Te.D2 - Therapy dog Handler: development of a certified

training course for dog handler in the AAI According to the ECVET

Procedures

Research Report

TABLE OF CONTENTS

Pages Description

Abbreviations

Introduction to Animal Assisted Therapy/Assistance (AAT/AAA)

Project Description

Background to AAT/AAA

Introduction to the National Reports prepared by the Consortium Countries

National Report: Romania

National Report: Italy

National Report: Lithuana

National Report: Malta

National Report: Portugal

National Report: Spain

Overall Finding

Limitations of the Research Process

Conclusions

ABBREVIATIONS

Word Abbreviations

Animal Assisted Therapy

Animal Assisted Intervention

Animal Assisted Education

Animal Assisted Activity

AAT

AAI

AAE

AAA

1. INTRODUCTION TO ANIMAL ASSISTED THERAPY/ASSISTANCE (AAT/AAA) Animal assisted therapy (AAT) as defined by the Pet Partners, formerly known as Delta Society, is a ‘goal-directed intervention in which an animal that meets specific criteria is an integral part of the treatment process’ (Kruger, Trachtenberg & Serpell 2004). AAT involves specifically trained animals and professionals working as co-therapists (Pet Partners, 2012). The European Society for Animal Assisted Therapy (ESAAT) defines it as a ‘deliberately planned pedagogy, psychological and socially integrative interventions with animals for children, youths, adults and senior citizens with cognitive, social-emotional and motor disabilities, behavioural problems and for focused support. It also includes health-promoting, prevention and rehabilitative measures’ (ESAAT 2011). In deed, the use of animals in promoting and improving the life of humans has been around for a long time, yet the complementary healing modality is not widely integrated into mainstream education and healthcare. Animals and humans have co-existed in therapeutic relationships with each other for more than 12,000 years (Serpell 2000). Records demonstrate that animals were used in different roles from companions to therapy for persons suffering from several conditions such as epilepsy, mental disorder, terminal illness and anxiety/stress disorder. It is well known that Animal-assisted therapy is designed to promote improvement in human physical, social, emotional and/or cognitive function (Fine, 2000). In most cases, AAT/AAA, which utilizes animals such as dogs, cats, horses, and dolphins, is not a stand-alone therapy, but rather used to enhance current interventions. Research indicates that the use of animals provides “stress-reducing or stress-buffering social supports” resulting in lowered blood pressure, reduced anxiety, and increased communication efforts. Additionally, studies examining the impact of AAT/AAA on children have found that the inclusion of animals during therapy serves as a catalyst in getting them to talk and bond with the therapist. Nonetheless, Most of European countries have problem when it comes to the lack of legal regulations and accreditations of different national bodies. This report is build from national reports prepared by partners in Te.D2 project, an innovative support and training programme, derived from a training course developed by ULSS 4 Alto Vicentino - Italy, which aids long term unemployed, to enter or re-enter the labour market in a new area of work.

1.2. PROJECT PRESENTATION Te.D2 - Therapy dog Handler: development of a certified training course for dog

handler in the AAI According to the ECVET Procedures" is a project funded under the

Erasmus + program, implemented by the Vasiliada Association – as Lead Partner,

with six major organizations from Europe:

• N.E.T. Networking Education & Training Association - Italy;

• Local Health Unit ULSS 4 Alto Vicentino - Italy;

• "Švietimo, tyrimu ir konsultaciju centras" Association - Lithuania;

• EPRALIMA_Escola Profissional do Alto Lima, C.I.P.R.L. - Portugal;

• The Geminarie Group - Malta

• "Social Asocrom" Association – Spain The main objective of the project is to develop an accredited training program, in the profession of handler dog - a major innovation for Romania. Project implementation period is December 215 - August 2017. The specific objectives of the project will be to adapt the Italian model to 6 countries, meeting the needs of the particular labour market contexts, VET systems and needs of the target groups in each country. 1.3. BACKGROUND TO AAT/AAT Since the 1970s the general global view of people was that pets were either a luxury or a throwaway item. However, a differnet phenomenon was bserved by a group of doctors and veterinarians who united their observations, stating that pets were having a positive impact on their human clients' health and happiness. They theorised that there was much more to this than just their patients' happiness and agreed that more scientific research há to be conducted on this matter. Thus, in 1977, the Delta Foundation was founded and in 1981, the organizations' name was changed to Delta Society. Undeniably, the Delta Society believed and worked to improve human health through the service and therapy animals founded by Dr. McCulloch, pioneering in the field of studying the therapeutic effects of the human-animal bond. In deed, AAT/AAA involves the “use” of trained animals in facilitating progress towards therapeutic goals. However, this is something that has not been well documented and the lack of studies to directlty examine the effects of pet therapy is clearly evident in most EU States.

1.4. INTRODUCTION TO THE NATIONAL REPORTS PREPARED BY THE CONSORTIUM COUNTRIES In view of what was written above, this research report aims at creating awareness of the different attitudes/approaches adopted in relation to AAT/AAA in the European countries and to present amongst other things national initiatives and strategies to promote AAT/AAA as well as highlight common problems in the consortium countries.

ANIMAL ASSISTED INTERVENTIONS IN ROMANIA BY VASILIADA ASSOCIATION

2.1 National Situation of AAT/AAA in Romania Animal assisted therapy (TAA) is a goal-oriented intervention in which an animal that meets specific criteria is an integral part of the therapeutic process. TAA is provided by a specialist who works with the animal in the course of therapy. Based on the contingency plan drawn up earlier in the standard therapy sessions are introduced elements of TAA, activities that rely on human-animal interaction, consonant with established therapeutic goals. A pet is an animal therapy previously been evaluated, trained and certified and designed to facilitate the relationship between the beneficiary and therapist. TAA shall foster social, emotional and cognitive development of a beneficiary, provide effective educational and motivational for participants, helping to achieve therapeutic goals or optimize its health. TAA may be provided in a variety of contexts, and may be integrated into individual therapy, and the treatment group. The therapeutic process is documented and evaluated. Animal assisted activities (AAA) consists of activities that are based on human interaction - animal having a recreational purpose and spontaneous, not being guided by a protocol previously agreed. They are not monitored or quantified objectives, providing opportunities AAA motivational, educational and / or recreational enrichment of quality of life. Animal assisted therapy (TAA), with animal assisted activities (AAA) are grouped under the generic name of animal-assisted interventions. Unlike other countries, Romania does not have a legislative framework for TAA, and any regulations regarding the settlement of these services .However, in our country exist qualified staff and dogs and horses TAA programs in Cluj, Bucharest, Iasi, Sibiu, Timisoara, Satu-Mare. Vier Pfoten Foundation involve from many years therapy dogs how may also perform search and rescue missions. Babes-Bolyai University in collaboration with the University of Agricultural Sciences and Veterinary Medicine in Cluj offers a postgraduate course in TAA training for people with special needs, bringing together students from all over Romania. However, now we are talking small numbers: few trained animals and few "jobs" for them. Regarding the interviews applied to organizations, 70% of those who provided information in this research say they have started to use animal therapy after 2010.

They also consider that animals in therapy it is an effective way to improve the quality of support programs for children with special needs. Also, 86% of respondents in this research began to provide animal-assisted therapy in an organized way, by setting up NGOs. Their target groups are especially represented by children and people with disabilities; also, they provide specialized services both in cabinet and in the schools, kindergartens and other educational centers. 2.2. Main National Trends Interest in therapy and assisted activities animal in Romania dates back somewhere in early 2000, when various foundations and associations of animal protection began to offer services to people (from children to the elderly) how needs physical and intellectual recovery. Although it was practiced by several national NGOs, animal assisted therapy is not well known at the national level, and, at this moment also, it is not viewed like a choice of therapy, beneficiaries prefer classical therapies (medical or psychological), primarily due to lack of specific information. At the moment, in Romania, there is no legislative framework to regulate this form of therapy. All the therapy activities are regulated by procedures and regulations developed by different NGOs who practice this activity. In Romania there is only legislation relating to stray dogs and modalities for holding dangerous dogs. Another national trend is related with the need to prepare specialists in animal-assisted therapy for persons with disabilities, children with special needs, people with mental disorders, etc. But, the first step in achieving this is to develop a new profession in Romanian legislation, namely Animal Therapist or Dog Handler. Regarding scientific validated approach to animal assisted therapy in Romania, we can say that it began in 2006, when the Babes-Bolyai University (Faculty of Psychology and Educational Sciences) offered a postgraduate course of therapy and animal assisted activities (course coordinator: assoc. prof. dr. Alina Rusu). Also in the Faculty of Psychology and Educational Sciences, It began coordinating graduation papers and dissertation papers in the field of human-animal interaction, activities that have resulted in various articles and books. And over the period 2006-2014 were conducted several research projects on the effects of interaction with pets (dog therapy) on increasing the efficiency of different procedures standard treatment such as behavioral therapy and method of Social Stories for children diagnosed with autism, namely:

1. The Effects of Animal Assisted Therapy on Communication and Social Skills: A Meta-Analysis: Authors: Chitic, Victor; Rusu, Alina S.; Szamoskozi, Stefan – Publication date: March 2012; Source: Academic Journal: Transylvanian Journal of Psychology; Vol. 13 Issue 1, p1 Abstract: A meta-analysis was conducted to determine the effectiveness of Animal Assisted Therapy procedures (AAT) on the communication and social skills of several categories of individuals. The inclusion criteria for the articles were: (1) to be published in English, (2) to cover the AAT domain, (3) to utilize a control group, and (4) to offer enough data to allow the calculation of the effect size (d Cohen's) of the AAT interventions on the social and communication skills. Four studies met the selection criteria. A large effect size was found for the effects of AAT programs on improving the communication and social skills of individuals participating to the studies. Also, several variables moderating the effects of AAT were identified, such as: the type of animal used and its level of training, the method of therapy administration (i.e., individual, group or mixed), the type of measurement and the number and duration of the sessions. Further research is needed to clarify the functional mechanisms of AAT. However, the current meta-analysis indicates that AAT might function as a complementary therapy in the treatment of communication and social skills deficits. 2. Interaction with a Therapy Dog Enhances the Effects of Social Story Method in Autistic Children: Andreea A. Grigore1 and Alina S. Rusu - Publication date: 2014; Source: Society & Animals, Volume 22, Issue 3, pages 241 – 261 This study explored the effects of a combination between two methods that have proved to enhance the social abilities of autistic children—Social Story and Animal Assisted Therapy. The main hypothesis of this investigation was that a naturally enriched social environment (i.e., the presence of a therapy dog) improves the effectiveness of Social Story method. Two social skills were targeted: (1) the ability to greet a social partner and (2) the ability to introduce oneself to a social partner, by using a standard single-subject research design. Three preschool autistic children were included in the study. The dependent variables were the frequency of the appropriate social interactions relevant to the target social skill, the level of prompt needed to provide the expected social response, and the frequency of social initiations. The presence of the therapy dog while reading the social story increased the frequency of social initiations and decreased the level of social prompt needed to elicit social responses from children with autism. Regarding the opinion of the stakeholders, just 3 of 10 people interviewed know specific information related to animals assisted therapy and took contact in their work with this type of therapeutic intervention. However, all those interviewed showed their interest to have access to information about the range and would be interested to explore the possibility of promoting animal therapy in the institutions in which they

work. A broad segment of social service providers feels the need to increase the level of promoting the benefits of animal therapy, in perspective of diversification and development assistance and therapy services to people with special needs. In this regard, 8 in 10 respondents said they do not know the legal aspects that regulate this activity and have no information about training programs in this field but are interested in such programs and would be willing to facilitate the participation of employees in training courses for animal-assisted therapy. As for the need to authorized a specific professions in the field of therapeutic intervention, the stakeholders interviewed believe that a specific profession would find difficult to place in Romanian infrastructure of social work, but considers appropriate to initiation / specialization in this area other professionals, such as psychologists, social workers, psychologists, etc. Their specialization in animal assisted therapy would provide them the opportunity to improve therapy methods they use with different groups of vulnerable people. 2.3. National Bodies responsible for AAT/AAA At the moment, in Romania, there is no national body responsible for AAT/AAA. 2.4 National Policies, Strategies and Initiatives implemented to promote and improve AAT/AAA As stated above, there is no legislative framework to regulate this form of therapy. All animal assisted activities are regulated by procedures and regulations developed by different NGOs who practice this activity. In Romania there is only legislation relating to stray dogs and modalities for holding dangerous dogs. 2.5. The Therapy Dog Trainer There is no national framework in place to regulate the Therapy Dog Trainer. 2.6. Identification of Best practices Even if, in this moment, in Romania there is no specific legislation that regulate this type of activity, there are several NGOs that have developed animal therapy services:

• Dog Assist Association – Cluj-Napoca, Romania: The "Keep calm with dogs" is developed, since January 2014 by the Dog Assist Association in partnership with the Babes-Bolyai University and the Agricultural Sciences and Veterinary Medicine University. The project is addresses to students from both educational institutions and aims to reduce the stress associated with exams session by interacting with therapy dogs.

