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Animal Assisted Interventions


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Animal Assisted Interventions

  1. 1. Animal-AssistedInterventionsBeki DellowOccupational TherapistMay 2013
  2. 2. Learning Outcomes• How do animals make us feel?• Definitions• Case study – Dorothy – Pets as therapy• Evidence-base• Implications• Local and National Guidelines• Summary• Day Hospital – Meet Tia and Eunice• Questions• References
  3. 3. ‘Those of you who know the power of a wet, cold nose, a loving lookthat melts your heart, or a wagging tail that makes you smile, you canreadily imagine the potential of uncovering that power to heal thepain that often floods our clients’ (Pichot and Coulter, 2007 p6)
  4. 4. How do animals make usfeel?
  5. 5. ‘He makes me feel relaxed and unconditionallyloved when he curls up on my lap; he makes mefeel invigorated when I take him out for a longwalk on a fresh day; he makes me feel safe whenIm home alone; he exasperates me when he moltsall over my clothes and furniture! The list isendless! But I wouldnt change him for the worldcos the pros outweigh the cons! ‘ :-)‘My pets make me feel happy and wanted,especially after a bad day, coming home to theaffection (purring) of my cat and my dogswagging tail being excited to see me gives me abuzz!!! But in a phrase probably "happy andcontent"!!’ :)‘Accepted and always have someoneto talk to. Company and externalfocus - you cant let your animals gethungry just because you feel downor fatigued’‘Awww, well I would not be withoutmy boys, they are good company,know when I am unhappy or poorly,they are loving, faithful and justlove their mum lol (Simba &Sweetie)’
  6. 6. Definitions
  7. 7. Animal-AssistedInterventions (AAI)‘A broad term that includes what is traditionallyknown as Animal-Assisted Therapy or Animal-Assisted Activities’Society for Companion Animal Studies (2010)
  8. 8. Animal-Assisted Activities(AAA)‘The casual meet and greet activities that involvepets visiting people. The same activity can berepeated with many people, unlike a therapyprogramme that is tailored to a particular person ormedical condition’Delta Society (2009a p1)
  9. 9. Animal-Assisted Therapy(AAT)‘A goal-directed intervention directed and/ordelivered by a health/human service or professionalwith specialised expertise, and within the scope ofpractice of his/her profession. AAT is designed topromote improvement in human physical, social,emotional, and/or cognitive functioning’
  10. 10. Case Study
  11. 11. Meet Dorothy• Recovering from a stroke on the rehabilitationward (Left-sided weakness)• Lived alone but had a supportive family• Difficult to engage in traditional occupationaltherapy interventions (e.g. personal care) despiteencouragement . Nurses bed-bathing• Had remained in bed recently, hoist transfersonto the commode/wheelchair. Not participating
  12. 12. Thinking Outside the Box• What could I do differently tomotivate Dorothy?• What was meaningful to her?• What did her loved-ones think?• Policy/procedures/team thoughts?• How? When? Where?
  13. 13. Meet Holly• Photograph of Holly on the windowsill• Smiled when she talked about Holly and missed her• Initially didn’t want to see her, ‘it will be too painful’,‘she might jump up on me’, ‘it wouldn’t be fair to Holly’• Family on board and staff – gentle encouragement• Meetings arranged with Holly and Dorothy’s daughterin the hospital grounds• Dorothy reported feeling happy during these emotionalinteractions with Holly and her mood appeared to lift
  14. 14. Special StudyThinking Outside theBoxAn Exploratory Study intoOccupational Therapy Staff Views ofAnimal-Assisted Interventions:Opportunities and Implications forOccupational Therapy Practice withResearch QuestionWhat do occupational therapists andoccupational therapy assistantsunderstand about Animal-AssistedInterventions, and how do they considerthis service can be integrated into theirpractice with patients in a hospitalsetting?
