OTAC 2017 Psychiatric AD and ESA Handout...
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OTAC 2017 Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected] Occupational Therapy Association of California October 21 st , 2017; 4:15-5:45 pm Summary This workshop describes the roles of dogs in health care through defining the terminology of animal assisted interventions, assistance animals, and emotional support animals. The workshop content is geared toward entry-level clinicians, as well as practitioners who have attained a general working knowledge of current practice trends in animal assisted interventions. Content will include detailed discussion of the biology of the human-animal bond, terminology and skills of psychiatric assistance dogs and emotional support dogs, client screening and considerations, and screening of trainers and assistance dog training organizations. Focus is on increasing knowledge of theoretical foundations and standards of practice, with review of relevant literature, opportunity for resource development, and competent application of the subject matter.
Transcript of OTAC 2017 Psychiatric AD and ESA Handout...
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
Occupational Therapy Association of California October 21st, 2017; 4:15-5:45 pm Summary This workshop describes the roles of dogs in health care through defining the terminology of animal assisted interventions, assistance animals, and emotional support animals. The workshop content is geared toward entry-level clinicians, as well as practitioners who have attained a general working knowledge of current practice trends in animal assisted interventions. Content will include detailed discussion of the biology of the human-animal bond, terminology and skills of psychiatric assistance dogs and emotional support dogs, client screening and considerations, and screening of trainers and assistance dog training organizations. Focus is on increasing knowledge of theoretical foundations and standards of practice, with review of relevant literature, opportunity for resource development, and competent application of the subject matter.
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
Terminology/Definitions Animal Assisted Interventions (AAI) Categorical term that includes animal assisted therapy (AAT), animal assisted education (AAE), animal assisted activity (AAA), and animal support (AS). AAIs include informal or formal goal-directed intervention [leisure, therapy or education] that is designed to promote improvement in physical, social, emotional, and/or cognitive functioning of the person(s) involved and in which a specially trained animal-handler team is an integral part. AAI is directed and/or delivered by a practitioner with specialized expertise and within the scope of practice of his/her profession. Formal AAIs include AAE and AAT. Informal AAIs include less goal-directed, more casual or spontaneous interactions. AAI may be provided in a variety of settings, may be group or individual in nature, and may be implemented for persons of any age. (AAII, n.d.)
Animal Assisted Activities (AAA) • Provide informal opportunities for motivational, educational, or recreational benefits
(AAII, n.d.; AVMA, n.d.; IAHAIO, 2014; Pet Partners, n.d.). • Teams are specially trained, evaluated, and registered through a volunteer visiting organization to
conduct short visits in various facilities. • Role may change if working within AAT or AAE
Animal Assisted Therapy (AAT)
• Formally goal-directed, structured, and measured intervention designed to promote improvement in physical, cognitive, and psychosocial functioning of the participants (AAII, n.d.)
• Delivered by a licensed/degreed healthcare professional with specialized expertise and within scope of practice
• Potential participants and animals involved are carefully screened for appropriateness of intervention and precautions
• Process is planned, modified, documented, and evaluated
Animal Assisted Education (AAE) • Formally goal-directed, structured, and measured intervention designed to promote improvement in
cognitive functioning of the participants (AAII, n.d.) • Delivered by a licensed/degreed educational professional with specialized expertise and within scope
of practice • Potential participants and animals involved are carefully screened for appropriateness of intervention
and precautions • Process is planned, modified, documented, and evaluated
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
Assistance Dogs
• Defined by Assistance Dogs International (ADI) as an overall term that includes: o Guide dogs: for people who are blind or with visual impairments o Hearing dogs: for people who are deaf or hard of hearing o Service dogs: for people with disabilities other than vision or hearing, such as physical
disabilities, psychiatric disabilities, autism, seizures/other medical conditions
• Americans with Disabilities Act (ADA) Title III: “service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability... The work or tasks performed by a service animal must be directly related to the individual´s disability. Examples of work or tasks include ... helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors. The crime deterrent effects of an animal´s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition.” (U.S. DOJ, 2016).