• Vier Pfoten Foundation – Bucharest, Romania: The organization started to conduct animal therapy programs in Romania, since 2004. Starting 2014, the organization opened an Animal Assisted Therapy Day Centre - Dogs for People; in this center, they use stray dogs who are specially selected and trained for these type of activities. The therapy sessions are conducted by a team of psychotherapists, coaches and specially trained dogs. The beneficiaries of the therapy programme, are children in need.

• Therapy Animals” Association – Galati, Romania

• Therapy Animals” "Therapy Animals" is a non-profit association made up of volunteers whose mission is to bring people and animals together: The activities of therapy are generally addressed to adults and children suffering from various psychological disorders, social, physical (people with impaired vision, speech, hearing, physically disabled, disabilities, mobility impairments), children diagnosed with attention deficit hyperactivity disorder, and healthy people who want to enjoy the companionship of animals.

• “Angel Dog” Association – Satu Mare, Romania: The organization has acquired legal personality in late 2009 of the members shared passion for man's best friend - the dog. The organization's goal is to train guide dogs for the blind, the rehabilitation of persons with disabilities, solitary persons, with animal assisted therapy. 2.7 Bibliography and References

1. http://www.dogassist.ro/terapie-asistata-de-animale/ 2. https://caini-utilitari.ro/activitati/terapie-asistata-de-animale/ 3. http://www.vier-pfoten.ro/proiecte/caini-pentru-oameni-terapie-asistata-de-

animale/ 4. http://www.vier-pfoten.ro/proiecte/caini-pentru-oameni-terapie-asistata-de-

animale/ 5. http://terapeuti.ro/afectiuni-tuburari-psihice/rolul-terapeutic-al-animalelor-

terapia-asistata-de-animale 6. http://terapeuti.ro/afectiuni-tuburari-psihice/rolul-terapeutic-al-animalelor-

terapia-asistata-de-animale/ 7. http://www.psihospecialist.ro/index.php/en/articole-m/113-rolul-terapeutic-al-

animalelor-si-terapia-asistata-de-animale.html 8. http://ziarulfaclia.ro/conf-univ-dr-alina-s-rusu-ciinii-cele-mai-indicate-animale-

de-companie/ 9. http://jurnalul.ro/viata-sanatoasa/terapii-complementare/terapia-cu-animale-

691992.html

10. http://psiedu.ubbcluj.ro/data/uploads/doc/curs_perfectionare/editia-05-curs_postuniv_terapie_asistata_de_animale.pdf

11. http://www.teranima.ro/

12. http://www.scritub.com/medicina/TERAPIA-ASISTATA-DE-ANIMALE-

IN15320202311.php

13. http://www.asociatia-activity.ro/terapia-asistata-de-animale/

14. http://www.digi24.ro/Utile/Search/?q=terapie%20asistata%20de%20animale

15. http://www.psihoterapeutul.ro/servicii/terapia-asistata-de-animale/

16. http://www.agerpres.ro/social/2016/01/28/a-fost-deschis-primul-centru-de-terapie-asistata-de-animale-in-care-sunt-folositi-caini-comunitari-13-44-45

17. http://www.copiiidecristal.ro/terapia-asistata-de-animale/

ANIMAL ASSISTED INTERVENTIONS IN ITALY

BY ASSOCIAZIONE N.E.T & ULSS4

3. Abstract: The use of animals for therapeutic educational purposes fits into the broader context of the relationship man-animal, a relationship with ancient roots. In recent years approaches that rely on the use of pets both for therapeutic and educational purposes were re-evaluated and implemented considerably due to the change of the role of animals in today's society and thanks to a series of documents / rules that have started to give general indications about Assisted Interventions with Animals and also thanks to the research activities at national level. 3.1 National Situation of AAT/AAA in Italy: The use of pets for assisted activities has been recognized as an official care with the President of the Council of Ministers Decree on the 28 of February 2003. [1] This Decree has established for the first time in the history of our country the role that an animal can have in the emotional life of a person and the therapeutic value of pets. The definition of worth methodological tools and guidelines regulating such practices is needed by all professional groups working in this field in order to safeguard both human health and the welfare of animals used in therapies. It should be emphasized that the people involved are most frequently represented by the elderly or children, particularly vulnerable and in need of customized interventions, especially in the case of specific diseases. In Italy until 2015 the situation was extremely heterogeneous. There was not a clear legal definition regarding the procedures and minimum requirements necessary to start activities with animals. This led to the creation of a heterogeneous landscape of workplace self managed and often self certified, with operational methods often very different one another. At the same time, the self referring training is neither coordinated nor regulated. Moreover the information regarding the AAI is also still insufficient, sometimes offered in a sensationalist way, and also the scientific research is just at the beginning. The latest transposing of the National Guide Lines partially solved the above mentioned critical issues.

3.2. Main National trends: The therapeutic/educational employment of animals started in Italy 20 years ago from the European and USA researches of the ’60. There is not an exact date but it is commonly agreed to locate the Interdisciplinary Conference on "The role of animals in today's society", held in Milan on December 6, 1987, as the date on which in Italy we started to talk about AAI in an official manner. From that moment on, there was a revival of cultural initiatives at various levels: International Conference "Anthropology of a passion", dedicated to the human-animal relationship and the therapeutic role of animals, Milan 1991. SISCA (Italian Society for Applied Behavioral Sciences), organized in 1997, in Padua. A conference entitled "Pet Therapy-getting better with animals" and in 1999 in San Patrignano a conference entitled "the dog helps man - the discovery of Pet Therapy." At the same time we are witnessing an increase in activities involving horses, dogs and dolphins and, in more recent times, even donkeys. One of the main factors that has limited the development of AAI in Italy is certainly to be found in the fact that, at least until a few years ago, the activity was carried out almost exclusively by vets, who have had the honor to lead and spread the culture of animals in teaching contexts, but have not been able to engage in an important way doctors, psychologists, etc. depositories of care, education and re-education of people. Until a decade ago, many works have been carried out. Nevertheless they were not coordinated nor adequately disseminated and shared and this has meant that much valuable information was lost. The first interventions made in Italy consisted of visiting schools, 56%, [2] nursing homes for the elderly, 33%, [2]. In schools the main goal was the dissemination of knowledge in the field of animal. Meetings focused on ethological knowledge of various domestic species with particular attention to dogs Later the main objective was compounded by the need to prevent attacks by dogs and prevent dropouts through specific education in schools. In nursing homes for elderly, the goal was to foster interpersonal relationships, support the mood and make people have a good time. Only when even doctors and psychologists began to be interested in AAI, we began to implement projects and research of a scientific nature and experience the effectiveness of AAI in more areas and especially to pay greater attention to the AAT (animal assisted therapy). At the same time the need to take into account the point of view of the animals emerged. It was an ethical and juridical issue but also practical. The belief that the effectiveness of therapeutic practice was linked, in an important way, to the fact that the animal involved is a positive participant and has as such benefits from the practice to the point of being able to speak of a kind of inter-species "therapeutic

alliance" became more and more important. 3.3. National Bodies in charge of AAT/AA In 2009, with the Ministry of Labour Health and Social Policy Decree, at the headquarters of the Istituto Zoo profilattico Sperimentale delle Venezie nearby Verona and Vicenza the National Reference Centre for AAI - Pet – therapy is started up. There are many public and private organizations that have been working for several years with Pet Therapy, both in terms of training, research and implementation of activities, these include universities, associations, health services. Some example to follow: Aicote (Rome), Aiuca (Lecco), Antropozoa (Florence), ANIRE(Milan), Anucss (Rome), Auriga (Rome), Dogs For Life (Trento), Cave Canem (Padova),Center Pet Therapy Health Authority4" Alto Vicentino"(Vicenza), Equestrian Rehabilitation Center" Vittorio DiCapua "Niguarda (Milan), Equestrian Rehabilitation Center Villa Buon Respiro(Viterbo), Cooperative"LesignolaLaboratory(ReggioEmilia), Facultyof Veterinary Medicine(Pisa), Faculty'of Veterinary Medicine(Sassari), Facultyof Veterinary Medicine(Teramo), Polozoo-anthropological(Trieste). SIUA(Bologna). The National Guide Lines of March 23rd 2015, transposed to each Region in 2016 expect that all structures involved with AAI in different ways must have specific requirements in order to be included in a specific list. As soon as this list will be completed it will be published and available for consultation. 3.4 National policies, strategies and initiatives to promote and improve AAT/AAA In Italy we started speaking about AAA/AAT in 1987 in a Conference held in Milan, but we have to wait till 2003 when the Italian government and laws speak about the issue. With the State-Regions Agreement on the welfare of pets and pet therapy of 6 February 2003, the Italian Regions and the State undertook to "facilitate the maintenance of contact of individuals, elderly and children in particular, whether they are residents at residential facilities, such as nursing homes and sheltered accommodation or admitted to institutions of care, with a pet they own or with animals still employable for the "pet therapy." This agreement was then inserted into the President of the Council of Ministers Decree of the 28 February 2003, providing, each one within their own skills, the adoption of provisions aimed at the use of pet therapy for the treatment of elderly and children. The two regulations give to the Regions the responsibility to issue specific and additional laws for Pet Therapy. In 2005, the Veneto region issues, first region in Italy, the Regional Law n. 3 dated 03 of January 2005 on "Measures on complementary therapies (smile therapy and pet therapy)" in which the pet therapy is defined as a set of activities and therapeutic

practices carried out alongside the traditional medical therapies, with the use of animals. The law then goes on to other topics concerning the training of the workers, the method of application and the need to carry out a proper research. [3] From this law, which, however, is effective only within the Veneto region, a working group is created with the aim to identify specific guidelines. [4] This working group involved different professionals like doctors, vets, psychologists, educators, professional dog trainers, etc., have the task of "defining the procedures and responsibilities for the design, prescription, administration and evaluation of assets and care practices, therapeutic and rehabilitative involvement with animals, implemented together with the traditional medicine therapies and defining operational standards applicable throughout the region related to the activities and practices with care and treatment of animals involved by applying the principles of LR 3/2005. (Regional Law) " In 2005 the opinion of the National Bioethics Committee on the bioethical issues related to the use of animals in activities related to health and human well-being was released. [5] In this document four types of human-animal relationships for the purpose of human well-being and health are taken into consideration: a sick human beings living with an animal in their own home or in a nursing home; training and employment of an animal who aids a disabled person in his/her daily life; the assisted therapy with animals and the assisted activities with animals. Later, other regions have issued similar laws to give specific guidelines about the AAI: Apulia Region, the Regional Law n. 11 of 21 May 2008, the Autonomous Province of Trento, Provincial Law no. 4 of 28 May 2012; The autonomous Region of Valle D'Aosta, Resolution no. 1731 of 24 August 2012; Friuli Venezia Giulia Region, Regional Law n. 154 of 22 March 2012. In 2009, with the Ministry of Labour Health and Social Policy Decree, at the headquarters of the Istituto Zoo profilattico Sperimentale delle Venezie nearby Verona and Vicenza the National Reference Centre for AAI - Pet – therapy is started up . The main activities of the National Reference Centre are a) promoting the research to standardize operational protocols for the behavioral and health control of the animals used in the programs of AAI (animal assisted intervention); b) strengthening the collaboration between human and veterinary medicine to identify synergies and operational research to guarantee an improvement of the results of activities carried out in the area of interest; c) improving the knowledge about the applicability of such interventions with certain categories of patients (elderly, children with autism, mentally disabled); d) the organization and management of training programs; e) data collection and dissemination of information to the international scientific community. [6] In November 2011, a working group specifically established has developed a draft of national guidelines, presented at the Fiera cavalli (horse fair) the same year. This document gives indication on the correct and uniform application of AAI and defines

the different areas of interests. It differs and defines what is meant by AAA, AAE and AAT, underlying four basic principles which cannot be ignored: the need for a multidisciplinary team, the importance of training for workers, as well as the protection of the patient/user and the animal. [7] A fundamental stage in the legal procedure was the latest transposition (march 23rd, 2016) of the National Guide Lines about Animal Assisted Intervention of march 23rd, 2015 by some Italian Regions. In this document all contexts related to AAI are defined: definitions, features and tasks of the multidisciplinary team, requirements for structures hosting the AAI, operational methods, types and requirements for dogs employed in AAI, training needs for all people belonging to the multidisciplinary team. 3.5. The Therapy dog trainer The animal trainer is the one who deals above all with the management of the animal within the AAI session. To be able to act in an appropriate manner requires training and a continuous improvement so that each project can be conceived, planned and implemented as efficiently and effectively as possible, in accordance with the user’s and animal’s needs. To access this training, you have to have at least a high school degree. The animal trainer, during the training will get excellent skills with respect to the animal, both from the behavioural point of view and the well-being point of views during the session he/she is the one mainly dealing with the management of the animal in all their aspects. In relation to the patient/ user he/she is supposed to have a good knowledge of diseases. This will allow him to know how to manage him/herself and manage his/her animal in different conditions and especially what to ask to the animal in relation to the specific situation. Moreover the animal trainer monitors the health and well-being of the animal,before, during and at the end of the sessions,in cooperation with the vet. The animal trainer, should have the:

