THERAPY(DOGS:( HAS(MEDICINE(GONE(TO(THE(DOGS?(((( (YES,(AND(IN(A(GOOD(WAY)

THERAPY(DOGS:( HAS(MEDICINE(GONE(TO(THE(DOGS?(((( (YES,(AND(IN(A(GOOD(WAY) Henri(R.(Nolin,(CPP,((( ( Angelina(Dallmann(Marino,(( MHS,(OTR/L,( ( (KD9(Chief,(CDP(

THERAPY DOGS: Has medicine gone to the dogs? (Yes, but in a good way) Presented by: Angie Dallmann Marino, MHS, OTR/L Hank Nolin, CPP K-9 Chief Nolin, CDP, and friends.

! THERAPY DOGS: Has medicine gone to the dogs?

Brief History of Occupational Therapy 1700 s Age of Enlightenment Phillipe Pinel and William Tuke Moral Treatment and Occupation 1840-1860 Golden years of Moral treatment and Occupational U S Civil war Susan Tracy early 1900 s Occupational Nurse George Barton and Dr. W. Dunton, Occupational Work

March 15, 1917 National Society for the Promotion of Occupational Therapy 1930 s Scientific Approach 1940 s Rehabilitation Movement due to the return of 1000 s of returning injured troops 1947 Occupational Therapy and Rehabilitation Journal 1956 COTA developed 1965 Covered by Medicare Quality of Life NOW OCCUPATION is main focus

Evolution of animals in therapy THERAPY DOGS: Has medicine gone to the dogs:

! Greeks used dogs to lick the wounds of soldiers after battle.! 9 th century, Gheel, Belgium. Daily caring for animals were used in therapy to assist disabled. Grooming, feeding, cleaning of the farm animals was included in the daily exercises for reintroducing patients into normal life. (Hmm OT)! 1600s First record of a Guide dog in Greece.! 1792 York Quaker Retreat, England. Facility was designed for humane treatment of the insane patients. Therapy included caring for birds, rabbits, and sheep.

!Florence Nightingale insisted there be birds in the hospitals and rooms where she worked. birds are an excellent pleasure for an invalid confined to bed for a long time.!1867 Bielefeld, Germany Epileptic patients were allowed to interact with, and care for, birds, cats, dogs and horses.!1919 after WW I, Secretary of The Interior Dr. Franklin Lane insisted that military hospitals in Wash., D.C. have dogs available to ease the mental pain of recovering soldiers.

!1941 First Guide dog!1942 Pawling NY Air Corp Convalescent Hospital had recovering veterans working at center farms. Dogs and forest animals were introduced to help those patients who needed rest and relaxation.

!1944 Dr. James Bossard. First recorded in a modern medical journal that pets were: -Sources of unconditional love -Outlets for people to express love -Opportunities for people to express power -Social lubricants -Companions -Teachers to help children learn toilet skills, sex and responsibility

The love of animals is one of the universals in existence of both. Household pets are an integral part of family life: they must be considered a basic implement in mental hygiene Bossard 1950!1961 Dr. Boris Levinson the Father of Animal Assisted Therapy (AAT) a nonverbal patient interacted with his dog and spoke to the dog! (Joe s Story will come later) PET THERAPY

!1971 Sam and Liz Corson, Ohio State Univ. Psychiatric Hospital Staff, continued Levinson s work with pets and children to improve social skills.!1973 Skeezer from Ann Arbor, Michigan Child s Psychiatric Hospital (Book and movie)!1970 Ethel Wolf was the first to systematically study the correlation between animals and therapy.!1972 Levinson surveyed 435 psychotherapists in New York State found that 1/3 had used pets in therapy, mostly dogs and cats

!1976 first dog used for hearing assistance!the United States Army Medical Department Journal: Canine Assisted Therapy in Military Medicine April-June 2012

! AAT - ANIMAL ASSISTED THERAPY! Regarded as a goal directed intervention in which animal that meets specific criteria are an INTEGRAL part of the treatment process! Directed and or delivered by a health professional with special training within the scope of their profession! Key features: specified goals and objectives for each individual and measured progress

! AAA - ANIMAL ASSISTED ACTIVITY! Delivered in a variety of environments by specially trained professionals, paraprofessionals, and/or volunteers in association with animals which meet criteria Key features: An absence of specific treatment goals, the volunteers and treatment providers are not required to take notes, and the visit is spontaneous

Angie s Simba Graduates From Basic Obedience School. Simba Is now in Advanced Training

