Assessment of Therapy Animals: Using a Goodness-of-Fit Conceptualization

Posted by on Apr 19, 2020

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How do we determine if an animal is suitable for therapy work? This is a key question that deserves careful consideration. It is important that the animal has the proper temperament and behavior for therapy work so that risks are reduced and the animal is comfortable with the job.

Common Assessment Processes

Many of the assessment processes in use today arose through therapy animal programs with a focus on volunteer visitation and social support programs, such as visits to people in hospitals, elder-care facilities, hospices, and schools. What has evolved for these purposes seems to work well in those contexts. The assessment is paired with risk reduction requirements, such as dogs always having to be leashed.

The large longstanding therapy animal programs typically have “tests” that include a number of behaviors that the animals are expected to perform to a certain standard. The tests often revolve around behaviors required by the typical settings in which therapy animal teams visit. For example, tests might include reactions to grooming, behavior when touched, remaining in a Sit-Stay position (dogs), remaining calm if the handler is out of sight, reactions around medical equipment such as canes or walkers, behavior when visiting adults and children, reactions when meeting a neutral dog (dogs), specific behaviors such as Leave It (dogs), and overall responsiveness to the handler. There are expectations of the handlers as well in terms of how the animals have been trained, how well the handler understands basic body language, and how the handler works with the animal in a respectful manner. The major programs differ, but the testing typically involves 10 to 25 items that the handler asks the animals to perform.

This article is not at all critical of these methods designed for those purposes. They were developed with specific environments and types of visits in mind. Although these tests of human-animal teams have been used to assess animals involved in professional work, too, they are not always perfectly aligned with the rather different expectations of what best serves clients involved in mental health, allied health, or more involved educational settings.

Why Professional Therapy Work with Animals Is Often Different

Professional work with therapy animals occurs when a paid professional decides to involve an animal in their work. There are specific goals to be met, and the therapist works with the animal to help clients meet those goals. A physical therapist might ask for more activity from a dog, for example, when helping a client walk across the room after a knee replacement. A speech therapist might want the dog to learn cues with certain phonemes that can help clients utter those sounds. An occupational therapist might ask a client with a hand injury to grasp a spongy ball to toss to a dog, or to clip a lead rope to a horse’s halter. A mental health therapist might want an animal to be able to engage in a wide range of specific activities depending on the client’s goals. For example, the client might benefit from playing a game with a cat in which the cat can paw at and move a spinner for the game board, or from running an obstacle course with a dog who must jump over and crawl under various objects along the way.

There are a number of differences between professional involvement of animals (Animal-Assisted Therapy, AAT) and the volunteer form of Animal Assisted Interventions (AAI) commonly called Animal Assisted Activities (AAA) that involve friendly visits and social support. First, the interactions in AAT can be more varied.  Because the animals are often fully involved in actual therapeutic interventions, they benefit from knowing more trained or cued behaviors that facilitate clients’ movement toward their goals.   Second, the relationships involved in therapy are often lengthier and potentially more emotional and/or intense. The same clients might be seen for a long time, and depending on the problem area, clients might experience and express more emotional reactions. The animals need to be prepared and able to handle this level of intensity. Third, because of the greater involvement of clients in therapy sessions, there can be more risk to the animals. In more physically active or emotionally expressive forms of therapy, greater movement by clients in the presence of, or directly with, the animals can pose an increased risk of the animal being in the way or struck by moving props. For example, children in mental health treatment such as play therapy can move a great deal, such as running around, brandishing toys in their enthusiasm or imaginary play, or using props that make noise or appear unusual (e.g., strange masks). Similarly, the animals can also be exposed to a wider and more intense expression of feelings, and they might not be able to distinguish between “real” feelings and those expressed in pretend play at times.

As my 95-year-old mother recovered from a fall at home as a patient in a skilled nursing facility, I took Josie Patches, one of my current play therapy dogs, in to visit. My mother’s occupational therapist, Christina MacKenzie, was interested in how dogs could be involved in her work. This was an informal session to illustrate. I asked what goals she was working on, and they involved range of motion of my mother’s arm/shoulder and core strength. We jointly developed a fun activity where my mother reached up high to grasp the treats from a small dish and then bent forward to give it to JP. JP was very patient in her Sit-Stay until the treat was presented to her. This was a simple, but fun and engaging intervention for my mother, and Josie enjoyed it, too. (Because we were in this facility, JP was on a loose leash. Photo used with permission.)

