Animal-Assisted OT: Providing Safe and Ethical Services

Dr Jessica Hill, Associate Lecturer in Occupational Therapy, The University of Queensland

What is Animal-Assisted Therapy?

Animal-assisted therapy (AAT) involves the deliberate incorporation of a trained and assessed therapy animal into pre-existing, evidence-based therapy modalities such as occupational therapy (International Association of Human Animal Interaction Organisations, 2015). Within the field of occupational therapy, AAT is viewed as a purposeful activity in which an animal is incorporated into an intervention with the aim of enhancing an individual’s therapy engagement and performance skills (Andreasen et al., 2017). AAT has been suggested to facilitate engagement in occupational therapy sessions with a range of client populations including children with cerebral palsy, autistic children, ‘at risk’ youth, and older adults diagnosed with dementia (Hill, 2020).

An expanding research base and increasing media exposure of the proposed benefits of AAT has resulted in a rapid rise of animals being included in occupational therapy interventions in Australia. However, with limited education and training pathways available, questions must be asked about whether the profession truly understands how to incorporate AAT into occupational therapy sessions effectively, in a manner that is safe and ethical for the clients and animals.

For the past six years I have incorporated AAT into my practice. When I first decided to embark on my animal-assisted journey, I enrolled in what was then the only therapy dog training course in Australia. Needing to attend this five-day, intensive face-to-face required me to travel with my dog from Brisbane to Melbourne at considerable cost. Ethical concerns about animal welfare–in particular, how many days a week was appropriate for one therapy dog to work–prompted me to buy a second dog and again travel to Melbourne for training. Since then, I have completed a number of additional courses and workshops in AAT and am trained in canine and equine-assisted therapy.

Acknowledging the limited information available to occupational therapists about the ethical delivery of AAT services, I embarked on a PhD with the aim of further expanding the evidence base for this intervention. This six-year journey has allowed me to fully appreciate the complexity involved in delivering AAT, and guided my passion in working with therapists to ensure animal-assisted services are delivered in a way that is effective, safe and ethical for the clients and animals.

My work in the field of AAT has raised significant concerns about the way in which this highly specialised intervention is being implemented. One common perception is that because AAT is ‘unregulated’, additional training or education is not required to incorporate this intervention into occupational therapy practices. Occupational therapists are required by Section 2.2 of our Code of Conduct (Occupational Therapy Board, 2014) to work within our scope of practice and maintain appropriate knowledge and skills to ensure safe and competent care. Furthermore, when deciding to include an animal in our practice, we must acknowledge that we hold an ethical responsibility of care to both our clients and animals. Failure to recognise these responsibilities will cloud our understanding of ‘best practice’ and impact our professional integrity (Coghlan, 2020).

Our Ethical and Professional Responsibilities

When considering our ethical responsibilities as occupational therapists, Gillon’s (1994) four prima facie principles of nonmaleficence, beneficence, autonomy, and justice are a good guide.

Nonmaleficence (do no harm) and beneficence (promote well-being)

Practising AAT without the appropriate training or knowledge carries a high risk of harm to clients. Like any treatment modality, it is imperative that occupational therapists incorporate therapy animals into sessions in a way that is goal-directed, occupationcentred and informed by the best available evidence (Hill et al., 2019). Occupational therapists must have a clear understanding of client goals, the occupational therapy intervention they intend to use, and

the way in which the inclusion of the therapy animal will assist in facilitating client engagement (Hill et al., 2019).

Occupational therapists must ensure they do not allow the presence of the therapy animal to distract themselves or their client from the overall goals (Hill et al., 2019).

Poor understanding of the underlying theories of AAT, in particular attachment theory, also has the potential to cause harm. When entering into a therapeutic relationship, clients should feel safe to make mistakes knowing they have a secure, non-judgmental base to turn to for support (Hill, 2020). It is crucial that therapists understand what secure attachment looks like, and the ways in which we can support its development (Hill, 2020). Actions that could fracture the relationship include the animal being removed as a consequence of undesired behaviour or verbalising the animal’s dissatisfaction in the client as a result of behaviours (Hill, 2020). It is also important to be aware of the impact of the bond formed between the client and the therapy animal when it is time to end the therapeutic relationship (Hill, 2020). Failure to take these situations into account has the potential to cause distress.

Inadequate ability to assess an animal’s temperament and to appropriately train the animal may also potentially expose clients to physical harm in the form of bites, scratches, and kicks (Coghlan, 2020).

Respect for autonomy Autonomy relates to an individual’s ability to make a self-determined choice (Coghlan, 2020). AAT must be delivered as an opt-in service in which the client is provided with adequate information to make informed consent (Coghlan, 2020). To do this, the client must fully understand the nature of the service including the potential benefits and risks (Coghlan, 2020). Therapists must therefore fully understand what is involved in AAT and be able to communicate this to the client in a way that does not bias them towards the therapist’s preferred method of treatment (Coghlan, 2020). In addition to the autonomy of our human clients, we must also respect the autonomy of our animals. Animals should work in environments that allow them to consent to interaction (Hill et al., 2020). This involves working off lead, in a space that is large enough to allow them to move away from unwanted interaction (Hill et al., 2020). Additionally, the handler must have a thorough understanding of animal body language so they can identify when their animal is uncomfortable and intervene in a way that protects the welfare of the animal whilst not compromising the well-being of the client (Hill et al., 2020).

Justice Within the space of AAT, justice refers to respecting all humans and animals equally (Coghlan, 2020). As health professionals, we are taught to put the needs and the well-being of our clients ahead of all else (Coghlan, 2020). When working with animals, however, our responsibilities extend beyond this, as the welfare of the animals needs equal consideration (Coghlan, 2020). This requires therapists to have an in-depth knowledge of animal selection, behaviour, and welfare concerns to ensure the safety of both the client and the therapy animal (Hill et al., 2019).

What To From Here?

While the field of AAT remains in its infancy, progress has been made. This has included the development of a number of recommended standards of practice for incorporating AAT into health professions (Animal Therapies Ltd, 2020; Driscoll et al., 2020; Winkle and Ni, 2019). While the available standards of practice might have minor differences, there are a number of suggestions that are consistent. These include the need for additional training in order to deliver AAT safely and ethically, continued completion of professional development and supervision, appropriate animal selection and assessment, and ensuring occupational therapists continue to deliver a service that is goal-directed and occupation-focused (Animal Therapies Ltd, 2020; Driscoll et al., 2020; Hill, 2020; Winkle and Ni, 2019). It is recommended that all occupational therapists considering embarking on their AAT journey familiarise themselves with these standards of practice to ensure they are delivering a service that supports the needs and well-being of their clients and animals.

About the Author Dr Jess Hill is an Associate Lecturer in Occupational Therapy at The University of Queensland and has six years’ experience working as an animal-assisted therapist with children and adolescents. Jess has recently completed her PhD at The University of Queensland, exploring the efficacy of canineassisted occupational therapy with autistic children. During this time Jess has published six journal articles and two book chapters on the topic of animal-assisted therapy.

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