– Knowledge: it refers to theoretical knowledge, the framework in which to place their own work;

– Know-how: it is the practical side, the management of the dynamics of the work settings, reading and acceptance of the emotions of the dog and people, reading the body language of the dog,how to guide the dog during the sessions;

– To be: it is the ability to"be there"during the relationship,this implies a deep knowledge of themselves and the dog and the capacity to work in team. The animal training should have a deep knowledge about: a. In relation to the dog:

• the morphology of the dog;

• the sensory system;

• the bases for learning; b. dog training fundamentals according to the relational model;

• characteristics and behavioral requirements for a "social dog";

• monitoring systems to detect the dog stress;

• interaction between men and animals;

• dog welfare;

• health aspects. c. In relation to the AAI settings:

• Deep knowledge of the different types of patients (disability, addictions, psychiatry, elderly,and conduct disorders, pervasive developmental disorder (autism spectrum); The dog trainer should also:

• identify the activities to be undertaken to achieve the objectives of the project;

• have the knowledge of legal issues and insurance. d. In relation to employment opportunities: many associations have been created: The profiles inside these associations are different and include: psychologists, vets, professional educators, animal trainers, physical therapists, etc.., everybody with a long experience in AAI that from 2016 will have to be recorded in the regional list. 3.6. Identification of Best practices: The best practices are aimed at raising the quality of professional services and addressing key issues such as: interdisciplinary, action plan, constant monitoring of human health and animal welfare in the human-animal interactions. This means that involved workers have to have a deep knowledge and be expert in the issue, planning and teamwork, integration between the knowledge of the dog trainer and the referent of intervention. [8] Among the achieved projects, some still ongoing:

• A three-year research project on the prevention of bullying: Proposer: Ass. Gli Amici di Sari, Bolzano;

• Experimental project on eating disorders(multicentric): Bodiesinvolved: S.OrsolaBologna, Emilia Region, Faculty of veterinary Bologna, Veneto, Lazio, UmbriaRegions;

• The other half: Animals Assisted Therapy session for the guests of Day Centres(multicentric). Proposer: ULSS4 "Alto Vicentino";

• All for one, one for all (multi) AAE session for primary and secondary school pupils: Proposer: ULSS4 "Alto Vicentino";

• The third Age: (multicentric) Animal Assisted Therapy for elderly of nursing homes for: Proposer: ULSS4 "Alto Vicentino";

• Zoo-anthropology and school:a donkey and a teacher: proposer: Ass Un asino per amico – Trento;

• Experimental project of rehabilitation 'ADHD through the equestrian rehabilitation. Body will: Spinal UnitNiguarda, Milan;

• Pilot study of rehabilitation with the donkeys during childhood. Proposer: Giovanni di Dio: Fate bene fratelli, Roma

• Evaluation of the effectiveness of the animal Assisted Activities session at the clinic of the University Hospital of Dentistry Meyer of Florence. Proposer: University Hospital Meyer, Ass. Antropozoa, Firenze;

• Animal Assisted Session in the rehabilitation of cognitive-behavioral disease Alzheimer's. Proposer: Department of Neuroscience and Maternal-InfantSciences, Sassari;

• Animal Assisted Therapy in the treatment of headache in children. Proposer: Salesi Hospital Foundation, Ancona;

• Pilot project on the detection of the possible therapeutic effects of Animal Assisted Activities (AAT) in ex-preterm children (28-32 SG) who are 2 years old with limited mobility / attention problems with minor brain dysfunction. Proposer: ULSS4 "Alto Vicentino";

• Study on the improvement of adaptability to the context and specific social skill learning in individuals who have suffered abuse and mistreatment through Animal Assisted Therapy with the dog (AAT). Proposer: C.E.R.R.I.S, Verona;

• Experimental project of rehabilitation of children with cerebral paralysis by equestrian session. Promoter: Spinal Unit Niguarda, Milan;

• Observational study on improving adaptability to the context and learning of specific social skills in people with autism spectrum disorder (ASD) in childhood followed in a Center of Diagnosis, Care and Research through Animal Assisted Activity with a dog (AAT ). Proposer: Centre for the diagnosis, treatment and research for autism, Ulss20, Verona;

• A research project focused on children with attention deficit disorder and hyperactivity disorder (ADHD). Proposer: Città degli Asini, Padua;

• Project “Argo, a dog as a friend” for young women with nutritional disorders. Proposer Ulss 4 “Alto Vicentino”;

• Project “that place of fairy tales”: narration, drawing and AAI at Oncoemathology Day Hospital of San Bortolo Hospital, Vicenza. Proposer Ulss 4 “Alto Vicentino”;

• AAI at Pediatric Day Hospitalat Santa Chiara Hospital, Trento. Proposer: Pediatric department of Santa Chiara Hospital, Trento;

• Pediatric surgery animal assisted intervention. Proposer San Matteo Hospital,

Pavia;

• AAI with patients suffering from chronicle diseases at reumathological Day Hospital. Porposer: EnteCareggi Hospital, Firenze;

• Assisted Psychology with horses for women whom had mastectomy. Proposer: Association “The animated hayloft”, Monza;

• Project “4 paws for nursing” Pet therapy project for pediatric oncoemathology. Proposer: Association “The Other way”, Cagliari;

• Equestrian rehabilitation and neuoromotor disabilities in developmental age. Proposer: Association Rubens, Torino; 3.7. Bibliography and References: 1. Decreto del Presidente del Consiglio dei Ministri n. 51; 03/03/03, Accordo Stato-Regioni sul benessere degli animali da compagnia e pet-therapy. 2. Cirulli F, Alleva E. Terapie e attività assistite con gli animali: analisi della situazione italiana e proposta dilinee guida. Roma: Istituto Superiore di Sanità, Rapporti ISTISAN 2007;07/35. 3. Legge Regione Veneto n. 3; 03/01/2005. Disposizioni sulle terapie complementari (terapia del sorriso e pettherapy). 4. Decreto Giunta Regionale Veneto n. 4130; 19/12/2006. Interventi assistenziali e terapeutici che prevedono il coinvolgimento di animali – Linee Guida. 5. Comitato Nazionale di Bioetica (C.N.B.). Problemi Bioetici relativi all’impiego di animali in attività correlate alla salute e al benessere umani. 2005. 6. Decreto Ministero del lavoro, della salute e delle politiche sociali; 18/06/2009. Istituzione di nuovi Centri di referenza nazionali nel settore veterinario. 7. Cavedon L. I progetti del CRN in relazione ai bisogni dell’utenza. Seminario L’attività scientifica e sperimentale del centro di referenza nazionale per gli IAA. Montecchio Precalcino 2012. 8. Cirulli F. Linee guida nazionali. Convegno nazionale Linee Guida Nazionali per gli Interventi Assistiti con gli Animali. Fieracavalli,Verona. 2011 9. Agreement betweenGovernment, Regions and AutonomousProvinces of Trento e Bolzano: “National Guide Lines for AnimalAssistedIntervention of March 23rd, 2015” 10. Moretti C.et al. Manuale Operativo Regionale. Regione Veneto 2010. 11. Marinelli et al. Metodi di valutazione della qualità della vita dell’animale da compagnia nella relazione col proprietario. In Proceedings of the Fourth National Congress of the SOFIVet, 2001; pp. 25-27. 12. Cirulli F, et al. Animal-assisted interventions as innovative tools for mental health. Ann Ist Super Sanità 2011; 47: 341-348. 13. Orlandi et al. Pet therapy effects on oncological day hospital patients undergoing chemotherapy treatment. Anticancer Res 2007;27:4301-3. 14. Abate SV et al. Impact of Canine-Assisted Ambulation on Hospitalized Chronic Heart Failure Patients' Ambulation Outcomes and Satisfaction: A Pilot Study. J CardiovascNurs 2011.

15. Cerino S e et al. Non conventional psychiatric rehabilitation in schizophrenia using therapeutic riding: the FISE multicentre Pindar project. Ann Ist Super Sanità 2011; 47: 409-414. 16. Brian Reichow et al. Development of the Evaluative Method for Evaluating and Determining Evidence-Based Practices in Autism. J Autism DevDisord 2008; 38:1311–1319. 17. Mark Weist et al. Formative Evaluation of a Framework for High Quality, Evidence-Based Services in School Mental Health. School Mental Health 2009; 1:196–211. 18. KenthSvartberga. Personality traits in the domestic dog (Canisfamiliaris). Applied Animal Behaviour science 79 (2002) 133–155. 19. Janet Eggiman. Cognitive-Behavioral Therapy: A Case Report -- Animal-Assisted Therapy. Advanced Practice Nursing eJournal. 2006;6(3). 20. Allie Phillips. Therapy Animals Supporting Kids (TASK) Program.Delta society, Manual 2008 21. Antonelli E. Cusinato E. Attività assistite da animali: effetti sul benessere soggettivo di anziane frequentanti un centro diurno. G Gerontol 2012;60:215-223 22. Verga M., Michelazzi M. Benessere degli animali da compagnia e possibili implicazioni sulla relazione uomo animale. Ital. J. Anim. Sci. 2009; vol. 8:231-240 23. Kathie M. Cole et al. Animal Assisted Therapy in patients hospitalized with heart failure. American Journal of Critical Care 2007;16:575-585 24. Tore B. Animal related activities ad appreciation of animals among children and adolescents. Antrozoos 2001; 14:2 25. Julius H. et all. L'attaccamentoaglianimali, unavisioneintegrata della relazioneuomo-animalenellapettherapy, Hogrefe, 2014 26. Giusti, E., La Fata S., Quandoilmioterapeuta è uncane, Sovera, 2004

ANIMAL ASSISTED INTERVENTIONS IN LITHUANIA BY "ŠVIETIMO, TYRIMU IR KONSULTACIJU CENTRAS" ASSOCIATION

4. Abstract: Nowadays Animal Assisted Therapy is making its very first steps in Lithuania. For this report there were made interviews with 12 dog handlers, interviews with stakeholders and an interview with government representative body. There is only a little specialized literature in animal assisted therapy field and only one scientific research report done by now. However, canine therapy is doing a big job in people’s health field and people working with AAA/AAT are doing their best to form standards or ethical guidelines for animal assisted therapy. 4.1. National Situation of AAT/AAA in Lithuania Only in the last few years first attempts to define quality criteria have been made, but the development into policies, guidelines and standards is missing, there is incomplete process documentation, lack of indicators to determine the achievement of objectives. In Lithuania there is no public body that deals only with AAA. However, The main body which regulates alternative medicine in Lithuania is Lithuanian Ministry of Health. Legitimacy of animal assisted therapy in Lithuania depends only on this institution. However, employees of the Ministry do not have the competence in AAT/AAA area, so Lithuanian healthy living and alternative medicine Chamber is preparing recommendations, which will be presented to the Ministry of Health. The question is still problematic, because today the Ministry of alternative medicine

practitioners only see people with higher medical education in animal assisted activities. This applies not only to canine therapy, and other animal therapies, but also to yoga, reiki, acupuncture, homeopathy, etc [1]. Moreover, in Lithuanian Healthy Living and Alternative Medicine Palace there a canine therapy committee is established which has six members who are working with AAT legitimization. The Lithuanian university of Health Science is preparing Masters degree courses of Animal Resource Management, which will focus on animal assisted therapy. However, this program is not yet accredited program of study by quality assessment center, but the documents for accreditation are already prepared and passed for accreditation. The profession of Animal Resource Management will help for legitimization of animal assisted therapy in Lithuania. It will be the beginning for some standards of animal assisted therapist profession. Moreover, this program will include not only dog assisted therapy but also horse, dolphin and other animals. 4.2. Main National Trends Animal assisted activities began with a meeting with people with disability, in elderly people's homes, orphanages, and later the number of meetings increased, they began to visit the oncological departments and people with mental disabilities. There are many public and private organizations that have been working for several years with Pet Therapy, both in terms of training, research and implementation of activities connected with animal therapy [3]. Nonetheless, there are a lot of of organizations in animal assisted therapy field [4]: In 2006 Lithuanian Cynological Society (LCS) members with their dogs started visiting schools, kindergartens and older care homes. In 2010 they organized a seminar - meeting with the Latvian animal assisted therapy professionals. In 2012 they started cooperation with the Polish union. This organization organizes seminars and dog testing. In 2012 "Socactiva" was founded. This NGO organizes sessions for people with disabilities, sessions are physical or artistic activities integrating animals, usually dogs. In 2013 Kaniterapija Association was founded in Vilnius and "Happy Paws" in Klaipeda. These organizations organize seminars and dog testing. They work in rehabilitation centers, homes for the elderly. In 2014 Canine Therapy Help Center was founded in Kaunas. It works in rehabilitation centers, homes for the elderly.