Much more is typically asked of the animals on these many dimensions, and as a result, the usual forms of assessment might be lacking for professional AAT in three primary areas: (1) the animals need to be extremely well socialized to experience these additional demands without stress, (2) the testing of 15-25 pre-established behaviors does not necessarily mean that the animals will be able to handle the varied and intense requirements of this type of work, and (3) a wider range of personality types of the animals might be useful, and tests used to make AAA determinations might rule out animals who would be valuable in professional work. The usual assessment methods are useful to get a general idea of the animal’s suitability, but more information is needed, not only for the safety of clients, but also for the well-being of the animals.

A dog involved in actual therapy might need greater initiative and problem-solving abilities to interact with the props and activities used to meet client goals.

A Different Conceptualization is Born

This article presents an alternative method for assessing the suitability of animals for professional therapy work. It is not at all intended to be critical of the methods briefly described above. It is designed for a different purpose and to meet the inadequacies of more common methods when applied in the context of professional therapy work.

This idea came about in 2004 after I began involving my dog Kirrie in my play therapy work. Although Kirrie had passed the Canine Good Citizen Test, she was clearly not a “traditional” therapy dog. She was full of energy, curious about what was going on with people, eager to learn new things, and she initiated activities and games. She was smart and created mischief if she wasn’t sufficiently mentally stimulated. She worked beautifully with children and families in play therapy, but seemed most eager when she was right in the midst of the action. As I considered some of the therapy dog tests at the time, I was worried that I might have to train some of the enthusiasm and initiative out of her, and I knew all of that would be valuable in my work. I also didn’t want to try to “remake” her into someone she wasn’t. I had tried to work with her on-leash, as is understandably a requirement for dogs going into hospitals or nursing homes, and it did not work well in play therapy. Off-leash, she listened well, engaged voluntarily and appropriately with clients, and could negotiate her way around the playroom toys much more easily. After careful consideration, I knew I needed to allow her to be herself at all costs. If she then fit well with my work, that was all to the good.

I knew from my experience taking her off leash that there was huge therapeutic value in allowing her natural and voluntary behaviors. Because she was free to come and go, when she approached clients with her entire back end wagging, they knew she was genuinely pleased to see them. If she walked away when they became boisterous, they also knew (with my facilitation) that her reaction was authentic. It became a great way to strengthen clients’ empathy as I challenged them to adjust their behavior to create a more comfortable environment for her. [This way of working was further reinforced the following year when Tracie Faa-Thompson of the UK and I formed a partnership to further develop the field of Animal Assisted Play Therapy® (AAPT). Tracie had been working in very similar ways with her horses.] At the same time, I understood the importance of a well-behaved animal when working with clients. I began to think about how I could ensure that safety while permitting Kirrie to be herself.

With my post-grad degrees in psychology and human development and family studies, I was familiar with a concept from child development called “goodness of fit.” Based on research, goodness-of-fit suggests that the greater the compatibility between the individual and his or her environment, the better the adjustment of the individual. When extrapolated to nonhuman animals, goodness-of-fit looks at the compatibility of the animal’s personality, motivations, and interests with the environment in which the animal exists. If a horse, a herd animal and by nature a trickle-feeder, is kept alone and stabled rather than being out on grass with other horses for long periods, one might expect some physical (often digestive) and behavioral (often stereotypies) issues to arise. It simply is not a good fit for that species or individual.

The goodness-of-fit concept can easily be applied to most AAIs, but is particularly useful for professionals involving animals in their work. In many ways, this parallels the personnel practice of finding qualified candidates to match job descriptions. When we ask animals to work with us, it behooves us to ensure that they are cut out to do those particular “jobs.” In Animal Assisted Play Therapy® (AAPT) we use this concept, but more commonly in reverse. While we can write the “job description” and then try to find animals who fit it well (which we might try to do when first selecting an animal to join our families), we find it easier to assess the animals and then determine what roles they are best suited for in the scope of our work. The nature of play therapy is that it can take many forms, often aligned with theoretical orientations as well as Schaefer’s “powers of play.” This is also true of therapists who work from both eclectic and integrative approaches to psychotherapy. In allied health and educational professions, there is also great variation in the types of problems and potential roles that animals can play. There are many “job descriptions” depending on the nature of the problems, the skills of the therapist, and the specific needs of the clients. Animals with different personalities. motivations, skills, and interests might perform different roles within this array of options. Chapter 8, Animal Preparation for AAPT, in the award-winning book, Animal Assisted Play Therapy (VanFleet & Faa-Thompson, 2017, Professional Resource Press) delves into this topic in greater detail. The next section here looks at how this concept has been incorporated since 2004 in selecting and assessing animals for AAPT work.

