Road construction: Building and evaluating pathways to save lives

Transcription

1 Road construction: Building and evaluating pathways to save lives Dr. Brenda Dines, DVM, Maddie s Fund Shelter Medicine Resident, University of Wisconsin-Madison Shelter Medicine Program Dr. Gail Schroder, DVM, UW/UCD Maddie s Shelter Medicine Fellow Dr. Melissa Resnick, DVM, UW/UCD Maddie s Shelter Medicine Fellow Maddie s Shelter Medicine Fellowship Program A partnership between University of Wisconsin Shelter Medicine and UC Davis Koret Shelter Medicine programs

2 What is pathway planning? A road map for animals in the shelter, but also before they come to the shelter A little different for each shelter Works closely with other progressive shelter techniques (open selection, managed admission, intake diversion, daily rounding, capacity for care, etc.) Not all or nothing

3 When do we use Pathway Planning? Can and should happen before ever entering the shelter Retention Diversion Education Sometimes necessary at the time of intake

4 Volunteers Directing the Path

5 Why pathway plan? Promotes animal welfare Decreased LOS Less disease Less shelter acquired behavior disorders Employee satisfaction and empowerment

6 Some of the pathways Stray Open Selection Infectious Disease Non- Infectious Disease Legal Cases Quarantine Dangerous Euthanasia

7 Some of the pathways Puppies/kittens Dangerous <6 weeks Quarantine >6 weeks Ill Immediately adoptable Immediately transfer Feral/Return to Field Legal Cases Euthanasia Foster medical/behavioral Open selection Infectious disease Non-infectious disease **Intake Diversion

8 How does it work with other progressive sheltering components? Open Selection Daily Rounding Strays Change pathway as needed Infectious Disease Non-Infectious Disease Capacity for Care Shelters define when certain pathways are full Medical Behavioral Gail Schroder will explain it best as she goes through her behavior pathway Managed Admissions Can have many components Melissa Resnick explains how pathway planning and managed admissions worked in her shelter Foster Slow-Track

9 We are more alike than we We can show you are unalike

10 Road Construction: Building and Evaluating Pathways to Save Lives Case Study: Greenhill Humane Society Gail Schroder DVM, UW/UCD Maddie s Shelter Medicine Fellow Maddie s Shelter Medicine Fellowship Program A partnership between University of Wisconsin Shelter Medicine and UC Davis Koret Shelter Medicine programs

11 My shelters Greenhill Humane Society Private Non-Profit limited admission shelter 1500 animals/yr 1 st Avenue Shelter Municipal City/County open admission shelter 2000 animals/yr

12 My shelters Adoption Guarantee ( no-kill ) shelters with a 96-98% LRR for dogs Many legal/welfare cases with bite history or other behavioral challenges Medically unhealthy animals get seen by vet right away, but behaviorally unhealthy animals are given more time to adjust

13 My role in the shelter: Director of Shelter Medicine and lead veterinarian for past 10 years First veterinarian to work at the shelter in 2008 now have 2 additional vets on staff 7 years prior experience in private practice with a focus on Behavior Medicine

14 Typical behavior cases in my shelter: Sunny Fear aggressive.. Adopted & returned 4 times, bit last adopter in the face 4 weeks in shelter Bailey Active & untrained, fearful around strangers, dog reactive in the shelter 7 weeks in shelter Devo Fear aggressive, dog aggressive. Attacks kennel gate when other dogs go by 3.5 months in shelter Tank Multiple medical problems & is resistant to handling. Dog aggressive 1.5 years in shelter

15 Is there a path out of the shelter for these dogs? Our challenges: Stressful environment Minimal rehabilitation or training programs in place No daily rounds Long Length of Stay Few local rescues willing to take them Many animals beyond our resources to treat

16 Paths available: euthanasia Challenging Behavior Cases Adoption Need more time to evaluate Long length of stay Welfare concerns Safety concerns

17 Destination Postcard Creating a path where none existed before: My goals: Improve the welfare of stressed, fearful dogs Decrease Length of Stay and prevent overcrowding/warehousing Develop a plan for managing challenging behavior cases

18 Creating a new path: euthanasia Challenging Behavior Cases Adoption Need more time to evaluate Make a plan for further assessment, training, enrichment, rescue/foster, or??

