and improving quality and degree of

social interaction

•Positive effect on coping ability and communication

•No results on cognitive performance

•Suggested more research examining the frequency of sessions, suitable

target groups and optimal AAI duration

Recent Studies cont.

Impact of animal-assisted therapy for outpatients

with fibromyalgia (Marcus et al 2013)

•Evaluation of the effects of brief therapy dog visits compared to time

spent in a waiting room (patients attending a tertiary outpatient pain

management facility)

•Self-reported pain, fatigue and emotional distress

•Data evaluated from 106 therapy dog visits and 49 waiting room

controls

•Average intervention duration 12 minutes

•Significant improvements were reported for mood, pain and other

measures of distress after the therapy dog visit

•Concluded that brief therapy dog visits may provide a valuable

complementary therapy for fibromyalgia outpatients

Recent Studies cont.Developing effective animal-assisted intervention

programmes involving visiting dogs for institutionalised

geriatric patients: A pilot study (Berry et al 2012)

•19 patients (men and women), mean age of 85

•Interactions between patients and visiting dogs occurred either in a

therapeutic context (physical therapy sessions) or in a social

situation (socialisation sessions)

•Measured mood, depressive state, social interactions, apathy,

cortisol levels were measured in the saliva

•Dog-mediated interactions affected the daily increase in cortisol

levels, having an ‘activational effect’ in contrast to the apathetic

state of the institutionalised older people, concluding that they

appear to be promising tools to improve social skills and enrich their

daily activities

Recent Studies cont.

An evaluation of an Animal-Assisted Therapy program

in an adult inpatient rehabilitation unit (Markovich and

Kristen 2012)

•Qualitative analysis of patient feedback surveys and an analysis of

data from a measurement log used to assess changes in mobility and

ambulation goals in traditional therapy versus AAT sessions

•Themes included enjoyable emotional and physical interaction with the

dog, distraction from pain and discomfort and dog’s assistance in

therapy goals

•85% had improved standing tolerance with AAT, 42% mobility improved

•Suggested future studies to examine differences between effectiveness

of AAT with specific therapy goals

American StudyCasey (1996)

• Surveyed American occupational therapists who had

experience of using Pet-Facilitated Therapy (PFT) in their

practice

• Concluded that PFT has the potential of becoming a more

recognised modality in occupational therapy and could be

used in practice in both health care and service user’s homes

with ease

• Identified drawbacks and highlighted the need for standards

of practice and protocols to be developed

American Study cont.Casey (1996)

• Risks are addressed and acknowledged, such as

exposure to allergens and possible injury to service

users

• Pointed out that the issue of potential injury or abuse of

the animals themselves is not raised by any of the

participants

• Stated that the need for further research due to the

diverse nature of PFT and suggested people’s own pets

potentially being used to promote mobility and

motivation

American Study cont.Casey (1996)

• Increased attention and

motivation during

treatment

• Increased eye contact

• Followed directions better

• Demonstrated increased

verbalisation during the

PFT sessions

Norwegian Study Berget et al (2009)

• Measured therapists’ and farmers’ attitudes,

knowledge and experiences of Animal-Assisted

Therapy (AAT) with farm animals for clients with

psychiatric disorders

• Delivered as part of Green Care (a concept that

involves the use of farm animals, landscape, gardens

and plants in co-operation with health institutes for

different groups of clients)

Norwegian Study cont.Berget et al (2009)

• Most therapists confirmed the evident potential of

offering AAT services with farm animals, believing

that it had contributed to clients increased

interaction skills with other humans

• The study concluded that AAT using farm animals

was was believed to contribute more successfully to

clients with mental health problems than any other

occupational therapy interventions

American StudyVelde et al (2005)

• Analysed three qualitative case

studies, including Ferrese et al (1998)

- Described the perceptions of

occupational therapist and clients

regarding AAT

- American occupational therapists

working with older people in long-

term care settings (psychiatric, skilled

nursing facilities, facility for people

with developmental disabilities) were

interviewed

American Study cont.Velde et al (2005)