• Trained tasks versus natural behaviors Psychiatric Assistance Dogs
• A dog that is trained to do specific tasks for a person with a psychiatric disability to mitigate symptoms or help overcome the inability to perform major life activities
• Dog needs to be able to recognize these symptoms/behaviors AND respond to them • Examples of tasks
o Mitigating symptoms:
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
§ Confusion/disorientation: guiding person home on cue, blocking person from crossing intersections
§ Hallucination: notify person if there is a real person/object, not a hallucination § OCD behavior: dog interrupts and redirects behavior § Fear/anxiety of entering home: searching house and turning on lights before
human enters, alerting if someone is there o Mitigating side effects:
§ Dizziness when bending forward: dog picks up objects from the floor § Sedation: alerting and waking up person for smoke alarms § Fetching medication when person is unable to rise to a seated position due to side
effects from missing medication o A task cannot be something that the person can do himself, such as carrying medication
or reminding the person to take medication when they could use an alarm/watch instead. • Literature
o Among people with progressive disorders, and people with severe depression, service dog partners scored significantly higher in positive affect (Collins, et al., 2006)………
• Laws that apply o ADA – includes wording for service animals for people with psychiatric disabilities o Air Carrier Access Act (ACAA)
§ Defines service animals as any animal that is individually trained or able to provide assistance to a qualified person with a disability; or any animal shown by documentation to be necessary for the emotional well-being of a passenger
§ Psychiatric service animals are recognized as service animals, but are considered to be emotional support animals and, therefore, subject to the applicable regulatory requirements, i.e. documentation (AVMA, 2017).
Emotional Support Dogs • Emotional Support Animals
o May be an animal of any species o Provides companionship and comfort to individuals with psychological disorders o Does not have to be trained to perform any particular task o The use must be supported by a qualified physician, psychiatrist or other mental health
professional based upon a disability-related need • Laws
o Emotional support animals are NOT considered service animals under the ADA, so do not necessarily have public access except……….
o Fair Housing Amendments Act of 1988 (FHA) (42 U.S.C. § 3604) § Defines assistance animal as an animal “that works, provides assistance, or
performs tasks for the benefit of a person with a disability, or provides emotional support that alleviates one or more identified symptoms or effects of a person's disability”
§ An emotional support animal may be considered a “reasonable accommodation” in housing facilities with no-pet or restricted pet policies
o Air Carrier Access Act (ACAA) (14 C.F.R. § 382.117) § A commercial airline must permit emotional support dogs and other animals to
accompany qualified passengers with a disability on a flight. § Airlines may require that a passenger traveling with an emotional support
provide written documentation.
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
Literature • Benefits of pet ownership
o “The occupations involved in caring for a pet hold the potential to enable personal and social well-being, to acquire and express personal and social identity, and to achieve individual and national self actualization.” (Zimolag & Krupa, 2009)
• Human animal interaction (HAI) o Psychophysiological effects of oxytocin from HAI may include increased social
interaction, decreased stress and anxiety, and enhanced human health (Beetz, et al., 2012) o More……….
• AAA o Improved self-esteem and self-determination, and decreased positive symptoms of
schizophrenia and emotional symptoms relative to control (Chu, et al., 2009) • AAT
o Adults and older adults with schizophrenia who received AAT improved in the areas of social functioning (Barak et al., 2001; Kovacs et al., 2006; Villalta-Gil et al., 2009), independent living skills (Kovacs et al., 2004), and negative symptoms such as anhedonia (Menna et al., 2012; Nathans-Barel et al., 2005; Villalta-Gil et al., 2009).
o NIRS can be used to objectively and physiologically measure effects of AAT. Individuals with mood disorders who received AAT had increased blood oxygenation levels and cerebral activity in the prefrontal cortex, which indicates decreased symptoms of depression (Aoki et al., 2012).
o In skilled nursing facilities, older adults with symptoms of depression and apathy showed improved symptoms and increased social behavior after participating in AAT (Berry et al., 2012).
Client Screening/Considerations
• History with animals • Lifestyle • Physical conditions • Client factors • Skills/abilities
Trainer/Organization Screening
• Relationship-based, force-free, positive reinforcement training techniques • Individualizes training for the client and his/her needs and abilities • Trainers from Assistance Dogs International, Certification Council for Professional Dog Trainers
(CCPDT), International Association of Animal Behavior Consultants, or other reputable organizations
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
Resources
• Local Training Organizations o Examples of ADI Accredited Assistance Dog Training Organizations in California (see
https://www.assistancedogsinternational.org/location/california/ for contact information and more organizations)
§ Canine Companions for Independence Southwest (Oceanside, CA) § Canine Companions for Independence Northwest (Santa Rosa, CA) § Tender Loving Canines Assistance Dogs (Solana Beach, CA) § Paws’itive Teams (San Diego, CA) § Bergin University of Canine Studies (Rohnert Park, CA)
• Educational o FAQ About Service Animals and the ADA (U.S. DOJ, 2015)
§ https://www.ada.gov/regs2010/service_animal_qa.html o DOT Service Animal Definitions Matrix
§ https://www.transportation.gov/sites/dot.gov/files/docs/P2.SA_.Issue%20List.SA%20Matrix.pdf
o Service Animals and Emotional Support Animals (Brennan, 2014) § https://adata.org/publication/service-animals-booklet
o FAQs on Emotional Support Animals (Wisch, 2015) § https://www.animallaw.info/article/faqs-emotional-support-animals
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
References American Veterinary Medical Association. (2017). Assistance Animals: Rights of Access and the Problem
of Fraud [PDF]. American Veterinary Medical Association. Aoki, J., Iwahashi, K., Ishigooka, J., Fukamauchi, F., Numajiri, M., Ohtani, N., & Ohta, M. (2012).