19 The new path:: STEP 1 Started weekly rounds to identify dogs needing behavior help STEP 3 Involved staff & troubleshooting the process STEP 4 Documented our progress! STEP 2 Created a spreadsheet to communicate status changes and updates

20 STEP 1 Weekly rounds: WHO: Veterinarian, kennel manager and lead kennel tech WHERE: visually evaluate every dog in their kennel WHAT: Discuss all history and behavior seen in shelter, and brainstorm all options for training, foster care, rescues, enrichment HOW can we prevent this dog from deteriorating in the shelter?? No more wait and see. Every dog has a plan!

21 STEP 2 Used a spreadsheet to track status and outcomes Monitored progress of each dog Collaborative communication tool Visualization of successes and failures name Receiving #/ description Intake date Locat ion You r initi Date U/U als identified Date of rounds discussio n Diagnosis/ situation details arrived on BQ (until 1/19), possible RTO. AWO (Molly) needs to determine Rosco rottx fas GS 16-Jan 16-Jan outcome by 1/20 Kukui Is on a 10 day BQ after Black/whit e put bull A FAS KMB attacking another dog and then redirrecting onto 2/6, 2/13 another person. Has been Rescue/ transfer options? noowned hx of dog fight in home. Coco blk pitx 17-Jan ghs GS 17-Jan fear ag, growls at gate 1/29-22-Jan now also afraid of men bit Dixie thru gate. dog ag A but great w/ people. has Black pit been easily manageable in Girl mix GHS shelter arrived on BQ. spinning in cage. no imp on traz. now gold akita x chewing on gate. hx of sep Smokey Jan ghs GS 15-Jan 1/15, 1/22 anx per o. yes Previous history of A aggression, unpredictable Tan Staffie aggression, barking, Zo Mix fas KMB growling, lunging at kennel No Was adopted. In the adoptive home he was out playing with his adopter Hans A GHS KMB when he charged and No Bear Labrador Mix A GHS KMB No Rescue/ transfer calls & outcome Rehab/ training options? no due to history no- too dangerou s yes consider search&r escue evaluatio no fear ag, fear of strangers 1/23, and some men. was 1/30, 2/6, improving at 1st then Kylo Ren /21/2018 fas gs 2/14/2018 2/13 declining no- owned yes Came in as PDD after Hyde Tan/White pit bull A FAS KMB attacking another dog and redirrecting onto a person 13-Feb biting them as well. This is No u/u for high anxiety level in any enclosure we put her in. Does not like being KK FAS ASH 15-Feb 20-Feb left alone. Constantly hx of multiple severe bites. severe fear ag. started on trazodone for Goofy/Zeu Feb fas GS 20-Feb 20-Feb Gunnar tricolor hound Jan ghs GS 15-Jan 1/15, 1/22, 1/29 Rehab/ training calls & outcome Curent outcome/plan Date of LOS from final U/U to outcome outcome getting RTO'd today days RTO, if not able to RTO most likely pts. on 2/13, PTS on elected PTS (definitely) 2/21 w/ if not RTO. GS 2/20- per blow dart 16 days high value treats in PTS if not improved by 1/29. doing better prior to 1/29, will continue to OP jar for work on. Adopted 1/ Days Still doing well with people but has started to show quite a bit of stress in her kennel, days discussed pts 1/22 but staff said a vol is 2/2/2018 interested in adopting. adopted 1/29 vol pulled out, by vol 18 days Note: Rec pts by KMB when Has been stray hold is up ; No due doing a 1/27 KB-Waiting to reevlautate with Gail on 30-Jan 14 days to history lot better Rec pts by KMB. Talking to staff on ; Completed pts on days Has been adopted and returned several times for anxiety problems. Carmalita with Training Adopted! days comfort, unable to safely no no bit during exam 1/15, growls and cowers when approached.fearag. not improving since 1/15 yes no- too dangerou s was available for adoption but scared off many people. U/U decision made, then RTO, if not able to RTO most likely pts. on 2/13, elected PTS (definitely) if not RTO once BQ available for adoption.try thundershirt, toys. if behavior in shelter 14-Feb 24 days 20-Feb 8 days 2/23 adopted 8 days PTS if not rto per GS 2/20; RTO Days MF rec pts per GS 1/22. assessed staff thinks is doing and better, is available as made hidden gem d/t Days major medical issues on Slick Mar ghs gs 30-Mar 2-Apr intake no no rec pts per gs. staff was waiting on paperwork being signed? pts 4/3/18 5 days