As this photo of AAPT workshop participants in the UK shows, this pony is usually unfazed by novelty or people appearing in odd costumes. He likes being with people and sometimes sniffs the novel items they don. (Typically in AAPT we work at liberty without ropes, but there are times ropes are used for safety purposes. These participants know that if he chooses to move away, they can remove the rope to permit that.)

The Assessment Process of Animal Assisted Play Therapy®

Based on the goodness-of-fit model, assessment of the suitability of animals for work is a three-part approach. We must (1) determine the animal’s personality, motivations, abilities, and interests, (2) look at trained behaviors and how regulated and responsive the animal is within the therapist-animal partnership, and (3) define what roles, if any, are best suited to the animal’s unique self. Furthermore, this approach is used only in conjunction with in-depth training of the therapist. The responsibility for safety belongs to the therapist rather than expecting the animals to tolerate intrusive human behaviors. Therapists must learn ethology, animal behavioral science, positive training skills, and how to read and interpret their species’ body language and communication signals fluently. While many of the large therapy animal programs do ask handlers to learn about these important areas, the expectation in AAPT is for therapists to learn this knowledge and these skills to a very high level, given the differences in professional work already discussed. There are specific skills, such as proactive attention, where the therapist can look ahead and see potential sources of stress before they materialize, and split attention, where the therapist continuously shifts attention between the clients and animals, that are critical to their ability to take full responsibility for the safety of all involved humans and animals. Given this level of skill in the therapist, the goodness-of-fit approach can offer greater safety and flexibility to the therapeutic process while ensuring animal well-being in the process. The three components of the goodness-of-fit model as applied to AAPT follow.

1. Assess the Animal’s Personality, Motivations, Abilities, and Interests

The study of animal personality is an emerging and broadening field. Most currently-used temperament tests of dogs (different from therapy dog tests) have been developed to assess dogs in shelters for their soundness and suitability as family pet dogs. There are varying degrees of rigor in determining their validity and reliability, but most have achieved popularity through the use by dog trainers and shelter workers who believe they are useful. One form of assessment that differs is the Clothier Animal Response Assessment Tool®, or CARAT, developed by Suzanne Clothier. It provides a look at many features of the unique animal under a variety of conditions, and offers a view of that animal’s most likely ways of responding. This tool has had some preliminary reliability work done on it, and there is a certification program available. It is one of the tools that is suitable for getting a clear picture of who the animal is. It is our hope that there will be increasing numbers of animal professionals who become certified in its use and that more of the validity and reliability metrics can be done on it.

When we first considered applying the goodness-of-fit model to animals involved in AAPT in late 2004, we realized we needed an assessment tool that looked more at the uniqueness of the animal than the tests of various behaviors that were prevalent in the therapy world at the time. The Animal Appropriateness Scale (AAS) was developed by Risë VanFleet with the input of many animal professionals and therapists.

The development process entailed a thorough review of the then-current literature on the characteristics of good therapy animals, most of which was about dogs. Eventually, data from several years of AAPT practice and discussions with Tracie Faa-Thompson and AAPT-profesionals-in-training were added to fine-tune the measure. Preliminary testing for inter-rater reliability was conducted in 2014-2015 that led to revisions. The AAS has been used for several years and is now undergoing final revisions in preparation to have studies of its validity and reliability completed.

The AAS requires multiple observations of the animal being assessed, and the owner (usually the therapist) completes it as well as an independent rater trained in its use. The two compare and discuss their respective scoring. It can be at this point that an animal is deemed suitable or unsuitable for AAPT work, but in many cases, the animal is considered suitable along with recommendations for training and handling to provide sufficient support to the animal for this type of work.

The AAS uses a 5-point scale to get a picture of the animal on multiple dimensions in four domains across multiple situations. © 2009, 2020. R. VanFleet with the IIAAPT. All rights reserved.

The AAS has four broad domains that are assessed:
• Physical/Sensory Functioning
• Social Functioning
• Adaptability
• Psychological Functioning
Together these domains include 30 dimensions of characteristics to be rated through careful observation. The resulting profile is considered to be a picture of how the animal is functioning at this point in time and likely to function in the future. While most features are believed to be enduring, some are likely to change with age, illness, or significant events in the animal’s life.