Evaluation of cerebral activity in the prefrontal cortex in mood [affective] disorders during animal-assisted therapy (AAT) by near-infrared spectroscopy (NIRS): A pilot study. International Journal of Psychiatry in Clinical Practice, 16(3), 205-213. doi: http://dx.doi.org.libproxy.library.wmich.edu/10.3109/13651501.2011.644565
Barak, Y., Savorai, O., Mavashev, S., & Beni, A. (2001). Animal-assisted therapy for elderly schizophrenic patients: A one-year controlled trial. The American Journal of Geriatric Psychiatry, 9(4), 439-442.
Beetz, A., Uvnas-Mobery, K., Julius, H. & Kotrschal, K. (2012). Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Frontiers in Psychology, 3. doi: 10.3389/fpsyg.2012.00234.
Berry, A., Borgi, M., Terranova, L., Chiarotti, F., Alleva, E., & Cirulli, F. (2012). Developing effective animal-assisted intervention programs involving visiting dogs for institutionalized geriatric patients: A pilot study. Psychogeriatrics, 12(3), 143. doi: 10.1111/j.1479-8301.2011.00393.x
Brennan, J., & Nguyen, V. (2014). Service Animals and Emotional Support Animals. Retrieved September 21, 2017, from https://adata.org/publication/service-animals-booklet
Collins, D., Fitzgerald, S., Sachs-Ericsson, N., Scherer, M., Cooper, R., & Boninger, M. (2006). Psychosocial well-being and community participation of service dog partners. Disability and Rehabilitation: Assistive Technology 1(1-2), 41-48. doi: 10.1080/09638280500167183
Chu, C.I., Lieu, C.Y., Sun, C.T., Lin, J. (2009). The effect of animal-assisted activity on inpatients with schizophrenia. Journal of Psychosocial Nursing, 47(12), 42-48.
Menna, L. F., Fontanella, M., Santaniello, A., Ammendola, E., Travaglino, M., Mugnai, F., et al. (2012). Evaluation of social relationships in elderly by animal-assisted activity. International Psychogeriatrics, 24(6), 1019-20. doi:http://dx.doi.org.libproxy2.usc.edu/10.1017/S1041610211002742
Kovacs, Z., Kis, R., Rozsa, S., & Rozsa, L. (2004). Animal-assisted therapy for middle-aged schizophrenic patients living in a social institution. A pilot study. Clinical Rehabilitation, 18(5), 483-6. doi: http://dx.doi.org/10.1191/0269215504cr765oa
Kovacs, Z., Bulucz, J., Kis, R., & Simon, L. (2006). An exploratory study of the effect of animal-assisted therapy on nonverbal communication in three schizophrenic patients. Anthrozoos, 19(4), 353-364.
Nathans-Barel, I., Feldman, P., Berger, B., Modai, I., & Silver, H. (2005). Animal-assisted therapy ameliorates anhedonia in schizophrenia patients. Psychotherapy and Psychosomatics, 74(1), 31-5.
Wisch, R. F. (2015). FAQs on Emotional Support Animals. Retrieved September 21, 2017, from https://www.animallaw.info/article/faqs-emotional-support-animals
U.S. Department of Justice. (2015, July 20). Frequently Asked Questions about Service Animals and the ADA. Retrieved September 21, 2017, from https://www.ada.gov/regs2010/service_animal_qa.html
U.S. Department of Justice. (2016, December). Revised Final Title III Rule: A Compilation of Regulatory Provisions and Guidance -- Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities. Retrieved September 21, 2017, from https://www.ada.gov/regs2010/titleIII_2010/titleIII_2010_regulations.htm
Villalta-Gil, V., Roca, M., Gonzalez, N., Domènec, E., Cuca, Escanilla, A., ... & Haro, J. M. (2009). Dog-assisted therapy in the treatment of chronic schizophrenia inpatients. Anthrozoös, 22(2), 149-159.
Zimolag, U., and Krupa, T. (2009). Pet ownership as a meaningful community occupation for people with serious mental illness. Am. J. Occup. Ther. 63, 126–137.
OTAC 2017
Melissa Winkle, OTR/L, FAOTA: [email protected] Karen Ni, OTD, OTR/L: [email protected]
Melissa Winkle, OTR/L, FAOTA President, Dogwood Therapy Services
President, Animal Assisted Intervention International Albuquerque, NM
Karen Ni, OTD, OTR/L President, SunDog Therapy
Los Angeles, CA [email protected]