"AAI ANIMAL ASSISTED INTERVENTIONS! AAT + AAA = AAI! Emerging term used to define therapeutic interventions that intentionally includes or incorporates animals as a part of the therapeutic process or mileu! (Kruger, et al., 2004)

! Pet therapy! Pet facilitated therapy! Pet psychotherapy! Pet-facilitated psychotherapy! Pet-mediated therapy! Companion animal therapy! Co-therapy with an animal

! The love of life or living systems. (Amer Medical Encyclopedia)! The biophelia hypothesis suggests that there is an instinctive bond between humans and other living systems. The urge to affiliate with other forms of life, as described by Edward O. Wilson.! Erich Fromm suggested that biophelia describes "the connections that humans have subconsciously seek connection with the rest of life

Social support from ourselves and others The Attachment Theory Attachment is an emotional bond between you and another person or animal. Early human bonds are formed with caregivers (parents). These feeling can be transformed to an animal which is seen as helping the person grow and heal. John Bowly, Phd, first attachement theorist When frightened, securely attached children will seek comfort from their care giver. If that caregiver is perceived to be an animal, then the child will relate to the animal.

THERAPY DOGS: Has medicine gone to the dogs?

The Research Barker, S.B, Wolen, A.R. (2008) Friedmann, E. (1995) Odendaal, J.S.J. (2000)! Biochemical reactions! Physiological reactions! Benefits NOTE: OXYTOCIN LEVELS INCREASE WITH THE PRESENCE OF ANIMALS DURING THERAPIES THERAPY DOGS: Have medicine gone to the dogs?

! Relaxation and reduced anxiety! Distraction from pain! Distraction from worry! Tasks at hand seem easier to complete! Stress level is reduced! Improved relations with others! Improved performance! Fawcett, N. R. & Gullone, E. (2001) Cute and cuddly and a whole lot more. A call for empirical investigation into the therapeutic benefits of human-animal interaction for children, Behaviour Change, 18(2), 124-133

CHIEF WORKING WITH PATIENT AT ONE OF ANGIE S FACILITIES

! Animals have been shown to ease the other social interactions and are often considered to be social catalysts or lubricants! Fine, A.H. (2010) Nimer, J. & Lundahl, B. Animal Assisted therapy A meta-analysis(2007)! Observing fish swimming in an aquarium or petting an animal can temporarily reduce blood pressure and regulate heart rate.! Fawcett, N. R. & Gullone, E. (2001) Cute and cuddly and a whole lot more. A call for empirical investigation into the therapeutic benefits of human-animal interaction for children, Behaviour Change, 18(2), 124-133! Friedman, E. Son, Heesook, & Tsai C. (2010 The animal human bond and Health and wellness

Introducing aquariums at mealtime in special units serving individuals with Alzheimer s caused this population to eat more! Edwards, N. E. and Beck, A.M., Animal assisted therapy and nutrition in Alzheimer s disease (2002)

WHAT ARE THE DIFFERENCES BETWEEN ALL OF THESE DOGS?

ASSISTANCE DOGS " An assistance dog is a dog trained to aid or assist a person with a disability. Many are trained by a specific organization, while others are trained by their handler/owner/disabled individual. " There are three classes of assistance dogs: " Guide dogs assist the blind and visually impaired " Hearing dogs, or signal dogs, help the deaf and hard of hearing " Service dogs refers to dogs not included above. They are trained to do other work, such as mobility assistance, autism, or other medical alerts (diabetes or seizures) and psychiatric service dogs. " NOTE>In the US the term service dog is used synonymously with assistance dog.

DIABETES DOGS CHIEF WILL INITIALLY SIT AND LOOK AT ME. HE WILL THEN CLIMB UP INTO MY LAP AND LICK MY FACE. HIS POUCH CONTAINS MY TEST KIT AND METFORMIN 1000 MG PILLS

WORKING DOGS " A working dog is a canine that is not merely a pet, but learns to perform tasks to assist and/or entertain its human companion. " This is a recognized classification of dogs in the American Kennel Club, but has a different meaning in the working world context " The canine is professionally trained to perform a task which assists its human handler in completing an assigned challenge. " Bomb detection, drug detection, bed bug detection, mold detection, termite detection, hunting dogs, herding dogs, etc. " Even the performing dogs on America s Got Talent

THERAPY DOGS " A therapy dog is trained to provide affection and comfort to people in hospitals, retirement homes, nursing homes, schools, hospices, disaster areas and people with learning disabilities. " Therapy dogs come in all sizes and breeds from Pomeranians to Great Danes " Proper Temperament is the most important characteristic of a therapy dog. " Friendly, patient, confident, gentle, and at ease in all situations " Enjoy human contact and content to be constantly pet or stroked. " Therapy dogs primary job is to allow unfamiliar people to make intimate physical contact with them. Hugs, kisses, pulling, petting and sometimes being laid upon. "