• Positive themes were reported including:

- Resident’s motivation, range of motion,

tolerance levels from physical activity

when pain is present

- Sensory interpretation and modulation

increased with animal interactions

- Emotional well-being was enhanced

- Social interactions improved

- Opportunities for nurturing were

provided

- A home-like environment seemed to be

created by AAT

Texas StudyHinman and Heyl (2002)

• Case study of a nursing home assessed the impact of the Eden

Alternative on the functional behaviours of the residents

• The Eden Alternative was developed to reduce resident’s

feelings of boredom, loneliness and helplessness through

interactions with animals (e.g. dogs and cats), children and

plants in their environment

Texas Study cont.Hinman and Heyl (2002)

• Interactions with animals were most commonly

observed and behaviours involving animals occurred

more frequently than those with children did or plants

did

• Residents mobility increased

• Motivation improved

• Anxiety and stress decreased when petting animals

• Observations of interactions with the animals elicited

a variety of positive social and physical responses

including a desire to assume a care-giving role,

smiling, laughing and talking

Implications

Local and National

Guidelines

Infection Prevention and Control Guideline No19

Animals in the Healthcare Setting (January 2012 –

2015)

Policy Statement

A key function of infection control is balancing the individual needs of patients with the needs of others in a healthcare environment. Allowing animals in hospital is therefore based upon a case by case risk assessment

Key Points• Animals used as therapy (e.g. Pets As Therapy, Caring

Canines), may have access to the rehabilitation wards at

Christchurch hospital

• Royal Bournemouth visitations must be individually risk

assessed in liaison with infection control policy

• Animals must not be permitted into or pass through the

following areas:

- Surgical, Orthopaedic wards, Acute Medical wards, Theatres,

Intensive Care Unit/ Coronary Care Unit/ High Dependency

Unit, Haematology/ Oncology, Isolation rooms or in contact

with patients with known transmissible infections/ disease,

Kitchens

Key Points• Responsibility of ward/ department manager to ensure

compliance with guidelines

• Ensure Animal-Assisted Activity/Therapy form is completed and

placed in patients notes prior to any visit

• Responsibility of the animal keeper to ensure required

documentation is up to date and available

• Animal keeper must remain with the animal at all times and kept

on a lead

• All staff on duty must be familiar with infection control guidelines

• Hands of all patients and staff must be washed following animal

contact

Patients own Pet

Visiting• Pets must be on a lead at all

times or appropriately

caged/contained

• No young animals prior to

primary inoculations

• Pet to have contact with patient

only

• Pet must be housetrained and

exercised prior to visit

• Pet must not enter hospital

premises if ill

• Contact may need to be reviewed

if the patient is immuno-

compromised

NICE Guideline -

DementiaThe NICE-SCIE Guideline on Supporting People with Dementia and their Carers in

Health and Social Care

(National Collaborating Centre for Mental Health 2007)

1.8.1.3: A range of tailored interventions, such as reminiscence therapy,

multi sensory stimulation, animal-assisted therapy and exercise, should

be available for people with dementia who have depression and/or

anxiety’ (p33)

8.6.1.2: For all people with all types and severities of dementia who

have comorbid agitation, consideration should be given to providing

access to interventions tailored to the person’s preferences, skills and

abilities. Approaches that may be considered, depending on availability,

include animal-assisted therapy (p260)

Summary• There is huge potential for animals to be

used in practice, with people of all ages who

experience problems effecting both their

physical and mental health and well-being

• It is evident that further research is needed

in this field, including issues such as

infection control and consideration of the

effects on the animals themselves

Meet Eunice & Tia

Your thoughts and

experiences?