In 2015 Lithuanian university of Health science Canine Therapy Professional Service Center was founded. This organization is carrying out research work in the field of animal assisted therapy, organizes seminars and conferences. Works in rehabilitation centers, homes for the elderly, the blind and visually impaired education center. 4.3 National Bodies in charge of AAT/AAA It is the very beginning of AAT/AAA in Lithuania. In 2012 Ministry of Health of the Republic of Lithuania approved dolphin therapy as psycho-emotional and physical training service, which led to further strengthening of the implementation of the idea of canine therapy development. AAT in Lithuania started in 2012 and in 2013 there were a few organizations founded which are still working in canine therapy. However, most of them don’t have common standards or ethical guidelines for animal assisted therapy. Lithuanian university of Health science and Klaipeda University started to perform scientific assessment of this issue. Nowadays there is quite a lot information about AAT in newspapers, TV shows, internet sites, usually information is developed by associations and depends on the reputation of the scientists and specialists. However, there is only one official scientific research in canine therapy field. With the growing number of dogs in AAT the organizations came to the conclusion that general quality standards were needed to reach sustainable recognition and acceptance of therapy-dog-teams. 4.4. National Policies, Strategies and Initiatives implemented to promote and improve the AAT/AAA; There are no strict regulations for legal requirements for people who want to work as therapists with animals. The main role in Lithuania has the Lithuanian Ministry of Health and Lithuanian Healthy Living and Alternative Medicine Chamber. 4.5. The Therapy Dog Trainer; The discussion about qualifications of the therapy dog trainer is a relatively young and dynamically developing area of animal assisted intervention and it is only the beginning. Twelve already working therapy dog trainers were asked to tell their opinion on this research. According to the research made in Lithuania, the therapy dog handler training should depend on the already existing competencies and education of a person who wants to be a therapy dog trainer. At present, there is no such kind of training in Lithuania. Most participants would like there to be studies after universities, enabling people who do not have medical or similar education to gain essential work

with patients knowledge, and vice versa - with certain medical or biomedical field of education in the other fields of knowledge (psychology, occupational therapy, physical therapy and so on). Access to employment is currently only based on projects or in private business, and there is no other opportunity to get a job in AAT field. 4.6 Identification of Best Practices; The aim of the nonprofit organizations in Lithuania is the professionalization of animal assisted therapy and education through upgrading the qualification of the therapy dog trainers, specialists and dogs’ testing for social therapy services. The most important aim for all organizations is to evaluate their effectiveness of animal-assisted therapy and education. Therefore some scientific researches were started. In 2014 there came out the very first scientific research report in canine assisted therapy field. Kreiviniene, Zukhbaya and Asiroviene [2] made a research and results of this article showed that “ten explorative canine therapy sessions considerably increased the parameters of quality of a child’s life and their family. Analysis of educators’ and psychologist’s feedback collected after each canine therapy session revealed considerable psycho-social changes in a child: the child was more open and had more courage to communicate in peer groups, verbal expression was greater and more precise, higher range of active verbal vocabulary, and the child was smiling more often. The Questionnaire with open questions filled by the mother revealed that canine therapy increased the child’s better adaptation possibilities in school, also changes in physical parameters (greater appetite, activity). Report of canine therapy observation divulged that sessions were important for child’s greater social development, verbal expression and cognitive development. Scale of emotional evaluation showed that canine therapy sessions have great importance in developing positive emotions.” 4.7. Biblography and Refereces; 1. Ketinimų protokolas „Dėl Valstybės sankcionuoto natūraliosios medicinos ir sveikos gyvensenos savireguliavimo funkcijos perdavimo Lietuvos sveikos gyvensenos ir natūraliosios medicinos rūmams“. 2014 m. sausio 10 d. Prieiga internete: www.sveikatosrumai.lt [žiūrėta 2016 03 11]. 2. Kreivinienė B., Zukhbaya, Z., Aširovienė, L.Kaniterapijos užuomazgos Lietuvoje: vieno atvejo studija, Tiltai, 2014, 3, 109–122, ISSN 1392-3137 (Print), ISSN 2351-6569 (Online). 3. L. Aširovienė „Kaniterapija Lietu voje“, pristatymas konferencijoje “Creative methods of occupational therapy”, 2014-11-08. 4. L. Aširovienė, E. Mickuvienė, V. Samuchova „Mokinių, turinčių įvairiapusį sutrikimą, komunikacinių gebėjimų ugdymas“, 2016-01-13. pranešimas: „Kaniterapijos taikymo poveikis įvairiapusį raidos sutrikimą turintiems mokiniams.” Vide

ANIMAL ASSITED INTERVENTION IN MALTA BY THE GEMINARIE GROUP

5. Abstract; The therapeutic use of pets as companions has gained increasing attention in recent years, not least in Malta. Pet interaction has been proven to be therapeutic in helping patients making the hospital surroundings less lonely and more like one's home. A more familiar surrounding helps patients towards the road to recovery. However, AAT/AAA in Malta is still at a young stage and there is limited local evidence/research to demonstrate that such a therapy exists. To date, there is no legal framework regulating AAT/AAA in Malta and all inititiatives carried out in relation to AAT/AAA are done by non-governmental organisations on a voluntary basis.

5.1. National Sitaution in Malta

Animals in Malta are regulated by the Animal Welfare Act of 2001 with its numerous additions and amendments over the years, the Electronic Identification of Dogs regulations of 2012 and other regulations on the sale of animals and minimum standards for animal sanctuaries.

There is no legal framework governing AAT/AAA in Malta and as stated above, there is no evidence leading to the beneficial use of animal contact. However, there is widespread consensus that animal welfare is a human responsibility and may be assessed on the basis of health, nourishment, safety and the ability of express innate behaviour.

All inititiatives carried out in relation to AAT/AAA are done by non-governmental organisations. In deed, it was only in 2001 that the first Animal Welfare Act was enacted, providing an invaluable legal framework to non-governmental organisations which tirelessly advocated for animal welfare and animal rights.

The Act strengthens the role of non-governmental organisations advocating for animal welfare and generally by promoting awareness on animal welfare issues through information campaigns and dissemination of information.

During these last two years, The Ministry for Sustainable Development, the Environment and Climate Change in conjunction with the Parliamentary Secretary for Agriculture, Fisheries and Animal Rights embarked on a review of existing national legislation concerning animal welfare with the scope of introducing the following provisions:

• establishing the office of the Commissioner for Animal Welfare;

• strengthening the role of the Animal Welfare Council and non-governmental organisations,

• strengthening and clarifying the functions of the Animal Welfare Director;

• establishing the enforcement powers of animal welfare officers;

• for a ban on the introduction and use of animals in circuses;

• increasing penalties associated with infringements of animal welfare legislation

Irrespective of the above, it is impossible to ignore the fact that locally animals are often treated poorly. The regularity with which one hears of instances of cruelty is alarming, as is the apparent lack of punishment for the perpetrators. One is inclined to wonder what role the law plays in the effective protection of animals, what status these ‘subjects’ are deemed to have in relation to the law and whether their categorization has any bearing on the law and its enforcement.

In order to understand better the Maltese scenario, it would be best to begin with a synopsis of existent legislation to provide an overview of the same and in so doing draw attention to those domestic instruments, at both primary and subsidiary level, which are of most significance and highlight any relevant measures.

The Civil Code contains just a few provisions concerning animals – mainly on civil liability for damage caused by an animal. The Criminal Code contains even less with regard to animals, with only two references found therein, one in a contravention affecting public order and another in a contravention against the person. Criminal liability for the ill-treatment of an animal is not contemplated in the Criminal Code.

The Code of Police Laws has other provisions on animals, including bathing restrictions for animals as supplemented by Legal Notice 31 of 1960. The Code also attends to the subject of stray animals while stray dogs in particular are covered by the Dogs Act. The Dogs Act contains provisions relating to dangerous dogs and also establishes a licencing requirement for dogs in general.

The Animal Welfare Act also tackles aggressive animals and a multitude of issues, most of which are connected with the well-being of animals.

The Animal Welfare Act is a success in some respects and a disappointment in others. The Act provides a satisfactorily wide definition of ill-treatment in an effort to include as many forms of animal abuse as possible, thereby casting the net of liability that much further. And because animal welfare is a notion that goes beyond not inflicting harm on an animal, in the Act it is established that any person who keeps an animal or agrees to look after it is responsible for its health and welfare. This is an improvement upon the basic obligation to provide an animal with adequate food,

shelter and water that was imposed under the repealed sections of the Code of Police Laws.

The Animal Welfare Act is a success in some respects and a disappointment in others. In fact, there is no mention in our laws about the Animal Assisted Intervention and as stated above, there is no national framework regulating pet therapy locally.

5.2. Main National Trends

Even though we have no national frameowork regulating AAT/AAA in Malta, there is widespread recognition amongst different non-governmental organzitions, working in the educational and health fields that AAT is a familiar method of treatment and rehabilitation in many diseases and conditions, whereby the animal becomes an important “behavioral facilitator”, causing positive modifications in the behavior and health of the patient. Numerous authors point to its importance, and in particular that the positive feedback between the patient, the animal, and the therapist reduces many symptoms, and improves the quality of life (Yeh 2005).

5.3. National Bodies responsibel for AAT/AAA

As already stated, There is no legal framework governing AAT/AAA and there is no specific body responsible for AAT/AAA in Malta.

Nonetheless, The Maltese Government in line with its political commitment, is recommending the appointment of a Commissioner for Animal Welfare. This is considered as a significant commitment by the Government towards projecting a higher deserved status to animal welfare issues and matters related thereto. The remit of the Commissioner for Animal Welfare shall be laid out in article 44A of the proposed amendments and shall include promotion and implementation on educational campaigns for the protection of animals, promotion of compliance with the Animal Welfare Act, enhancement of cooperation between entities and persons advocating for animal welfare and the formulation of recommendations for the implementation of matters touching upon animal welfare. The proposed amendments will also empower the Commissioner to review and investigate the workings of the Animal Welfare Council and of the Directorate for Animal Welfare and Veterinary Services. The outcome of these investigations shall ultimately culminate in the publication of reports and recommendations.

5.4. National Polices, Strategies and initiatives implemented to promote and improve AAT/AAA in Malta

There are no national policies and/or strategies regulating AAT/AAA in Malta. All initiatives are carried on a voluntary basis by civil society organizations.

In this research document, we have identified various initiatives by different organizations as follows:

– St Vincent de Paul Residence (SVPR):

Providing animal therapy as an aide to combat solitude, boredom and emotional distress to elderly people;

This is a hybrid between a nursing home and a hospital with a total population of over 1,100 residents; In these last months, A cat café complex – including two cat rooms, therapy room, kitten litter room and offices – was inaugurated;

The complex, developed in collaboration with Animal Guardians, offers the space and opportunity for professional therapeutic servicesled by therapist Suzanne Portelli Demajo.

Pet therapy had already been introduced within SVPR, albeit on a smaller scale: there was a dog in one of the halls, and birds and fish in other halls.

However, cats at SVPR are very popular and have also proven to be great for animal therapy.

– Service Dog Malta

Service Dog Malta Foundation is a registered NGO which has been set up since 17th April 2013, with the aim of of helping people with special needs by providing them with a service dog that has been trained to overcome some of the difficulties that they encounter on a day to day basis. Service is offered to:

• Hearing Impaired Individuals

• Autistic Individuals

• Individuals who are wheelchair bound or who have mobility issues

• Individuals with balance issues

• Individuals needing alert for certain conditions such as seizures and diabetes

• Individuals with psychiatric disabilities

Service dogs are supplied to the person with impairment FREE of charge.