Chief working with Hospice patient in S N F. Photos of his Labradors around his bed

Therapy Dogs and Handlers Provide:

The morale Factor For the Crew and mice

Cancer therapy goes two ways

DENTAL OFFICE UTILIZING THERAPY DOG TO HELP PATIENTS REMAIN CALM DURING NON SEDATATED PROCEDURES MAYO CLINIC, JUNE 2015

Hank s four year old grand daughter, Macy, with Scout. Macy has short gut syndrome and uses dogs as a support system. The dog will accompany her to various medical procedures.

Service Animal Definitions According to the 2012 edition of The Americans with Disabilities Act the only animals recognized as service animals are: DOGS and MINIATURE HORSES. These animals must be individually trained to do work or perform tasks for a person with a disability

Examples of Work or Tasks: " Guiding people who are blind " Alerting people who are deaf " Pulling a wheel chair " Alerting and protecting a person having a seizure " Reminding a person with illness to take medications " Calming a person with Post Traumatic Stress Disorder during an anxiety attack

Where are Service Animals Allowed? " Any and all facilities where the public is normally allowed to go " Hospital patient rooms, clinics, cafeterias, examination rooms, stores, public transportation " Prohibited areas: operating rooms, burn units.

$$$$$$$$$ CHIEF ON THE WAY TO VEGAS $$$$$$$$

! Applies to businesses, regardless of the number of employees! Enforced by a variety of federal agencies, local governments. And by private attorneys.! All entities are required to comply, regardless of their sources of funding.

Health and Sanitation codes: Establishments that sell or prepare food must allow service animals in public areas. ****EVEN IF STATE OR LOCAL HEALTH CODES PROHIBIT ANIMALS ON THE PREMISES!

CHIEF AND HIS STORY ABOUT HIS FRIEND JOE

! Activity: Brief the patient that they will be feeding the dog. Instruct the patient in what type of food is to be fed to the dog, and how much. Allow the patient to locate the proper food and bowl, measuring out the proper amount of food. Tell the dog to sit or wait during the preparation time. Place the bowl in the feeding area and allow the dog to eat. When the dog is done, retrieve the bowl, wash it and return it to its proper location.!! Expected results: This exercise will assist in hand eye motor synchronization, develop task completion skills, exercise sense of smell, encourage following orderly directions, and understanding the satisfaction of completion of an assigned task.!!!

Activity: Therapist/handler will settle the dog on the table. The patient will choose two photos, one from the stack of brush photos and one from the dog body part photos. The patient will then pick out the matching brush. The patient will then count out ten strokes of the brush to the pictured area on the dog. The brush will be cleaned and another photo set will be chosen. This is repeated three times, one for each dog body area. Starting with one body area at a time and increasing to three will slowly acquaint the patient with the stamina needed to complete this exercise. Expected result: This exercise will include manual dexterity extensions, experiencing various textures, exploring anatomy and completing assigned tasks.

Activity: This activity lets the patient have a bit more fun with the therapy dog. Have the dog positioned about 5 or 10 feet from the patient, seated and facing the patient. Have the patient toss the treats, one at a time, to the dog. The object is to have the dog catch the treat, but this will take some practice on the part of the patient, depending upon their condition. Allow the dog to fetch the treats, no matter where they fall. If the patient is accurate, have the dog move further back from the patient, increasing the distance to toss the treat. This can be done with bedridden patients, as long as there is space in the room for the activity to be accomplished without disturbing the roommate, if present. Expected Results: Exercise advanced motor skills, increase hand/eye coordination, judgement of distance, experience achievement.

! PERMISSION FROM MANAGEMENT with legal department review! Supply proven research, such as (see references)! Impact of animals on Patients activities, social interactions, mood changes and quality of life! Institutional impacts on staff performance, patient census, public relations and program costs! Reduction in medical costs, violent acts, need for medications! Improvement in staff morale and patients sense of independence! Reduction in patients length of stay, use of drugs, suicide attempts, and need for restraints! Increases in communication! New diagnostic procedures based on patients interaction with pets

! Help participants understand the personal-social skills necessary to function in the real world! How to acquire or enhance those skills thru AAT! Increase empathy skills! Improve self esteem! Improve communication skills! Increase sense of control! Increase mobility! Reduce abusive thoughts and behaviors! Improve sense of wellbeing! Increase cognitive functioning

