Animal-Assisted Interventions in Health Care Settings: A Best Practices Manual for Establishing New Programs

By Sandra B. Barker, Rebecca A. Vokes and Randolph T. Barker

Growing literature around the benefits of animal-assisted intervention (AAI) spurs health care professionals and administrators to start new programs. Yet the trend also raises questions of how best to begin and run successful AAI programs—under what circumstances, with what staff, and within what guidelines.

Animal-Assisted Interventions in Health Care Settings: A Best Practices Manual for Establishing New Programs succinctly outlines how best to develop, implement, run, and evaluate AAI programs. Drawing on extensive professional experiences and research from more than fifteen years of leading the Center for Human-Animal Interaction in the Virginia Commonwealth University School of Medicine, the authors discuss both best practices and best reasons for establishing AAI programs. For thorough consideration, the text explores benefits from a variety of perspectives, including how AAI can improve patient experience, provide additional career development for staff, and contribute favorably to organizational culture and to the reputation of the facility in the surrounding community.

Developed for administrators as well as for volunteers and staff, Animal-Assisted Interventions in Health Care Settings includes practical, case-based examples for easy comprehension and offers an accompanying online user-friendly template that can be adapted to develop practice-specific training, evaluation, and procedure manuals.

• Language: English
• Publisher: Purdue University Press
• Release date: Jan 15, 2019
• ISBN: 9781612495385

Sandra B. Barker

Sandra B. Barker is a professor of psychiatry and Bill Balaban Chair in Human-Animal Interaction at Virginia Commonwealth University (VCU). She is director of the VCU School of Medicine Center for Human-Animal Interaction. Barker has more than 25 years of direct experience in human-animal interaction research and animal-assisted intervention practice.

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Preface

The way we conceptualize and deliver health care is changing rapidly. From the movement away from fee-for-service toward pay-for-performance, to the increasing weight assigned to patient satisfaction, health care organizations must find new paths to not only address patients’ maladies, but enhance their overall well-being. It is in this environment that we look to complementary therapies: supplementing conventional clinical care, enhancing the patient experience, and improving the work environment for staff.

One such complementary therapy is animal-assisted interventions (AAI). Inquiries into the human–animal bond reveal new benefits applicable in the health care space, and with the availability of evidence-based guidelines, health care organizations enjoy a newfound flexibility to offer this service to patients, families, and staff.

At one large, urban, academic medical center, therapy dogs frequent the halls of the inpatient and outpatient units. As one medical resident said, There is a dog in this hospital every day. We rely on them like we do any member of frontline staff.

Research from the field of human–animal interactions, extensive experience in health care administration, and lessons from years of program management in a comprehensive medical center inform this new model for effective, safe, and sustainable animal-assisted intervention programming. In addition to this comprehensive manual, an online template incorporating manual recommendations is available for download (docs.lib.purdue.edu/) AAI and easy tailoring to your specific facility.

It is important to note that this is not a training manual for AAI practitioners, as such manuals already exist and are referenced in our resource section. It is the hope of the authors that this manual will provide a basis for expansion of animal-assisted interventions spanning the vast array of health care delivery organizations serving needs across the care continuum. All proceeds from the sale of this manual will be donated to the Center for Human–Animal Interaction, a nonprofit 501(c)(3) organization in the Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.

Thank you to the members of the Society for Healthcare Epidemiology of America (SHEA) Guidelines Committee who reviewed this manual’s recommendations related to infection prevention and control.

1

The Health Care

Administrator’s

Overview of AAI

Health care administrators face numerous challenges as they seek to provide the best experience and value for patients, as well as a fulfilling and healthy work environment for their teams. Evaluations of health care facilities once hinged on patient outcomes. However, in the age of pay-for-performance, reimbursements are increasingly based on quality, value, and patient experience. Additionally, health care administrators must recruit and retain a strong health care workforce while managing dissatisfaction and burnout among providers.

Evidence-based medicine supports provision of safe and effective clinical care, and now a new field of research seeks to provide evidence-based complementary therapy, improving patient experience, addressing provider stress, and adding value across the health care continuum. This manual was developed to provide guidance for health care administrators, managers, volunteer coordinators, and their staffs in establishing and coordinating one such complementary therapy, animal-assisted interventions (AAI), in health care facilities.

The manual reflects over a decade of direct experience in coordinating and maintaining an animal-assisted therapy (AAT), animal-assisted activity (AAA), and facility animal program in a major academic medical center; conducting research demonstrating the program’s effectiveness and contributing to the evidence base on the health benefits of animal-assisted interventions; and providing education and consultation on AAI in health care facilities. In addition, current resources relevant to AAI in health care settings were consulted and are listed in Additional Resources.

The recommendations presented are intended to offer program structure, best practices, and guidelines for AAI program evaluation as well as establish policies that maximize patient, staff, and AAI team safety and minimize risk. Since it is not feasible for this manual to cover all types of health care facilities, recommendations are offered for the most restrictive settings, acute care hospitals, with the understanding that these recommendations can be extended to other facilities such as residential and outpatient facilities. Administrators in less acute health care settings may wish to tailor these recommendations based on their specific needs.

Because dogs are the only species recommended for AAI in acute health care settings (Murthy et al., 2015), this manual refers specifically to therapy dogs and their human handlers, referred to throughout as AAI teams.

1.1Benefits of AAI

Published studies investigating the potential impact of AAI in health care facilities provide evidence of a number of benefits. However, it is important to point out that not all studies find patient benefits, which may be due to the type of intervention implemented, client population selected, and study design. Most interventions studied are structured or unstructured animal-assisted activities, rather than animal-assisted therapy in which the animals are an active component in a patient’s care plan. The vast majority of AAI studied have been conducted with therapy dogs.

Several studies report benefits for cardiovascular patients, including patients with congestive heart failure (Abate, Zucconi, & Boxer, 2011; Cole, Gawlinski, Steers, & Kotlerman, 2007), with hypertension (Allen, Shykoff, & Izzo, 2001), and post–myocardial infarction (Friedmann, Thomas, & Son, 2011). Published studies also show benefits for orthopedic patients post–joint replacement surgery (Havey, Vlasses, Vlasses, Ludwig-Beymer, & Hackbarth, 2014), as well as for women hospitalized with high-risk pregnancies (Lynch et al., 2014). Studies of AAI with psychiatric patients (Bardill & Hutchinson, 1997; Barker & Dawson, 1998; Nepps, Stewart, & Bruckno, 2014) also report benefits. While some evidence supports benefits for hospitalized children (Calcaterra et al., 2015; Kaminski, Pellino, & Wish, 2002; Sobo, Eng, & Kassity-Krich, 2006; Tsai, Friedmann, & Thomas, 2010), a recent critical review of the literature on AAI in pediatric hospitals cautions about the lack of sound evidence and calls for more rigorous research with this population (Chur-Hansen, McArthur, Winefield, Hanieh, & Hazel, 2014).