Services offered (non exhaustive list):

Pet as Therapy:

Service Dogs Malta offer a dog trained to provide affection and comfort to people in hospitals, retirement homes, nursing homes, schools, hospices, disaster areas, and to people with learning difficulties. A therapy dog's primary job is to allow unfamiliar people to make physical contact with it and to enjoy that contact. Children in particular enjoy hugging animals; adults usually enjoy simply petting the dog. The dog might need to be lifted onto, or climb onto, an individual's lap or bed and sit or lie comfortably there. Many dogs at Service Dogs Malta contribute to the visiting experience by performing small tricks for their audience or by playing carefully structured games.

Autism Assistance

Service Dogs Malta also provide service dogs trained to assist a person with autism, to help them gain independence, confidence, and the ability to perform activities of daily living similar to anyone else.

– Therapeutic Horse Riding – Inspire Foundation (Gozo)

Therapeutic Horseback Riding is a physical, occupational and speech-language therapy treatment strategy that utilizes equine movement as part of an integrated intervention program to achieve functional outcomes. Therapeutic riding can be beneficial to many people with special needs. The most obvious and often the most immediately recognisable benefit is physical, because riding is a very physical activity.

The horse provides a dynamic base of support, making it an excellent tool for increasing trunk strength and control, balance, building overall postural strength and endurance, addressing weight bearing, and motor planning. Equine movements offer well-modulated sensory input to vestibular, proprioceptive, tactile and visual channels. The effects of equine movement on postural control, sensory systems, and motor planning can be used to facilitate coordination and timing, grading of responses, respiratory control, sensory integration skills and attentional skills. Equine movement can be used to facilitate the neurophysiologic systems that support all of our functional daily living skills.

– Pet Cabin (Mater Dei Hospital)

As from next September 2016, it will also be possible to provide in-patient dog owners at Mater Dei Hospital the opportunity to re-unite with their dogs whilst under care.

A conservatory-like structure is being build, and it will be called the Reunited Pet Cabin, which will house garden furniture, which will be waterproof to allow the furniture to be hosed down for hygiene purposes, and be large enough to fit a wheelchair or even a hospital bed.

The cabin will be connected to the hospital interior so patients will not be exposed to any changes in temperature, and will also play host to other pet-related activities such as pet therapy

5.5. The Therapy Dog Trainer

There is nothing regulating Therapy Dog Trainers in our national framework.

A dog trainer is employed mainly on a position of trust because of the“experience in the sector and the role should involve amonsgt other things the training of both dogs and other dog handlers. There is also common consensus from the people interviewed that the Therapy Dog Trainer should have extensive experience with dogs/pets. The trainer should have made/or is in the process of doing studies to try and improve both in understanding dog bahviour and different training techniques.

One interviewee pointed out that a good dog trainer should be patient and have a good "feeling", an accurate intuition for what makes dogs do the things that they do. He/she should be decisive-fast handed and effective in all that he does. S/He should not be dogmatic, but flexible-always ready to re-examine his/her beliefs and methods and adapt them to the particular nature and endowment of the client.

A good dog trainer should also have the capacity to self-examine. When his/her dog makes a mistake or does not understand an exercise, s/he asks, "Where am I at fault?"

Finally, a good dog handler respects his dog not just as an asset or possession, or as a way of gaining recognition, but as a living, breathing and unique product of nature!

5.6. Identification of Best Practices

Todate there is no evience or record of a local best practice in relation to AAT/AAA.

5.7. Bibliography and References

1. 2001 Animal Welfare Act: http://www.um.edu.mt/__data/assets/pdf_file/0004/53581/AnimalWelfareAct.pdf

2. Dogs Act: http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=8788&l=1

3. Electronic identification of dogs regulations: http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=11664&l=1

4. Control of dogs regulations: http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=9752&l=1

5. Protection of animals offered in pet shops: http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=12084&l=1

6. Animal Transport Regulations: http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=11049&l=1

ANIMAL ASSISTED INTERVENTIONS IN PORTUGAL

BY EPRALIMA

6. Abstract

The Animal Assisted Therapy (AAT) is a technique focused, individualized and with specific criteria, in which the animal is an integral part of the treatment process. The AAT requires the intervention of a multi-disciplinary team of specialists in different fields, including physicians, psychologists, veterinarians and physical therapists. The AAT is a method that must be implemented, documented, evaluated and supervised regularly by health professionals duly qualified.

In Portugal, AAT is still a poorly explored field, both in theoretical and in practical points of view.

From the theoretical point of view, there are only a few academic works and the literature is still scarce. From the standpoint of the practical development, there are some organizations that are developing programmes, but there is a lack in qualified human resources, there is no access to appropriate training programmes and funding resources are needed.

There are no specific legislation and regulation about AAT in Portugal. Specific legislation only exists for guide dogs and assistance dogs. Some studies recognize the importance of AAT and some professionals seriously try to carry out some Animal Assisted Interventions, but there is no regulation regarding AAT. A recognized professional to conduct Animal Assisted Interventions doesn’t exist.

Intervention programmes are mainly developed by volunteers or in the basis of cooperation protocols between institutions.

The diagnosis carried out by Epralima regarding AAT in Portugal identified different levels of needs:

1. need to introduce national policies regarding AAT; regulate the professional profile of the Animal Assisted Therapist or regulate the profiles of the professionals who can incorporate AAT in their professional practices.

2. need to train professionals in the field of AAT and AAI; create a specialized and accredited course regarding AAI which allows to qualify professionals in AAI.

6.1 Introduction to the National Situation of AAI

Academic studies on AAT in Portugal are still few, as well as their dissemination as a valid therapeutic practice. But there are some animal assisted programmes that are being developed in various institutions.

From AAI research conducted in Portugal, we highlight the following scientific publications:

- “Effectiveness of animal-assisted interventions in preventing violence in acute psychiatric inpatients” (Marques, Mendes, Gamito & Sousa, 2015), a research article published in the Journal of Nursing with reference IV, no 5. The main objective of this research was to assess the effectiveness of an Animal-Assisted Intervention (dog) programme in preventing violence in acute psychiatric units. The programme proved to be effective in reducing the frequency and severity of aggressive behaviours and the use of psychotropic drugs. The investigators concluded that these interventions may be a complementary strategy for preventing and controlling violence in acute psychiatric inpatients.

- “The use of animals in interventions in children with Autism Spectrum Disorders” (Magalhães, 2014), a master's literature review at the Institute of Biomedical Sciences of Abel Salazar, Porto University. This work concluded that a rigorous and controlled investigation of the use of animals in interventions for children with autism spectrum disorders is necessary to permit the approval or disapproval of these interactions with strong scientific evidence.

- “Animal Assisted Therapy: a Literature Review” (Tavares, 2013), a master's literature review at the Portuguese Catholic University. This work consisted of a review of the most relevant research in this field, followed by the approach of the various forms of animal therapy, a discussion of the challenges, limitations and ethical considerations and a brief point about the state of the practice in our country.

- “The impact of Therapeutic Riding in psychomotor factors in children with special needs” (Martinho, 2011), a master's thesis at Minho University. The aim of this study was to investigate the impact that the psychomotor intervention may have under the Therapeutic Riding. Results showed an overall increase in performance in tone, lateralization, notion of the body, spatio-temporal structure, gross motor skills and fine motor skills for all children that participated in the intervention, in comparison with the period without the implementation of PPTR. Therefore, this study illustrates the importance of Therapeutic Riding as an effective and appropriate practice with children with special needs.

- “The resilience and self-esteem of a group of youths at risk: animal-assisted therapy proposal” (Ribeiro, 2010), a master's thesis at Fernando Pessoa University. The purpose of this study was to analyze the levels of self-esteem and resilience in a group of at-risk youth, the study of the relationship between these variables and the understanding of this samples’ opinion about AAT. The descriptive results of the study showed that, on average, the levels of self-esteem were low and the levels of resilience were moderate. A significant correlation was found to the variables opinion about ATT and willingness to own pets.

- “Violence in psychiatric context: evaluation of the effectiveness of a AAA programme” (Marques, 2008), a doctoral dissertation at the Institute of Biomedical Sciences of Abel Salazar, Porto University. This research was developed with primary purpose to assess the effectiveness of an intervention program for Animal Assisted Activities (dog) to prevention of violence in psychiatric context and promoting the socio-emotional welfare of adult’s patients. Three studies were accomplishment, the two first studies were aimed to characterize the violence in psychiatric context, select the fields of research and adapt, validate tools needed to study 3. The results showed that the AAA (dog) is efficient in the reduction of the frequency and severity of aggressive behaviours and in the reduction of use from psychopharmacological programme. But it does not influence the psychiatric symptomatology nor the experience and expression of anger. Concerning the level of well-being of the social-emotional of the patients, the results evidence that the intervention programme had a

positive and significant impact in promoting the distraction of the patients towards the stimulations that could be understood as threatening and focus and involving them in the activity in a motivated form. This behavioural change reflects the regulation of emotions and feelings, which may be the cause of aggressive behaviour, and increased welfare social-emotional. It was concluded that the AAA (dog) may constitute an additional and innovative strategy towards the prevention and control of violence in psychiatric context.

6.2 Main National Trends

In Portugal, the potentialities of Animal Assisted Therapies / Animal Assisted Activities began to be known recently, mainly based on foreign literature.

In the specialized literature we can find a distinction between three different types of interventions: AAA / AAI; AAT; AAE.

1. Animal Assisted Activities (AAA) or Animal Assisted Interactions (AAI). AAA / AAI can provide motivational, educational, attachment, relaxation, recreation, entertainment and socialization opportunities with emotional, cognitive and social benefits. These activities involve volunteers and/or professionals with their pets specially trained and with strict criteria of behaviour and health, to visit patients of all ages and different conditions in different environments. These activities can be practiced weekly, fortnightly or be sporadic, with an average duration of one hour. It can be practiced individually or in groups. AAA and AAI are aimed at improving the quality of life in general, whether for children, adults or elderly. Generally, the sessions are not scheduled by reference to a strictly planned treatment methodology and strictly planned session goals.

2. Animals Assisted Therapy (AAT). AAT is a targeted intervention with specific objectives for each pathology and person, in which the pet is specially trained with strict criteria of behaviour and health for the treatment process. It is a therapeutic process in which the animal is an integral part of the treatment. AAT is conducted by

health professionals and requires a multidisciplinary team with expertise knowledge. The intervention involves methodological procedures and it is documented and evaluated in each session. Usually, these activities are practiced weekly or fortnightly, with the average duration of one hour. The sessions are programmed and scheduled. AAT is aimed to promote the development of physical, social, emotional and cognitive functioning (thinking and intellectual abilities) of the assisted patients.

3. Animals Assisted Education (AAE).AAE follows the same criteria of AAT, but it is conducted by educational professionals, such as pedagogues, speech-language pathologists, others. Some authors integrate AAE in AAT.

From a practical point of view, we could almost say that practices are still in antipodes of the theoretical approaches. Some pilot studies put in evidence the benefits of Animal Assisted Therapies / Animal Assisted Interventions. However, there is still no regulation regarding AAT in Portugal. Consequently, there are some organizations and associations that have developed some programmes, but there is a lack of qualified human resources, as well as a lack of physical resources, because some equipment is too expensive and there are no founding sources available (for example, lifts to place people with mobility disabilities on the horses in the case of equestrian therapy and hippo-therapy).

In recent years, there is beginning to take place in the country the first steps to the emergence of the following modalities of animal assisted therapies: therapeutic riding, hippo-therapy, donkey assisted therapy, dogs assisted therapy. Intervention programmes are mainly developed by volunteers or in the basis of cooperation protocols between institutions.

Animal Assisted Therapy is beginning to gain some emphasis applied as a therapeutic method aimed at improving the social, physical, cognitive, motivational and emotional functions. For example, is beginning to be applied to children with Autism or Down Syndrome, and monitoring the elderly and young adults with Cerebral Palsy or other disorders, whether functional or psychological. Several Occupational Activity Centres and Cerebral Palsy Associations are beginning to resort to AAT and AAA.

During the research conducted in Portugal for the Te.D2 Project, were interviewed / surveyed 18 organizations / stakeholders that are developing Animal Assisted Therapy and Animal Assisted Activities, or have therapists that accompany their patients and participate in the therapeutic process.

The following organizations are developing AAT and AAA programmes:

- Canine Intervention Group of Portuguese National Guard (GNR) (https://www.facebook.com/GNRK9/).Canine Intervention Group of Portuguese

National Guard develops search and rescue dog training, dog training for fighting crime and dogs assisted therapies.

- Dogs Training Concept (http://dogstrainingconcept.com/). Dogs Training Concept, more than a canine training school is a philosophy of life that intend to include the dog as a family member. The organization develops canine obedience training, search and rescue dog training, dogs assisted therapies, dog trekking, dog summer weekend, demonstrations and visits to schools / other institutions, workshops.