22 STEP 3 Bumps in the road Will it increase euthanasia numbers? If we have space, then why not give them another week? Staff won t report bites due to fear of a euthanasia decision Aren t there more rescue/transfer options? I shouldn t have to justify my decision We don t have time to train dogs!

23 STEP 4 Where we started Lots of behaviorally challenging dogs with long LOS What everyone feared would happen: Quick decisionmaking without staff input More euthanasia of potentially manageable dogs What actually happened: Discussion of every dog s challenges Some dogs euthanized more immediately, to prevent suffering All other dogs receive a behavior plan Improved welfare for those who remain in the shelter Euthanasia numbers did not go up! Better outcomes for many of our challenging dogs!

24 Recent Case examples: Smokey Arrived on Bite Quarantine, Spinning in cage, dog aggressive 18 days in shelter Declan Separation anxiety, dog aggressive with redirected aggression to people 13 days in shelter Nevaeh. Adopted & returned multiple times. High energy, dog reactive in shelter 10 days in shelter Sean Severe dog aggression, fearful of dogs. With early intervention, became manageable in shelter 30 days in shelter

25 Did we reach our destination? My goals: Improve the welfare of stressed, fearful dogs Decrease Length of Stay Develop a plan for managing challenging behavior cases We will always need more resources to manage every challenging dog!

26 What else did we learn along the way? Some beneficial unintended consequences of pathway planning: Better communication between vets and staff: working together led to better teamwork Led to improved trust in euthanasia decision-making process More talking about behavior and enrichment! Staff working harder to prevent intake of dogs unlikely to do well in shelter (decreasing surrender of dogs with behavior challenges)

27 Conclusions: Nobody likes to talk about euthanasia, but avoiding the issue made it worse for the dogs- and for our staff, our finances, safety and space issues The problem wasn t euthanasia decision-making, it was a lack of focus and planning for the dogs most needing our help. Pathway planning can occur via baby steps, focusing on one problem at a time. Comfortable change is a slow process. Even if you fail at your ultimate goal, some beneficial unintended consequences may occur Create a path and see where it takes you!

28 Road construction: Building and evaluating pathways to save lives Case Study: ACCT Philly Dr. Melissa Resnick, University of Wisconsin/UC Davis Maddie's Shelter Medicine Fellow Shelter Veterinarian, Animal Care and Control Team of Philadelphia Maddie s Shelter Medicine Fellowship Program A partnership between University of Wisconsin Shelter Medicine and UC Davis Koret Shelter Medicine programs

29 Animal Care and Control Team of Philadelphia Open admission municipal shelter Took over the city s animal control contract in 2012 Annual intake of ~20,000 dogs and cats Serves a community of 1.5 million people (1/4 of population below the poverty level)

30 Despite your shelter s challenges, there may be small changes in pathway planning that can save lives! This is a high-volume shelter. This alone is challenging, but given the space, limited resources, and low staffing levels, the challenge is significantly compounded. -Humane Network consultation, 2015

31 Can your shelter better manage its intake? Can pathway planning save more lives? But how can we we manage intake when Provider shall accept from any citizen of the City any unwanted or stray animal that is delivered?!