This horse has potential as a good fit for AAPT work, in part because of his interest in the props the training group was using and his playfulness in swinging the container back and forth until it was emptied with all on the ground.

2. Observe the Animal’s Trained Behaviors/Responsiveness to Therapist

The next part of the assessment of animal suitability in AAPT is similar to the more common ways of assessing animals. The items are different based on the species and the type of work being done, but there are basic behaviors established to ensure that the animal is under stimulus control of the therapist/handler. These might include a dog’s ability to Stay or Wait for 15 seconds, a horse’s ability to turn and follow the therapist walking away when cued, or a cat’s ability to respond to careful petting without using claws or teeth. The lists established are designed for useful behaviors within therapy sessions and to ensure safety. Because in AAPT we prefer to avoid overtraining animals, these expected trained/learned behaviors are not extensive. Because therapists learn to read and recognize stress signals as soon as they arise and then to take appropriate steps to reduce that stress, there is no need for animals to demonstrate that they can handle intrusive human behavior or rough handling. It is the therapists’ responsibility, and part of their training, to learn to manage the situations to respond quickly to prevent this. Boundaries can be set with clients at the point their behavior stresses the animal, and therapists are encouraged to have an emergency cue for their animals to immediately get the animal to leave the situation. For example, a Behind Me! emergency cue teaches a dog to immediately leave whatever is happening and go behind the therapist/handler.

Tracie Faa-Thompson’s Sabii learning to Stay when just a pup. Training is important for the safety of all involved, and only positive, animal-friendly methods of teaching are used.

3. Therapy Involvement Plan

The Therapy Involvement Plan (TIP) is designed to determine what roles are best suited to the animal, given the information garnered through the AAS and the relationship with the therapist and clients. (There is a separate assessment of the therapist-animal relationship that is used in the AAPT certification process as well.). The TIP is a document submitted by AAPT therapists as they complete their training and supervision and begin work with their animals more independently. It helps assess if the therapist has a clear-eyed view of their animal and is following the goodness-of-fit concept. In this document, the therapist discusses the personality, interests, and abilities of the animal, the animal’s more sensitive areas, and how the therapist plans to involve the animal in their work. The TIP highlights how the animal’s characteristics are matched to the roles the animal is asked to play, and how the therapist will work to ensure that the more sensitive areas are protected. For example, considering a dog who is slow to warm up to people at first but then loves to work with them, a therapist will describe in the TIP how the dog will be slowly and safely introduced to new clients and the conditions under which the dog will be more fully involved after showing specific signs of comfort with the client.

AAPT does not expect to have perfect animals. Just as there are no perfect humans, there are no “perfect” animals for the work they are being asked to perform. In fact, it can often be the small imperfections, such as when the dog refuses to jump through a hoop, or the horse simply stops in the middle of the obstacle course, that yield the most powerful therapeutic experiences, as long as the therapist is skilled enough to facilitate them to that end. We have adopted this method of assessing animals because it (a) allows the animals to simply be themselves with voluntary and natural behaviors that are more authentic, (b) ensures that therapists see their animals clearly and have the skills to ensure their well-being and actual enjoyment of the process at all times, and (c) adds tremendous flexibility to the therapeutic relationships (therapist-animal, animal-client, client-therapist) and therapeutic process itself. Each intervention selected considers the client’s goals, the unique features of the animal, and the therapist’s skills and preferred methods of working with a particular problem area.

The dog pictured, Josie Patches, loves treats but has considerable naturally-occurring (and reinforced with training) patience. Here she waits for the person to place treats inside the rug that she is learning to push open with her nose. This activity makes full use of her interests and strengths.

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*Animal Assisted Play Therapy is a trademark of the Family Enhancement & Play Therapy Center, Inc. and its International Institute for Animal Assisted Play Therapy®.

The International Institute for Animal Assisted Play Therapy® offers online and live training courses for those interested in the many aspects of involving animals in a voluntary and reciprocal way in their mental health, allied health, and education services. www.iiaapt.org.


 

 

Author: Risë VanFleet, PhD, RPT-S, CDBC (Licensed Psychologist, Registered Play Therapist/Supervisor, Certified Dog Behavior Consultant, Certified AAPT Instructor), co-creator with Tracie Faa-Thompson of the field of Animal Assisted Play Therapy®, is shown here with three of her dogs, Josie Patches, Murrie, and Kirrie.

 

 

 

Article and photos © 2020, International Institute for Animal Assisted Play Therapy®, www.iiaapt.org. All rights reserved.