- ABRA_Associação Bracarense dos Amigos dos Animais (https://www.facebook.com/ABRA-Associação-Bracarense-Amigos-dos-Animais-

181328922027016/). It is a non-profit association, which on the one hand, temporarily hosts and takes care of abandoned animals, and on the other hand, develops Dogs Training, Dogs Assisted Activities and Dogs Assisted Interventions, search and rescue dog training, workshops. The interventions are done in a voluntary basis.

- Vinculum Animal (http://www.vinculumanimal.pt/wp/contactos/). Vinculum Animal is an association of professionals in the human and animal health. Vinculum Animal develops AAT and intends to contribute to the dissemination and development of a unique relationship that can be established between humans and animals.Professionals work in a psychotherapeutic context with children and adolescents at risk of social exclusion that are institutionalized, where the presence of dogs is a strong motivator factor.

- Cães Amigos (http://caesamigos.com/index.php/sobre-nos). It is a non-profit association, which aims to show how animals and humans can be peers, with benefits for both. Goals: Promote and disseminate Animal Assisted Interventions; Canine education; Promote and publicize seminars, courses, workshops regarding AAI.

- Supóneis e Cavalos (http://suponeis.blogspot.pt/).It is an equestrian centre that develops riding lessons for children and adults and develops therapeutic riding for children with special needs.

- Orelhas sem Fronteiras (http://www.orelhassemfronteiras.com/index.htm).It is a non-profit association, which intends to promote and enhance the donkeys. Its social aim is the safeguard, studies, to give information, the valorization of the donkey in general, in its various areas; namely the wellbeing and health of the animal, agricultural activities, entertainment, therapies, tourism, environmental, educational and creative activities in order to establish the connection to the eco-system and the environmental-cultural-heritage in the habitat of the donkey, as well as the setting up of a network of national and international exchange. The association promotes therapies and mediation practice with donkeys, coaching with donkeys, recreational activities with donkeys, health and animal welfare workshops, activities with donkeys

for people with special needs, activities with donkeys for children and seniors, walks with donkeys in silence, etc.

- Centro Equestre do Vale do Lima (http://www.centroequestrevaledolima.com/PT/).It is an equestrian centre that develops riding lessons for children and adults, promotes internships in traditional Portuguese riding and develops therapeutic riding for children and adults with disabilities and special needs.

- Quinta de Pentieiros (http://www.lagoas.cm-pontedelima.pt/ver.php?cod=0W). Quinta de Pentieiros is a farm integrated in the protected area of Bertiandos and S.

Pedro de Arcos Lagoons. It includes a pedagogical farm, touristic accommodation and an equestrian centre in which are promoted riding lessons for children and adults and therapeutic riding for children and adults with disabilities. The therapeutic riding is promoted in the basis of cooperation protocols with Schools, Occupational Therapy Centres and other organizations.

- Associação de Paralisia Cerebral do Viana do Castelo (Cerebral Palsy Association of Viana do Castelo) (http://www.apcvc.pt/). It is a non-profit, private organization of social solidarity, which mission is the intervention in people with cerebral palsy and related neurological diseases within Viana do Castelo district.

- Associação Portuguesa de Paralisia Cerebral de Leiria (Portuguese Cerebral Palsy Association of Leiria) (http://www.appcleiria.pt/). It is a non-profit, private organization of social solidarity, which has the objective of create localized responses/interventions to the specific needs of Children, Youths and Adults with cerebral palsy, or other related neurological conditions, as well as improve their quality of life and give support to their families.

The following organizations have protocols with entities that develop Animal Assisted Activities. The therapists accompany their patients (and in some cases they participate in the therapeutic process), usually one or two days per week, to the organizations where the interventions takes place:

- AAPEL_Associação dos Amigos da Pessoa Especial Limiana (http://aapel.pontedelima.com/). AAPEL is a non-profit organization which aims to support people with multiple disabilities, through occupational activities, sheltered employment, residential homes, home support. It includes an Occupational Activity Centre, working all day, even on vacation period. The OAC is aimed at Youths who are no longer at school age and adults who have multi disabilities. The therapists of the OAC accompany their patients to an equestrian centre in which therapeutic riding sessions are developed through a cooperation protocol.

- Associação de Paralisia Cerebral do Porto (Cerebral Palsy Associationof Porto) (http://www.appc.pt/). It is a rehabilitation centre for people with cerebral palsy. It includes three Occupational Activity Centres (OAC’s). In the OAC are daily developed diversified occupational activities which include socially useful activities and strictly occupational activities with different objectives according to each patient, but always looking for the socially integration of people with severe disability, aged over sixteen. The OAC of Gondomar promotes hippo-therapy sessions.

- Associação de Paralisia Cerebral de Évora (Cerebral Palsy Associationof Évora) (http://www.associacaodpedrov.pt/index.php?option=com_rib&view=item&id=20&catid=2&Itemid=155&lang=pt). It is a rehabilitation centre for people with cerebral palsy, neurological disorders and children with special needs.It includes one Occupational Activity Centre (OAC) which promotes animal assisted activities with horses and dogs.

- Associação Portuguesa de Pais e Amigos do Cidadão com Deficiência Mental de Ponte de Lima (Portuguese Association of Parents and Friends of People with Mental Disabilities of Ponte de Lima) (https://pt-pt.facebook.com/APPACDM-de-Ponte-de-Lima-211746292360074/). It is a centre for people with mental disabilities which include one Occupational Activity Centre (OAC). The therapists of the OAC accompany their patients to an equestrian centre in which therapeutic riding sessions are developed through a cooperation protocol.

- CERCICA_Cooperativa para a Educação e Reabilitação de Cidadãos Inadaptados de Cascais (Cooperative for Education and Rehabilitation of People with Disabilities of Cascais (http://www.cercica.pt/somos.php). It is aimed at youths and adults with mental disabilities and people with neurological diseases, such as Alzheimer's disease. CERCICA promotes animal assisted activities.

- Íris Inclusiva (http://www.irisinclusiva.pt/). Íris Inclusiva promotes the social inclusion of blind people through the development of a diverse range of projects, services and interventions focused on the development of autonomy, through a multidimensional and integrated approach and valuing the interaction between the blind people and their life contexts. Íris Inclusiva still does not promote animal assisted therapies or animal assisted activities but recognizes the benefits of these interventions for their target group.

- ACAPO - Associação dos Cegos e Amblíopes de Portugal (Association of the Blind and Partially Sighted of Portugal)(www.acapo.pt). ACAPO is a non-profit organization which aims to promote the social inclusion of people with visual disabilities. To make face to the target group (people with visual disabilities, their families and civil society), ACAPO provides services in social work, psychology, occupational therapy, accessibility, vocational education and training, Braille training. Guide dogs are used but animal assisted therapy is still not an implemented practice.

6.3 National bodies in charge of the AAI

Animal Assisted Intervention is an intervention field still poorly explored at the national level. Consequently, there are no national bodies in charge of the AAI.

6.4. National policies, strategies and initiatives implemented to promote and improve the AAI

In Portugal, there are no regulatory policies regarding Animal Assisted Therapies and Animal Assisted Activities. These interventions are not properly recognized and professionally regulated. Consequently, there are no specific legislation and regulation about AAT in Portugal. Specific legislation only exists on guide dogs and assistance dogs.

Some studies recognize the importance of AAI and some professionals seriously try to carry out some Animal Assisted Interventions, but there is no regulation regarding AAT. A recognized professional to conduct Animal Assisted Interventions doesn’t exist.

The intervention programmes are mainly developed by volunteers or in the basis of cooperation protocols between institutions.

6.5. The Therapy Dog Trainer

Dogs Assisted Interventions begin to be a reality in Portugal. Most of the Animal Assisted Interventions that are being carried out in the country are performed using dogs.

The research carried out in Portugal for the Te.D2 Project included 18 interviews with directors or therapists from organizations that promote Animal Assisted Therapies / Animal Assisted Activities. Also was interviewed one of the researches that published one scientific article about the effectiveness of animal-assisted interventions in preventing violence in acute psychiatric inpatients (Marques, Mendes, Gamito & Sousa, 2015).

The interviews / questionnaire surveys were done between April and May 2016.

The respondents belong to the following organizations:

- Canine Intervention Group of Portuguese National Guard (GNR) (https://www.facebook.com/GNRK9/).

- Dogs Training Concept (http://dogstrainingconcept.com/escola-de-treino/).

- ABRA_Associação Bracarense dos Amigos dos Animais (https://www.facebook.com/ABRA-Associação-Bracarense-Amigos-dos-Animais-181328922027016/).

- Vinculum Animal (http://www.vinculumanimal.pt/wp/contactos/).

- Cães Amigos (http://caesamigos.com/index.php/sobre-nos).

- Supóneis e Cavalos (http://suponeis.blogspot.pt/).

- Orelhas sem Fronteiras (http://www.orelhassemfronteiras.com/index.htm).

- Centro Equestre do Vale do Lima (http://www.centroequestrevaledolima.com/PT/).

- Quinta de Pentieiros (http://www.lagoas.cm-pontedelima.pt/ver.php?cod=0W).

- AAPEL_Associação dos Amigos da Pessoa Especial Limiana (http://aapel.pontedelima.com/).

- Associação de Paralisia Cerebral do Porto (Cerebral Palsy Association of Porto) (http://www.appc.pt/).

- Associação de Paralisia Cerebral de Évora (Cerebral Palsy Association of Évora) (http://www.associacaodpedrov.pt/index.php?option=com_rib&view=item&id=20&catid=2&Itemid=155&lang=pt).

- Associação Portuguesa de Pais e Amigos do Cidadão com Deficiência Mental de Ponte de Lima (Portuguese Association of Parents and Friends of People with Mental Disabilities of Ponte de Lima) (https://pt-pt.facebook.com/APPACDM-de-Ponte-de-Lima-211746292360074/).

- CERCICA_Cooperativa para a Educação e Reabilitação de Cidadãos Inadaptados de Cascais (Cooperative for Education and Rehabilitation of People with Disabilities of Cascais (http://www.cercica.pt/somos.php).

- Íris Inclusiva (http://www.irisinclusiva.pt/).

- ACAPO - Associação dos Cegos e Amblíopes de Portugal (Association of the Blind and Partially Sighted of Portugal) (www.acapo.pt).

- Associação de Paralisia Cerebral do Viana do Castelo (Cerebral Palsy Association of Viana do Castelo) (http://www.apcvc.pt/).

- Associação Portuguesa de Paralisia Cerebral de Leiria (Portuguese Cerebral Palsy Association of Leiria) (http://www.appcleiria.pt/).

Also a researcher from Higher Nursing School of Coimbra was respondent:

- Maria Isabel Dias Marques, Coordinator Teacher in the Higher Nursing School of Coimbra.

From the national diagnosis carried out by Epralima regarding AAI, we identified different levels of needs:

1. Need to introduce national policies regarding AAT; regulate the professional profile of the Animal Assisted Therapist or regulate the profiles of the professionals who can incorporate AAT in their professional practices.

“Professionalize the Animal Assisted Therapy will bring a higher work quality and a better quality on provided services.” (Gonçalo Brito, Commander of Canine Intervention Group of Portuguese National Guard – GNR)

2. Need to train professionals in the field of AAT and AAI; create a specialized and accredited course regarding AAT / AAI which allows to qualify professionals in AAT / AAI.

Specifically in what concerns to the Therapy Dog Trainer, we identified the following set of needs:

National Policies Level:

- Regulate the Animal Assisted Therapies;

- Set the Therapy Dog Handler profile;

- Professionalize the Therapy Dog Handler.

Training needs in Therapy Dog Handler:

- Principles of Anima Assisted Therapy;

- Animal aetiology;

- Dog's characteristics, Dog’s behaviour, Dog’s potentialities;

- Neuro-physiological and biomechanical basis of Animal Assisted Interventions;

- Dog training;

- Therapeutic Intervention Models with Dogs;

- Therapies design; Therapeutic setting;

- Methodology of a therapeutic session;

- Adjust the dog training to the pathologies;

- Evaluation of the therapeutic intervention (definition of performance criteria, elaboration of instruments).

6.6. Identification of Best Practices

In this section we opted to present one example of best practice from the point of view of the scientific research and three examples of best practice from the point of view of the practical initiatives and interventional programmes regarding Dogs Assisted Therapy and Dogs Assisted Activities.

6.6.1. Scientific Research

From the point of view of the scientific research, we choose one investigation article published in the Journal of Nursing (reference IV, no 5), entitled “Effectiveness of animal-assisted interventions in preventing violence in acute psychiatric inpatients”(Marques, Mendes, Gamito & Sousa, 2015).