A DOG IN MY FACILITY??????? Things to consider " Accidents happen: Murphy s Law " The risk of accidents is small " In 67,000 hours of contact hospital patients experienced NO ACCIDENTS OR ZOONOTIC incidents attributed to the animals presence. Canine Good Citizen, American Kennel Club program " Canine Good Citizen, American Kennel Club program " (Robb and Miller, 1982) (Stryker-Gordon, 1985) " Responsible AAI provisions " Certifications " Therapy Dogs, Inc. " Therapy Dog International " Delta Society " Alliance of Therapy Dogs " Liability Insurance

Guidelines for animal assisted interventions in healthcare facilities summary: " Basic and essential are compulsory HAND HYGIENE PRACTICES for patients, visitors and staff " Development of animal visitation program policies for patient-owned animals and AAIs by healthcare facility " Designation of an ANIMAL VISITATION LIASON (AVL) to support and monitor AAI programs as well as other visiting animals " Restrict suitable animal species to domestic companion animals that are household pets-no reptiles, non-human primates, rodents or recently domesticated animal species. " Verify the required temperament evaluation of all animals participating in the AAI program " Require AVL to successfully complete a course in evaluating temperament and to have animal behavior experience

" Require proof of veterinary examination and shot record on an annual basis " Restrict animals from patient lavatories, food prep areas and areas of limited access, ICU, etc. " Do not visit with patients during meals " Approach patient which is free of any invasive device, IV, bandages, etc. " Prevent animals from licking patients and staff " Report any aggression, scratches or inappropriate behavior to senior staff " Develop a system of contact tracing that, at a minimum, required the handler to sign in when visiting " Install an outside designated break area for the animal, with clean up bags trash can (Association for Professionals in Infection Control and Epidemiology, Inc. 2008)

Wounded Warrior Program: Many of them need something to do and volunteer at facilities

Pet Therapy Volunteer Programs AFTER THE ORLANDO SHOOTING

WORKING WITH SURVIVORS OF THE ORLANDO MASS SHOOTING

References " The United States Army Medical Department Journal: Canine Assisted Therapy in Military Medicine April-June 2012 EXCELLENT " www.cs.amedd.army/amedd_journal.aspx " Animal Assisted Therapy: Improving Treatment Outcomes, Course given by University of St. Augustine 1(800) 241-1027 " www.therapydogs.com " www.tdi-dog.org " www.deltasociety.org " TriService Nursing Research Program, Dr. Krause-Parello " American Kennel Club Good Citizen Program and Therapy Dog Program Certificate " Joint Commission on Accreditation of Healthcare Organizations " Project BARC " North Florida Therapy Dogs, Inc " History of Animal Assisted Therapy @yahoo.com " Canines and Childhood Cancer, WWW.Caninesandchildhoodcancer.org

" www.uscourts.gov/fedprob/june_2007/canine.html " www.pooch.org/about " www.nicic.org/library/017573 " Mallon, G. (1994) Some of our best therapists are Dogs, Child care forum 23(2): 89-101 " Levinson, B. (1965) The dog as co-therapist., In Annual Meeting of American Psychological Association, NYC " www.latham.org December 5, 2009 " Journal of creativity in Mental Health, (2006) Is counseling going to the dogs? 2(2) : 17-31 " Child and Youth Care Forum (1999) " Journal of Child and Adolescent Group Therapy, (2001) 11, 159-195 " Handbook on Animal Assisted Therapy: Theoretical Foundations and Guidelines for practice, 2 nd Edition, San Diego, Academic Press, A. Fine (2006) " Understanding the difference between AAA and AAT, December 3, 2009, www.fota.org " www.ericdigests.org/2002-3/animal " The Pet Connection, Univercity Press, Bustad and Hines

SPECIAL THANKS TO: LORI REDNER, OTD, OTR/L ANNE SCHEFKE, OTD, OTR/L Both are professors at Western Michigan University and have done extensive research in the area of Animal assisted Therapy. Without their inspiration this program would not have been possible.

THERAPY(DOGS:( HAS(MEDICINE(GONE(TO(THE(DOGS?(((( (YES,(AND(IN(A(GOOD(WAY) THE BOOK MAY BE ORDERED BY SENDING A CHECK FOR $25.00 TO: HANK NOLIN 5541 WINCHESTER WOODS CT. DELEON SPRINGS, FL. 32130 CREDIT CARDS VIA EMAIL: AIRLABS@AOL.COM ( Henri(R.(Nolin,(CPP( and((( Angelina(Dallmann(Marino,(( MHS,(OTR/L((

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GOOOOO DAWGS