  15. 15. Evidence-Base
  16. 16. Recent StudiesAnimal-assisted interventions for elderly patientsaffected by dementia or psychiatric disorders: A review(Bernabei et al 2013)•Literature review: 18 articles on dementia, 5 on psychiatric disorders•AAI were found to have positive influences on demented patients byreducing the degree of agitation and improving quality and degree ofsocial interaction•Positive effect on coping ability and communication•No results on cognitive performance•Suggested more research examining the frequency of sessions, suitabletarget groups and optimal AAI duration
  17. 17. Recent Studies cont.Impact of animal-assisted therapy for outpatients withfibromyalgia (Marcus et al 2013)•Evaluation of the effects of brief therapy dog visits compared to timespent in a waiting room (patients attending a tertiary outpatient painmanagement facility)•Self-reported pain, fatigue and emotional distress•Data evaluated from 106 therapy dog visits and 49 waiting room controls•Average intervention duration 12 minutes•Significant improvements were reported for mood, pain and othermeasures of distress after the therapy dog visit•Concluded that brief therapy dog visits may provide a valuablecomplementary therapy for fibromyalgia outpatients
  18. 18. Recent Studies cont.Developing effective animal-assisted intervention programmesinvolving visiting dogs for institutionalised geriatric patients: Apilot study (Berry et al 2012)•19 patients (men and women), mean age of 85•Interactions between patients and visiting dogs occurred either in atherapeutic context (physical therapy sessions) or in a social situation(socialisation sessions)•Measured mood, depressive state, social interactions, apathy, cortisol levelswere measured in the saliva•Dog-mediated interactions affected the daily increase in cortisol levels, havingan ‘activational effect’ in contrast to the apathetic state of theinstitutionalised older people, concluding that they appear to be promising
  19. 19. Recent Studies cont.An evaluation of an Animal-Assisted Therapy programin an adult inpatient rehabilitation unit (Markovich andKristen 2012)•Qualitative analysis of patient feedback surveys and an analysis of datafrom a measurement log used to assess changes in mobility and ambulationgoals in traditional therapy versus AAT sessions•Themes included enjoyable emotional and physical interaction with thedog, distraction from pain and discomfort and dog’s assistance in therapygoals•85% had improved standing tolerance with AAT, 42% mobility improved•Suggested future studies to examine differences between effectiveness
  20. 20. American StudyCasey (1996)• Surveyed American occupational therapists who hadexperience of using Pet-Facilitated Therapy (PFT) in theirpractice• Concluded that PFT has the potential of becoming a morerecognised modality in occupational therapy and could beused in practice in both health care and service user’s homeswith ease• Identified drawbacks and highlighted the need for standards
  21. 21. American Study cont.Casey (1996)• Risks are addressed and acknowledged, such as exposure toallergens and possible injury to service users• Pointed out that the issue of potential injury or abuse of theanimals themselves is not raised by any of the participants• Stated that the need for further research due to the diversenature of PFT and suggested people’s own pets potentiallybeing used to promote mobility and motivation
  22. 22. American Study cont.Casey (1996)• Increased attention andmotivation during treatment• Increased eye contact• Followed directions better• Demonstrated increasedverbalisation during thePFT sessions
  23. 23. Norwegian StudyBerget et al (2009)• Measured therapists’ and farmers’ attitudes, knowledge andexperiences of Animal-Assisted Therapy (AAT) with farmanimals for clients with psychiatric disorders• Delivered as part of Green Care (a concept that involvesthe use of farm animals, landscape, gardens and plants in co-operation with health institutes for different groups ofclients)
  24. 24. Norwegian Study cont.Berget et al (2009)• Most therapists confirmed the evident potential of offeringAAT services with farm animals, believing that it hadcontributed to clients increased interaction skills with otherhumans• The study concluded that AAT using farm animals was wasbelieved to contribute more successfully to clients withmental health problems than any other occupational therapy
  25. 25. American StudyVelde et al (2005)• Analysed three qualitative casestudies, including Ferrese et al(1998)- Described the perceptions ofoccupational therapist and clientsregarding AAT- American occupational therapistsworking with older people in long-termcare settings (psychiatric, skillednursing facilities, facility for people
  26. 26. American Study cont.Velde et al (2005)• Positive themes were reported including:- Resident’s motivation, range of motion,tolerance levels from physical activity whenpain is present- Sensory interpretation and modulationincreased with animal interactions- Emotional well-being was enhanced- Social interactions improved- Opportunities for nurturing were provided- A home-like environment seemed to becreated by AAT
  27. 27. Texas StudyHinman and Heyl (2002)• Case study of a nursing home assessed the impact of theEden Alternative on the functional behaviours of theresidents• The Eden Alternative was developed to reduce resident’sfeelings of boredom, loneliness and helplessness throughinteractions with animals (e.g. dogs and cats), children and
  28. 28. Texas Study cont.Hinman and Heyl (2002)• Interactions with animals were most commonly observed andbehaviours involving animals occurred more frequently thanthose with children did or plants did• Residents mobility increased• Motivation improved• Anxiety and stress decreased when petting animals• Observations of interactions with the animals elicited avariety of positive social and physical responses including adesire to assume a care-giving role, smiling, laughing andtalking
  29. 29. Implications
  30. 30. Local and NationalGuidelines
  31. 31. Infection Prevention and Control Guideline No19Animals in the Healthcare Setting (January 2012 –2015)Policy StatementA key function of infection control is balancing theindividual needs of patients with the needs of others in a
  32. 32. Key Points• Animals used as therapy (e.g. Pets As Therapy, CaringCanines), may have access to the rehabilitation wards atChristchurch hospital• Royal Bournemouth visitations must be individually riskassessed in liaison with infection control policy• Animals must not be permitted into or pass through the followingareas:- Surgical, Orthopaedic wards, Acute Medical wards, Theatres,Intensive Care Unit/ Coronary Care Unit/ High DependencyUnit, Haematology/ Oncology, Isolation rooms or in contactwith patients with known transmissible infections/ disease,
  33. 33. Key Points• Responsibility of ward/ department manager to ensurecompliance with guidelines• Ensure Animal-Assisted Activity/Therapy form iscompleted and placed in patients notes prior to any visit• Responsibility of the animal keeper to ensure requireddocumentation is up to date and available• Animal keeper must remain with the animal at all times andkept on a lead• All staff on duty must be familiar with infection controlguidelines
  34. 34. Patients own Pet Visiting• Pets must be on a lead at all times orappropriately caged/contained• No young animals prior to primaryinoculations• Pet to have contact with patient only• Pet must be housetrained and exercisedprior to visit• Pet must not enter hospital premises if ill• Contact may need to be reviewed if thepatient is immuno-compromised
  35. 35. NICE Guideline -DementiaThe NICE-SCIE Guideline on Supporting People with Dementia and theirCarers in Health and Social Care(National Collaborating Centre for Mental Health 2007) A range of tailored interventions, such as reminiscence therapy,multi sensory stimulation, animal-assisted therapy and exercise, should beavailable for people with dementia who have depression and/or anxiety’(p33) For all people with all types and severities of dementia who havecomorbid agitation, consideration should be given to providing access tointerventions tailored to the person’s preferences, skills and abilities.