One of the researchers of the study is Maria Isabel Dias Marques, Ph.D., Coordinator Teacher in the Higher Nursing School of Coimbra, who also accepted give a contribution to our diagnosis, responding to our questions.

Her contribution to the article consisted of: literature review; conducted the research plan; contribution to the implementation of the intervention programme; data collection; processing and analysis of data; discussion of the results; article writing.

Theoretical framework: Violence in acute psychiatric units is a major challenge for healthcare professionals due to its consequences.

About the quasi-experimental study:

Objectives: To assess the effectiveness of an Animal-Assisted Intervention Programme (with Dogs) in preventing violence in acute psychiatric units.

Methodology: Quasi-experimental study with an experimental group (26 patients) and an equivalent control group. The experimental group was subjected to a programme composed of 6 visits (15 minutes each one) by a dog/handler team over the course of 3 weeks. Every session involved 2 patients. The psychiatric symptoms and the experience and expression of anger were assessed before and after the programme. The aggressive behaviours were assessed during the programme.

Authors based their experimental study based in the idea that the resolution of the violence in hospitalized acute psychiatric patients is usually based on psychopharmacological treatments. However, it may also be achieved through therapeutic interventions in the environment, reducing the environmental stress and communicational, for example, through Animal Assisted Interventions (Nijman, 1999). The Investigators were based on the assumption that interact with a dog can facilitate adaptation to reality and promote behavioural adjustment to thereby develop a study to evaluate the efficacy of an Animal Assisted Intervention Programme (with dogs) in the prevention of violence in psychiatric units of short duration. The effectiveness of the programme should be measured through aggressive behaviour indicators (frequency, nature and severity), and psychiatric symptoms anger experience and expression of emotion.

The experimental intervention programme was based on the visit of a dog which included activities with a group of two hospital patients, in order to provide contact with the animal and interaction with patient's peer; the programme was conducted in two psychiatric units of short duration (one female and one male) and included 13 pairs of patients.

The sessions also had the participation of a dog trainer and a nursing professional, with specialization in Mental Health and Psychiatric Nursing (the investigator).Each group of two patients (pair) received the dog visits twice a week, benefiting six sessions over three weeks. The duration of each session was 15 minutes. In the sessions were introduced some objects: balls, dolls, brush and clicker (instrument

used by the dog trainer for positive reinforcement of the dog), which served as auxiliary instruments in the dynamics of the sessions. The dynamics of the sessions was animated according to the interests of patients at the time, and supported by the guidance of the dog trainer. For safety and comfort of the participants were required some similar features for each unit: room, equipment, lighting, average temperature, sound.

Results and Conclusions: The programme proved to be effective in reducing the frequency and severity of aggressive behaviours and the use of psychotropic drugs. No evidence was found on the impact of this programme on psychiatric symptoms and anger experience and expression.

These interventions may be a complementary strategy for preventing and controlling violence in acute psychiatric inpatients.

Referring to the efficiency of Animal Assisted Intervention Programme (with a dog) acute psychiatric inpatients, the results obtained corroborates the prevention of aggressive behaviour, mainly the frequency and nature (less impact and less use of medication control).It is also important to highlight the results of the experimental group, with regard to the decrease of the state of anger. Furthermore, the therapeutic programme had implications at the environment level, making it more humanized.

6.6.2. Practical Initiatives and Interventional Programmes

The organization Dogs Training Concept (http://dogstrainingconcept.com/) more than a canine training school is a philosophy of life that intend to include the dog as a family member. The organization develops canine obedience training, search and rescue dog training, dogs assisted therapies, dog trekking, dog summer weekends, demonstrations and visits to schools / other institutions, workshops.

- Dog Training Methodology

The dog training is done using positive reinforcement, based on rewards and play. It is used a wide range of methods and training techniques depending on the dog's needs, aiming to create an effective "grammar" between animal, owner and family. Toys are used as motivators. The Dog Trainer ignores the bad behaviour and seeks to capture the behaviours we want to see strengthened and repeated.

Types of Dog Training:

Individualized Training / Resolution of Behavioural Problems

This training is specific to solve problems identified by the dog owner and by reference to a diagnosis, in which a specific multi focused training plan is designed.

Basic Obedience Training / Socialization

This training is important for the development of a balanced temperament. Examples of basic obedience commands: sit, down, stay, come, walking on leash, walking without leash, return to the owner when called, pay attention, to calm down.

Advanced Obedience Training

This training is intended for dogs that have met with success the Basic Obedience Training. On the basis of the game, the fun and the positive reinforcement, the basic training methods are deepened. In the presence of other dogs and with different distractions, the training is developed acquire the following behaviours: staying at the door of a store; staying in the car with the door open; Bringing an object; barking at order; making the search for lost personal objects; carrying baskets and bags in the mouth; have a great control without leash and come quickly when called; fetching and delivering an object in and out of water; learning some tricks: giving paw, saying goodbye, sitting on two paws, rolling, walking backwards, entwining paws, passing inside obstacles, jumping over obstacles.

Search & Rescue Dog Training

The dogs are trained to search and rescue objects and people.

Dogs are first taught to track or trail and later are trained in air scent. Then, dogs naturally combine all three methods to locate a subject. Dogs instinctively use their noses to locate things in everyday life, so the real training is to teach them: to locate the lost person or article; to notify the handler that the subject or article has been found. This notification is called the alert. Dogs’ of Dogs Training Concept already participated in search and rescue operations, even outside country.

Demonstrations and Visits to Schools and other Institutions

The dogs are trained to search and rescue objects and people.

Dogs Training Concept frequently goes to schools and other institutions to do demonstrations with dogs, as well as to promote campaigns and workshops on dogs training, canine socialization and responsible ownership of dogs.

The organization has protocols with schools and other institutions to develop dogs assisted interactions programmes.

Dog Assisted Therapies

A dog can be trained to help a person in wheelchairs to perform daily tasks, such as, open a door, collect objects from the floor or inaccessible places, turn on lights, to undress certain clothes.

A dog can be trained to help a deaf person, for example, drawing attention to the ringing of a bell, to the cry of a baby, for a fire alarm.

In Dogs Training Concept is developed a work in which dogs are used to provide therapies with children and elderly people. Nowadays, a positive influence of animals on people is proved. Subsequently, Dogs Training Concept develops fun activities with the dogs of which can result from therapeutic, recreational and motivational results. Animal Assisted Therapy brings us to a therapeutic process in which the dog is part of the treatment.

The sessions are developed in articulation with health professionals, geriatrics, educators and dog trainer, in order to focus the dog's action on specific objectives previously defined in order to promote improvements in physical, social, emotional and/or cognitive functioning of patients.

The advanced training of dogs allows for complex exercises that capture such attention of patients that they keep the focus, concentration and positive attitude towards provided experiences.

Most of the programmes are carried out based on cooperation protocols with nursing homes, schools and other institutions.

Animal Assisted Therapy is an individualized programme and with specific criteria (assessed all sessions) in which the animal is an integral part of the treatment process.

6.7. Bibliography and References

Magalhães (2014). The use of animals in interventions in children with Autism Spectrum Disorders. Porto: Institute of Biomedical Sciences of Abel Salazar, Porto University.

Marques, Mendes, Gamito & Sousa (2015).Effectiveness of animal-assisted interventions in preventing violence in acute psychiatric inpatients. In Journal of Nursing, reference IV, no 5.

Marques (2008). Violence in psychiatric context: evaluation of the effectiveness of a AAA programme. Porto: Institute of Biomedical Sciences of Abel Salazar, Porto University.

Martinho (2011). The impact of Therapeutic Riding in psychomotor factors in children with special needs. Braga: Minho University.

Nijman (1999).Aggressive behaviour of psychiatric inpatients: Measurement, prevalence, and determinants. Maastricht, Netherlands: University Press Maastricht.

Paixão, V. (2007). Effects of one Animal Assisted Activities Programme in Children with Disabilities. Coimbra: Coimbra University.

Ribeiro (2010). The resilience and self-esteem of a group of youths at risk: animal-assisted therapy proposal. Porto: Fernando Pessoa University.

Tavares (2013). Animal Assisted Therapy: a Literature Review. Porto: Portuguese Catholic University.

ANIMAL ASSISTED INTERVENTIONS IN SPAIN

BY ASOCIACIÓN SOCIAL ASOCROM

7. Abstract

Most of European countries have problem when it comes to the lack of legal regulations and accreditations of different national bodies. That movement has a lot of volunteer workers who are trying to develop this method of therapy and make it more popular and in result more legally oriented. In this part of the world fighting for the rights and proper conditions of working as therapists just started but they develop very quickly.

7.1. Introduction to the National Situation of AAT/AAA

In December 1987, Purina Foundation was created (nowadays known as Affinity Foundation) for the promotion of the role of domestic animals in society, through a campaign to raise awareness on animal dumping in partnership with the Spanish Association for Psychiatry. The program aimed mainly at individuals facing exclusion of all sorts: drug addicts, criminals or ill. In 1993, Bocalán Foundation was established, adding a scientific component through the introduction of ABA in the

application of AAT and implementing AAT in intervention on autistic children. Since then, AAT begins to extend to the rest of Spain.

7.2. Main national trends

The definition of Delta society on AAT and AAI is adopted in a generalized manner and AAI-dedicated associations appear: ANTA (National Association for Animal Assisted Therapies and Activities); AETANA (Spanish Association for Animal Assisted Therapies and Nature); AIAP (Dog Assisted Therapies Association) and a great number of companies and training centers focused on AAT exclusively, or as a complement to their activities – principally in canine schools and equestrian centers.

Domestic animal’s perception has changed a lot in the past 10 years. There is a greater conscience for their care and well-being that has directly influenced the impact they have on the lives of others. Similarly, seeing eye dogs and AAI, have been impacted. Schools, associations, foundations and private ventures connected with the field increased in number. 161 websites offering these therapies are found online and although many people put AAT in practice, fewer are those who have the relevant experience and some carry AAT with untrained dogs and on a voluntary basis.

A study carried out in Catalonia shows a wide knowledge of AAT's existence, but a lacking conscience in what it represents or how it is applied. It is directly linked to dogs, horses, dolphins and other pets.

We will present an example of a good practices of an organization who combines the assistance with the therapy. It is called Associació d’Acció social DISCAN.

Similarly, several canine schools give AAT courses that give credit to the alumni training as technicians or experts in AAI and AAT. These include: Discan, Educan, Canaem, Dogtor Annimal, CTAC, Humanymal and others, where Bocalán Foundation stands out. There are also universities that give such courses and there is a Master focused on AAT at the University of Seville, the UAM, Oviedo University, Zaragoza University, the UCM and the UAB. (Autonomic University of Barcelona).

One of the most notable changes in AAI with dogs is the evolution in canine training in Spain, with the improvement in training techniques through the clicker training and the Behavioral Analysis as well as the performance at work and the options it provides during therapy sessions. It should also be highlighted the importance that the introduction of AAI has in specialized centers of particularly vulnerable groups: centers for the elderly, centers for special education, circular compounds etc... Also, the increasing interest and support from associations of parents with underprivileged children such as the APNA (Association of Parents to Autistic Children).

7.3. National bodies in charge of the AAT/AAA

No public organization regulates the AAI's, although some autonomic laws exist on guide dogs to some extent. Nonetheless, there is a law at the national level of Social Corporate Responsibility by which big corporations must direct a part of their benefits to social and charity work. This can enable the inclusion of AAT through private firms that practice it in public and private centers. There are also several associations and non-profit organizations that promote and regulate these practices.

The associations that need to be highlighted, due to their activity in the field of AAT's are:

• AIAP (Association for dog assisted interventions), functions as a non-profit at the national level. Its mission is to promote and to raise awareness on AAI's with dogs and other animals. It also works to let the general public know more about dogs used in social work.

• ANTA (National Association of animal assisted therapies and activities). Non-profit. Its mission is to promote the therapeutic and scientific use of AAT's and guide dogs to help the physically and intellectually challenged as well as the elderly and people in prisons.

• AETANA (Spanish Association for Animal and Nature assisted therapies)

• Affinity Foundation

• Associació d’Acció social DISCAN

7.4. National policies, strategies and initiatives implemented to promote and improve the AAT/AAA

There are no policies about AAI in Spain, but there are some regional policies for the assistance dog:

-Cataluña: “Ley 10/19913, del 8 de octubre, reguladora del acceso al entorno de personas con disminución visual acompañadas de perros lazarillo” “Ley 19/2009, de 26 de noviembre, reguladora del acceso al entorno de personas acompañadas de perros de asistencia.”