32 DOGS CATS Who is coming in? Where can we intervene? More than half of dog intakes are stray About 1/3 of all cats are surrendered and 2/3 are stray Average,

33 Why are pets surrendered to your shelter? What can we manage DOGS CATS Health of animal Lifestyle Changes Health of animal Moving/Housing Lifestyle Changes Moving/Housing data

34 When do animals come in to your shelter? Who does intake and interacts with the public?

35 Our goal: Pathway planning at intake (or shortly after) Euthanasia Rescue Adoption

36 Managed admission was key to pathway planning at intake

37 First we had to identify our potholes But managed admission can t apply to my shelter, we re open admission! Limited resources, staffing, and space No control over continuous influx of animals Almost no info collected about surrendered or stray animals Mindset of staff & community

38 We don t have time to do these long intakes! Staff reaction Owners will either exaggerate downplay medical or behavior issue This will never work here! We ll euthanize more surrendered pets People will just lie to us anyway! Owners will abandon pets in lobby or say pet is a stray We don t have enough staff

39 Our pathway to managed admission began in 2017 Help desk 2018 Scheduled a vet nurse at intake 2018 Surrender by appointment 2017 Changed intake process 2017 Changed intake area 2017 Surrender info on website 2017 Reduced surrender hours 2017

40 BEFORE Surrender info on website AFTER No mention of surrendered pets Created a Surrender page Animal Receiving hours 11-8" Few resources listed

41 Provided links to low-cost clinics Other resources What to bring

42 BEFORE Reduced surrender hours AFTER Animal receiving every day from 11-8 (really 8-8) Could even have field officers pick up unwanted pets Surrender hours 12-5 (May 2017) Surrender by appointment (started Fall 2017) Emergency situations accepted anytime (medical, behavioral, lifestyle changes)

43 BEFORE Changed intake area AFTER Intake area in lobby Crowded No privacy (owner shaming) Physical barrier between staff & public Intake area in side hallway

44 BEFORE (not quite) AFTER Turned extra bathroom into exam room (work in progress!)

45 BEFORE Changed intake process AFTER Owners filled out surrender paperwork without guidance Most were incomplete or unreadable Info not entered into Petpoint Each intake was different with subjective intake memos Created intake protocol for consistency Created intake exam templates Everything into Petpoint Info printed on cage cards is much easier for adopters to see

46 BEFORE AFTER Owner wrote on paper surrender form, often incomplete or ineligible Intake template

47 Surrender by appointment Started by using paper calendar Tried Google calendar Then moved to scheduling in Petpoint Entered owner and pet info ahead of time Opportunity to divert or prevent intake

48 BEFORE Scheduled a vet nurse at intake AFTER Customer service staff not allowed to handle animals Delayed exams of ill or injured animals Minor or non-issues getting immediate exams Essential questions not asked Limited ability to provide surrender interventions Nurses can examine animals Can determine if animal needs immediate vet exam or nothing at all Help some owners with easy fixes to prevent surrender Guide medical questions Help non-medical staff answer range of questions that come up

49 Community Help Desk Help Desk staff on-site 6 days a week beginning March 2018 Pet owners inquiring about surrendering their pets will be referred to the Help Desk where they will be provided resources to match their individual situation and help keep their pets, including cases of veterinary medical emergencies, behavioral issues, housing troubles, and more.

50 Community Help Desk Has become part of intake process! Have capacity to follow-up with owners later after having time to locate resources Can reach out to rescues directly

51 Bumps in the road What s an emergency situation and what s not? Getting message out to community who could previously walk in any time Empathy for the owner/finder at stressful time: How may we help you vs Do you have an appt? Working out dynamic between CSR and vet nurse Owner made appts but left without resources Knowing when to bend the rules

52 Bumps in the road

53 What happened? And what didn t happen? Evaluating the pathway Total intake went down Pets weren t all abandoned in the lobby as feared All departments benefitted from the changes (lifesaving, medical, adoptions, foster program)

54 What happened when we scheduled a nurse at intake? Evaluating the pathway

55 BEFORE Nurse at intake AFTER 2017: Owner reports cat having seizure No additional info collected 2018: Owner reports cat having seizure Many additional questions asked! Managing our admission saved this cat s life! And many like her

56 BEFORE Nurse at intake AFTER 2017: Senior with weight loss and lethargy Limited history collected 2018: Senior with weight loss and lethargy Many additional questions asked! Improved this dog s welfare, and many like her

57 Nurse at intake Surrendered for bleeding nail Nurse determined minor injury Diverted to a low-cost clinic Surrender prevented!