  36. 36. Summary• There is huge potential for animals to be usedin practice, with people of all ages whoexperience problems effecting both theirphysical and mental health and well-being• It is evident that further research is needed inthis field, including issues such as infectioncontrol and consideration of the effects onthe animals themselves
  37. 37. Meet Eunice & Tia
  38. 38. Your thoughts andexperiences?
  39. 39. References• Berget B, Ekeberg O, Braastad BO (2008) Attitudes to Animal-AssistedTherapy with Farm Animals Among Health Staff and Farmers Journal ofPsychiatric and Mental Health Nursing 15, 576-581• Bernabei V, De Ronchi D, La Ferla T, Moretti F, Tonelli L, Ferrari B, Forlani M,Atti AR (2013) Animal-Assisted Interventions for Elderly Patients affected byDementia or Psychiatric Disorders: A Review Journal of Psychiatric Research 47/6762 – 763• Berry, Alessandra, Borgi, Marta, Terranova, Livia, Chiarotti, Flavia, Alleva,Enrico, Cirulli, Francesca (2012) Developing Effective Animal-AssistedIntervention Programs involving Visiting Dogs for Institutionalised GeriatricPatients: A Pilot Study Psychogeriatrics 12/3, 143 - 150• Casey HM (1996) A Survey of Occupational Therapists Using Pet-FacilitatedTherapy Home Health Care Management and Practice 8 (4), 10 - 17
  40. 40. References• Delta Society: The Human-Animal Health Connection (2009a) What are Animal-Assisted Activities/Therapy? Bellevue: Delta Society [Online] Available from: [Accessed 6hApril 2013]• Ferrese L, Forster B, Kowalski R, Wasilewski L (1998) Occupational Therapists:Perspectives on Using Animal-Assisted Therapy with an Elderly Population.Unpublished Masters Project. Dallas: College Misericordia. In: Velde BP, CiprianiJ, Fisher G (2005) Resident and Therapist Views of Animal-Assisted Therapy:Implications for Occupational Therapy Practice Australian Occupational TherapyJournal 52, 43 – 50• Marcus DA, Bernstein CD, Constantin JM, Kunkel FA, Breuer P, Hanlon RB(2013) Impact of Animal-Assisted Therapy for Outpatients with Fibromyalgia PainMedicine 14/1, 43 – 51• Markovich, Kristen M (2012) An evaluation of an Animal-Assisted Therapyprogram in an adult inpatient hospital rehabilitation unit Dissertation AbstractsInternational: Section B: The Sciences and Engineering 73/2-B, 1258
  41. 41. References•National Collaborating Centre for Mental Health (2007) Dementia: The NICE-SCIE Guideline on Supporting People with Dementia and their Carers in Healthand Social Care London: The British Psychological Society & The RoyalCollege of Psychiatrists [Online] Available from: [Accessed 13thApril 2013]•Pichot T, Coulter M (2007) Animal-Assisted Brief Therapy: A Solution-Focused Approach New York: The Haworth Press•Roenke L, Mulligan S (1998) The Therapeutic Value of the Human-AnimalConnection Occupational Therapy in Health Care 11 (2), 27 - 43•The Society for Companion Animal Studies (2010) Animal-Assisted Activityand Therapy Burford: The Society for Companion Animal Studies (SCAS) inpartnership with The Blue Cross [Online] Available from: [Accessed 14thMarch 2010]•Velde BP, Cipriani J, Fisher G (2005) Resident and Therapist Views of Animal-Assisted Therapy: Implications for Occupational Therapy Practice Australian
  42. 42. UsefulContacts/Resources•• BSY (Animal Assisted Therapy Diploma)• Canine Concern – Tel: 01823 664300• Caring Canines – email: caringcanines@btinternet.comTel: 01202 579744• Pet Partners (formerly Delta Society)• Pets As Therapy – email: reception@petsastherapy.orgTel: 01844 345445