You can find attached the Catalan law.

-Comunidad Valenciana: “Ley 12/2003, del 10 de abril, de la Generalitat, sobre Perros de Asistencia para Personas con Discapacidades.”

-Galicia: “Ley 10/2003, del 26 de diciembre, sobre el acceso al entorno de personas acompañadas por perros de asistencia.”

-Illes Balears: “Ley 5/1999, de 31 de marzo, de Perros Guía.”

-Andalucía: “Ley 5/1998, del 23 de noviembre, relativa al uso de perros guía por personas con disfunciones visuales en el territorio de Andalucía.”

-Navarra: “Ley Foral 7/1995, de 4 de abril, reguladora del régimen de libertad de acceso, deambulación y permanencia en espacios abiertos y otros delimitados, correspondiente a personas con disfunción visual total o severa y ayudados de perros guía.”

-País Vasco: “Ley 10/2007, de 29 de junio, sobre Perros de Asistencia para la Atención a Personas con Discapacidad.”

-Región de Murcia: “Ley 3/1994, de 26 de Julio, de los disminuidos visuales y perros-guía.”

The main role in Spain has the Therapy Congresses and Animal Assisted Education promoted by the Affinity Foundation that puts together benefits and results of AAI's. Universities, association, professionals and families pitch in this initiative.

7.5. The Therapy Dog Trainer

The situation in Spain is confusing. It doesn't make a difference between the activity of professionals in the area –that have acquired their specialization in the last years, learning how to work with animals or simply including them in multidisciplinary teams –and people that practice it on a voluntary basis. As such, bad practices have arisen; making of AAI's a hobby or a way of making money. Two figures operate with AAI: the expert, qualified for the design of therapy sessions and identifying clear goal throughout the interventions and the technician, whose knowledge and experience in the training of animals is essential, he is the one responsible for training therapy dogs.

The tasks of AAI technician or trainer must be those of training the animal and work with it during the therapy sessions. For that effect, she must be very knowledgeable of the type of animal he/she is working with, in order to train it accordingly. But he/she must also know the collective of people with whom he/she is working so he/she can avoid unwanted situations and understand the task he/she is carrying out. He/she must also be fully aware of everything related to the animal's health and well-being, positive training based on the clicker method, the animal's nature, the interventions that can be done and how they can be done. At any rate, he/she is the one in charge of the animal's security during the session.

It's necessary to improve the training of therapy dog trainers in such aspects as health and well-being, training and handling. There are some wonderful professional

out there, but some lack the necessary knowledge to perform well their duty. There are two types of trainer profiles: the ones who have a lot of experience with dogs and none in therapeutic interventions and the one with no experience with dogs. This leads to the point where the trainer becomes essential and must be trained accordingly.

Although there are no legal regulations in Spain, AAI's have opened a new world to the field of therapeutic interventions. In the past years, animal well-being and canine training have been supported by many sectors of society, partly owing to their work assisting handicapped persons, the AAI's and promoting the education of domestic animals. For this reason, the role of therapy animals for AAI's has a deep importance for Spain. AAI's are beginning to be known, being a complementary part to therapy. Every year, new associations are created and AAT's are incorporated into their intervention therapies.

7.6. Identification of best practices

The Association Acció Social DISCAN is a non-profit organization created in July 2007, registered in the 1st section of the Register of Associations and Foundations of the Government of Catalonia (Generalitat de Catalunya) with the No. 34975.

The DISCAN Association is registered as a training school with zoological number core B 2500979 and is accredited as a Training Center Assistance Dogs with number center EGA 02/2012.

It also has therapy dogs and training.

The AAS DISCAN was born with the aim of providing a service to disabled people elderly and persons who are in risk of social exclusion.

The aims of the AAS DISCAN are:

Raising and / or training dogs in a selection process and study (carried out by professionals trained for this purpose), training them as service dogs (guide dog, assistance dog ,signal dog, warning dog, medical alert dog and autism) in order to be delivered to people with visual, physical, hearing impairment or other diseases autism spectrum disorder (as established by Law 19/2009, of 26 November, access to the environment of people accompanied by assistance dogs) they can see improved their quality of life.

Carry out intervention programs and / or assisted interaction with animals (whether dogs or other animals prepared for this purpose), organized by specialists in the subject, targeted the collective of the third sector (persons with disabilities, psychopathological disorders, risk of social exclusion, the elderly, children, etc.).

Strive for accessibility for people with disabilities, as well as the accessibility of assistance dogs and their users, making awareness and dissemination programs

aimed at general population, taking into account current legislation at all times (both animal welfare and the environment).

Join associations and / or national and international federations for promote and ensure standards and procedures appropriate both in the field of Dog care as in the intervention and / or assisted interaction with animals, ensure the proper functioning and development of these activities

Conduct studies and research projects on animal-assisted intervention to give to know the benefits of user conducting such activities, through seminars, interest, scientific events, publishing articles and broadcasting thereof on the website of the association, so they are accessible to all.

Conduct training courses, seminars and workshops, among others, to train future professionals in this field of work.

Presently, the AAS DISCAN has a multidisciplinary team in the field of Animal Assisted Intervention and Instruction Assistance Dogs composed of:

Meritxell Arias Teixidor

Special Education Teacher

M.Ed., currently doing a PhD in Special Education

Master in Intercultural Mediation

Professional Master in e-learning training

Expert in Animal Assisted Intervention

Assistance Dog Trainer

Expert authorized by the Catalan Institute of Professional Qualifications (Generalitat de Catalunya) with no ICQP-AA-00315, to exercise advisory functions and evaluation of professional qualification "SSC, Socioculturals Serveis to and for the community, SSCE, “Formació i Educació” for all the Spanish State.

Laia Niubó Vallverdú, Barcelona

Elementary School teacher

Psych pedagogue

Assisted Intervention Technique with Animals

Assistance Dog Trainer

Miriam López, Barcelona

Psychology

Assisted Intervention Technique Dogs

Esther Capdevila Baiges

Assistance Dog Trainer

Socialization agent

Internationally, they collaborate with the following entities:

- AAS Ethos, Portugal

Training in the field of Instruction Assistance Dogs

Two instructors trained by AAS DISCAN

- Tecla K-9, Training Dogs, Costa Rica

Training in the field of Instruction Assistance Dogs

Two instructors trained by AAS DISCAN

Collaboration and advice in the formation of the first guide dog trained in Costa Rica

- Cardea – Intervenciones Asistidas con Animales, Perú

Training in the field of Instruction Assistance Dogs

Three instructors trained by AAS DISCAN – processing

Collaboration and advice in the implementation of programs assisted therapy dogs

Technical Training Dogs Assisted Intervention

- Delphinus – México

Conducting a research study on "The Effectiveness of Assisted Therapy Dolphin users with Autism Spectrum Disorder, Down Syndrome and Paralysis Cerebral"

Collaboration and advice in implementing a program of assisted therapy dolphins

Training 6 ECAs (Animal Care Specialists) and 17 different therapist’s organizations (DIF, Astra AC, Fundación Jorge Alann AC) in dolphins assisted therapy

In the field of training, different courses are conducted annually in their organization, both online as blended learning, always taking into account the Apprenticeship and mentoring of student. We have also organized specific courses and training to entities outside Spain.

At university level, they have been organizers of the 1st Educational-Master in Intervention Animal Assisted Therapy (dogs, horses and marine mammals), and it has been performed during the four editions at the University of Barcelona.

In addition, they have made two presentations on Therapy Dogs at the University of Santa Paula, the only university with accredited physical therapy career of Costa Rica.

7.7. Bibliography and References

1. Mireia Orgilés, A. et al, Universidad de Murcia (España). Tratamientos Psicológicos Bien Establecidos y de elevada eficacia: Terapia de conducta para las fobias específicas, Psicología Conductal, Vol. 10, Nº3, 2002, pp. 481-502.

2. Vilalta Gil, V. et al. La terapia facilitada por animales de compañía como programa de rehabilitación adjunto para personas con diagnóstico de esquizofrenia crónica, Papeles del psicólogo, enero-abril, añ/vol. 28, número 001, pp 49-56.

3. Corpas Riquelme, B. Hipoterapia aplicada a diferentes patologías. Revista Encuentros T II - NUM 30 2012, pp. 45-47.

4. Ridruej, P. (2006): Manual de Terapia asistida: síntesis y sistemática. Barcelona: Fundación Affinity

5. Martinez, R. Atención a la diversidad y terapia asistida por animales. Programas y experiencias en el medio penitenciario. (2009). Revista de Educación Inclusiva, Vol. 2, Nº3, pp.112-133.

6. Serra-Mayoral, A, et al. Equinoterapia aplicada a los pacientes con trastorno mental severo: presentación de un programa de rehabilitación y estudio de un caso. Rehabilitación psicosocial (2011); 8 (1 y 2): pp. 37-43

7. Zamarra San Joaquin, M. P. (2002). Aranjuez. Terapia Asistida por animales de compañía. Bienestar para el ser humano. Rev. Temas de Hoy. Aranjuez. pp 143-149.

8. Uribe Posada, A. M. et al. (2012) ¿Cómo beneficia la equinoterapia a las personas con Sindrome de Down? Rev. CES Salud Pública, Volumen 3, Nº 1, pp 4-10

9. Vázquez Caiside L. La Terapia Asistida con Animales como parte de los programas de rehabilitación neuropsicologica. Psicología.com [Internet*. 2011 [citado 19 Sep 2011]; 15:33. Disponible en: http://hdl.handle.net/10401/4385

10. Signes Llopis, M. A. Terapia/ Actividad asistida por animales y la 3º Edad. www.atasafor.es

11. Signes Llopis, M. A. Terapia/ Actividad asistida por animales y discapacidad física. www.voraus.com

12. López-Cepero, J. et al. (2012). Una Aproximación actual de las intervenciones asistidas por animales en la literatura científica: logros y metas de futuro. Sevilla

13. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1989-38092015000300001

14. http://aai-int.org/about/History.aspx

15. http://biblioteca.universia.net/html_bura/ficha/params/title/intervencion-asistida-animales-iaa-analisis-situacion-espa%C3%B1a-animal-assisted-intervention/id/64806847.html

16. http://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=19&ved=0ahUKEwiOkva-jrzMAhUCCBoKHbnGCag4ChAWCFkwCA&url=http%3A%2F%2Frecyt.fecyt.es%2Findex.php%2Fescpsico%2Fissue%2Fdownload%2F2392%2F114&usg=AFQjCNFpRCK9gXPKVvAXuig3DQ0uHPeEvg

17. https://animalassistedtherapydogblog.wordpress.com/category/aai-aat-education/

18. https://www.researchgate.net/publication/51207440_Animal-assisted_interventions_in_internal_and_rehabilitation_medicine_A_review_of_the_recent_literature

19. www.aetana.es

20. www.bocalan.es/fundacion

21. www.fundacion-affinity.org

22. www.adam-europe.eu/

23. http://www.terapiaconperros.com/

24. http://perrosdealertamedica.com/

25. http://www.ctac.cat/CTAC/ctacinicio.html

26. http://www.aepa-catalunya.org/formacio.php

27. http://www.arcadys.org/

28. http://www.aepa-euskadi.org/index-cas.htm

29. http://www.parlamento.euskadi.net/pdfdocs/leyes/ley20070010_t_cas.html

30. http://www.aepa-madrid.org/

31. http://www.solidaridadintergeneracional.es/discapacidad/index.php?pid=servicios&fservicio=98902

32. http://www.asociacionhydra.org/

33. http://www.canplanet.com/residencia-animals/es/inici.html

34. http://www.adiestramientoeducan.com/

35. www.discan.org/

36. http://www.lealcan.org/

37. http://www.paat.es/asociacion/index.php

38. http://www.adiestradorcanino.com/webdelperro/terapia-asistida-con-perros/143

39. http://binden.es/perros-de-asistencia/

8. OVERALL FINDINGS AND LIMITATIONS OF THE RESEARCH PROCESS

Finding from this research report show an increase interest in the presence of animals, thus supporting the use and investigation of animal assisted therapy. The presence of an animal can in deed act as a social catalyst.

It is true that in certain countries pet therapy has been taking lace for many years, but there is still litle research in the majority of the consortium countries to demonstate the positive effects of Animal Assisted Therapy and under what conditions AAA/AAT

can best be made of use. Furthermore, many questions have not yet been addressed, thus there is a need for further research in this field.

9. CONCLUSIONS

Animal assisted therapy appears to offer promising results. It can therefore be concluded that further research and theory development needs to be conducted on animal assisted therapy. In deed, there is a lot of planning, training and work to be done so that animal therapy is safe and beneficial for the different beneficiaries in the consortium countries.

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