58 Having nurses at intake allowed for immediate pathway planning! Surrendered for dystocia Nurse was able to get history Spay! Surrendered for laceration Nurse was able to get history Laceration repair and spay! HSUS Pets for Life Return to Owner program-in use for years but nurses had better idea of our capacity

59 What happened when templates were used? Evaluating the pathway

60 BEFORE AFTER urinates outside of box 2-3 times a day for 3-4 months, no crying or straining, recent weight loss, eating less, no vet care for problem I don t know going out of his box urinates outside of box a few times a week, box changed once a week, one box, no change in weight or appetite"

61 Inappropriate elimination template CSR manager tried it herself I never thought to ask these questions but they re so helpful One of the top reasons for surrendered cats More info absolutely changed pathway

62 Intake templates Better capture of behavior info in the home (or even brief time with finder) gives dogs a better chance at adoption!

63 BEFORE Intake templates AFTER Owner wrote on paper surrender form, often incomplete or ineligible Info about pet s history and behavior on cage card that adopters can easily read

64 What happened when we moved to surrender by appt? So what happened? Evaluating the pathway

65 Surrender by Appointment The public adjusted! They made and kept appointments More time to get info at intake Can anticipate who is coming in When needed can contact owners to push back appt We re still open admission we aren t saying no, just not right now

66 Delaying intake by less than one day saved this dog s life! Surrender by Appointment

67 Unintended beneficial consequences Shortening surrender hours meant more medical staff available Allowed kennel staff to clean kennels and cages before new animals arrive Better flow at front desk Less questions from rescues and adopters We all saved time!

68 We don t have time But a 15 minute investment at intake saves hours of time for veterinary and life-saving staff later! It takes time to: Shave for a spay scar Guess the medical or behavior problem What did the owner mean when the form says has diabetes owner or cat?! Doing what out of the litter box? How is dog out of kennel? Identify a pathway

69 Unintended beneficial consequences Our original goal was managed admission of surrendered pets intake but also very useful for strays

70 Unintended beneficial consequences Having intake templates for strays improved outcomes

71 Unintended beneficial consequences Having intake templates for SNR and TNR cats improved outcomes Any medical issues noticed? Cat has a messed up paw Area found: alleyway

72 How did we fix the potholes? Showing staff success stories Retraining our public Seeing how it benefited every department Starting the process even if it s not perfect! Letting staff know we want feedback and want to make it work

73 Evaluating the path The CSRs finally admitted that the templates actually make their job easier! The intake protocol and templates make it a lot easier to train new staff. - Director of Community Services I feel like it s better because we can tell if the animal needs an exam right away We notice things that used to get missed on intake We can keep some pets in their homes when we tell owners there s a solution! - Veterinary Nurses

74 Evaluating the path People are more willing to wait for an appointment and give us more info when they realize we are trying to help them and find the best outcome for their pet. Now we can provide some resources while they re waiting. For some people this is a heartbreaking decision and they need to be met with compassion. - Customer Service Supervisor

75 Evaluating the path The intake templates have been extremely helpful for the Lifesaving Department, and also for our rescue partners The current questions ask important information that had not be captured on a consistent basis. The questions and template format helped to increase the overall standard of quality of information captured upon intake. Info about the animal's history with children and other animals has been extremely helpful, as oftentimes our rescue partners ask prior to making a commitment for an animal. We use the medical history to see what new animals should be to be prioritized for promotions. Since exams are also listed on the kennel card, the rescue partners are able to immediately see it. Overall the intake templates have been a huge quality of life improvement for both Lifesaving staff and our partners! - Senior Manager, Lifesaving

76 Are we there yet? What do we need to get there? More trained customer service staff Improve intake exam room Schedule vet nurses in evening Collect more behavior info Continue to get staff feedback and modify process as needed Provide more surrender intervention Remember, it doesn t have to be perfect think of it as just a trial

77 Questions? Maddie s Shelter Medicine Fellowship Program A partnership between University of Wisconsin Shelter Medicine and UC Davis Koret Shelter Medicine programs