References• Berget B, Ekeberg O, Braastad BO (2008) Attitudes to Animal-Assisted

Therapy with Farm Animals Among Health Staff and Farmers Journal of

Psychiatric and Mental Health Nursing 15, 576-581

• Bernabei V, De Ronchi D, La Ferla T, Moretti F, Tonelli L, Ferrari B, Forlani

M, Atti AR (2013) Animal-Assisted Interventions for Elderly Patients

affected by Dementia or Psychiatric Disorders: A Review Journal of

Psychiatric Research 47/6 762 – 763

• Berry, Alessandra, Borgi, Marta, Terranova, Livia, Chiarotti, Flavia, Alleva,

Enrico, Cirulli, Francesca (2012) Developing Effective Animal-Assisted

Intervention Programs involving Visiting Dogs for Institutionalised Geriatric

Patients: A Pilot Study Psychogeriatrics 12/3, 143 - 150

• Casey HM (1996) A Survey of Occupational Therapists Using Pet-Facilitated

Therapy Home Health Care Management and Practice 8 (4), 10 - 17

References• Delta Society: The Human-Animal Health Connection (2009a) What are

Animal-Assisted Activities/Therapy? Bellevue: Delta Society [Online]

Available from: http://www.deltasociety.org/Document.Doc?id=10

[Accessed 6h April 2013]

• Ferrese L, Forster B, Kowalski R, Wasilewski L (1998) Occupational

Therapists: Perspectives on Using Animal-Assisted Therapy with an Elderly

Population. Unpublished Masters Project. Dallas: College Misericordia. In:

Velde BP, Cipriani J, Fisher G (2005) Resident and Therapist Views of

Animal-Assisted Therapy: Implications for Occupational Therapy Practice

Australian Occupational Therapy Journal 52, 43 – 50

• Marcus DA, Bernstein CD, Constantin JM, Kunkel FA, Breuer P, Hanlon RB

(2013) Impact of Animal-Assisted Therapy for Outpatients with

Fibromyalgia Pain Medicine 14/1, 43 – 51

• Markovich, Kristen M (2012) An evaluation of an Animal-Assisted Therapy

program in an adult inpatient hospital rehabilitation unit Dissertation

Abstracts International: Section B: The Sciences and Engineering 73/2-B,

1258

References•National Collaborating Centre for Mental Health (2007) Dementia: The

NICE-SCIE Guideline on Supporting People with Dementia and their Carers

in Health and Social Care London: The British Psychological Society & The

Royal College of Psychiatrists [Online] Available from:

http://www.nice.org.uk/nicemedia/live/10998/30320/30320.pdf [Accessed

13th April 2013]

•Pichot T, Coulter M (2007) Animal-Assisted Brief Therapy: A Solution-

Focused Approach New York: The Haworth Press

•Roenke L, Mulligan S (1998) The Therapeutic Value of the Human-Animal

Connection Occupational Therapy in Health Care 11 (2), 27 - 43

•The Society for Companion Animal Studies (2010) Animal-Assisted

Activity and Therapy Burford: The Society for Companion Animal Studies

(SCAS) in partnership with The Blue Cross [Online] Available from:

http://www.scas.org.uk/Human-companionanimalbond/Animal-

assisted_activity_and_therapy.aspx? [Accessed 14th March 2010]

•Velde BP, Cipriani J, Fisher G (2005) Resident and Therapist Views of

Animal-Assisted Therapy: Implications for Occupational Therapy Practice

Australian Occupational Therapy Journal 52, 43 - 50

Useful

Contacts/Resources• www.animal-assisted-therapy-cheshire.com/animal-assisted-therapy.html

• BSY (Animal Assisted Therapy Diploma) www.bsygroup.co.uk

• Canine Concern – Tel: 01823 664300

• Caring Canines – www.caringk9s.webeden.co.uk email:

caringcanines@btinternet.com Tel: 01202 579744

• Pet Partners (formerly Delta Society) http://petpartners.ontidwit.com/

• Pets As Therapy – www.petsastherapy.org email:

reception@petsastherapy.org Tel: 01844 345445