Health Technology Assessment Of Assistance Dogs And Dog Assisted Interventions

Dogs as an assistive aid for people with disabilities date as far back in time as the first century CE. Today, dogs are used in various settings to help and assist humans. ‘Assistance dogs’ is an umbrella term for guide dogs, hearing dogs and service dogs. They are custom trained to help and support their owners in their everyday life and thereby give them greater independence. Dogs who perform dog-assisted interventions are another type of working dog, where the dog and the owner work together as a team visiting people with various needs in different settings such as hospitals and nursing homes. These visits aim to strengthen people’s inner motivation, using the dog as an external motivator. There is a lack of evaluations of working dogs in the health technology assessment context, and in the health economic evaluation context. Hence, there is a need for structured analyses that include both the short and long-term effects and the costs of assistance dogs and dog-assisted interventions. The overall aim of this thesis is to explore and assess the use of assistance dogs and dog-assisted interventions. The research questions were investigated using a variety of methods. In paper I, inferential statistical analysis was used to analyse patient-reported outcomes measures. In paper II, a thematic content analysis was employed to explore the experiences of service and hearing dogs. To study the long-term cost-effectiveness of physical service dogs and diabetes alert dogs, a decision analytic model was used in paper III. The input data in studies I, II, and III was obtained from the Service and Hearing Dog Project. In paper III, the data was also supplemented with information from published literature and expert opinions. Paper IV investigated the effects and cost-effectiveness of dog-assisted interventions, and takes the form of a systematic review. Paper I showed that a service or hearing dog may have positive impact on its owner’s health-related quality of life, well-being and activity level. Paper II showed that owners of service or hearing dogs experienced both positive physical and psychosocial effects from their dog. Negative experiences were also identified, for example being denied access to public places and negative attitudes from other people. Paper III showed that physical service dogs and diabetes alert dogs are cost-effective in comparison with regular companion dogs, resulting in both lower costs and a gain in QALYs. The one-way sensitivity analysis did not change the results, but the probabilistic sensitivity analysis showed that the results were uncertain. Synthesizing the results from the review in paper IV showed that dog-assisted interventions for therapeutic purposes led to minor to moderate effects in psychiatric conditions. Dog-assisted interventions as an activity had minor to moderate effects on cognitive disorders, and dog-assisted interventions for support purposes were beneficial in different types of medical interventions. Studies of cost-effectiveness were lacking. To conclude, assistance dogs are valuable and may be cost-effective for use as assistive aids and dog-assisted interventions render minor to moderate effects in certain situations in healthcare settings. Användning av hundar som hjälpmedel för personer med funktionsnedsättning går att spåra ändå tillbaka till första århundradet e.Kr. Idag används hundar i människans tjänst i en mängd olika sammanhang. Assistanshundar är ett samlingsbegrepp för ledarhundar, signalhundar och servicehundar. De är specialutbildade för att hjälpa och stödja sina ägare i deras vardag och på så vis ge dem möjlighet till att leva ett mer självständigt liv. Hundar som utför hundassisterade interventioner är en annan typ av tjänstehund, men deras jobb är inte att hjälpa sin ägare. Istället arbetar hundar som utför hundassisterade interventioner och deras ägare som ett team. Tillsammans besöker de personer med olika behov i olika miljöer som exempelvis sjukhus eller äldreboende. De arbetar med att stärka motivationen hos personerna de träffar. Idag saknas det övergripande utvärderingar som tittar på olika aspekter av den här typen av hundar. Det saknas även utvärderingar som specifikt studerar effekter och kostnader av assistanshundar och hundassisterade interventioner. Det finns därför ett behov av strukturerade analyser som inkluderar både kort- och långsiktiga effekter samt kostnader för denna typ av hundar och interventioner. Det övergripande syftet med denna doktorsavhandling är att utforska och utvärdera användningen av assistanshundar och hundassisterade interventioner. Frågeställningarna studeras med ett brett urval av metoder. I studie I analyseras patientrapporterade utfallsmått med statistiska metoder. I studie II genomförs en tematisk innehållsanalys för att undersöka förarnas upplevelser av service- och signalhundar. För att analysera den långsiktiga kostnadseffektiviteten av fysiska servicehundar och alarmerande diabeteshundar i studie III konstrueras en beslutsmodell. Datamaterialet i studie I, II och III hämtas från service- och signalhundsprojektet. I studie III kompletteras data med information från publicerad litteratur och med expertutlåtande. I studie IV studeras effekterna och kostnadseffektiviteten av hundassisterade interventioner genom en systematisk litteraturöversikt. Studie I visade att en service- eller signalhund kan ha en positiv inverkan på deras ägares hälsorelaterade livskvalitet, välbefinnande och aktivitetsnivå. Resultaten från de tematiska analyserna i studie II påvisade att ägare av en service- eller signalhund upplevde både positiva fysiska och psykosociala effekter av sin hund. Negativa erfarenheter av hunden identifierades också, till exempel att hunden begränsade möjligheten att vistas i offentliga miljöer och andra personers negativa attityder. Studie III visade att fysiska servicehundar och alarmerande diabeteshundar är kostnadseffektiva i jämförelse med vanliga sällskapshundar, de var både kostnadsbesparande och innebar en QALY-vinst. Känslighetsanalyser av specifika parametrar påverkade inte resultaten, men den probabilistiska känslighetsanalysen visade att resultaten var osäkra. Resultaten från den systematiska litteraturöversikten i artikel IV visade att hundassisterad interventioner som ges i terapeutiskt syfte hade små till måttliga effekter vid psykiatriska tillstånd. Hundassisterade aktiviteter hade små till måttliga effekter vid kognitiva störningar och hundassisterade interventioner som gavs som stöd vid olika typer av medicinska insatser var fördelaktiga. Studier gällande kostnadseffektivitet av hundassisterade interventioner saknades. Sammanfattningsvis, assistanshundar som hjälpmedel ger positiva effekter i flera dimensioner för sina ägare och är sannolikt kostnadseffektiva. Hundassisterade interventioner uppvisar små till måttliga effekter i vissa situationer i hälso- och sjukvården.

The human-animal bond has therapeutic value regardless of the nature of the interaction. Recently, the work has begun to diverge into two distinct directions. First, many organizations continue to support volunteer visiting teams in a variety of community settings; however, a secondary breed of programs are emerging as more healthcare, social service, and educational practitioners carry the responsibility to ensure professional level standards of practice that blend seamlessly with each disciplines practice framework. The patient, client, and student goals are formal and practiced in a discipline specific modality. Dogwood Doga is not meant to be a “cookie cutter” book for activities, rather, it is meant to educate professionals about how to think about intervention or educational plans, activity and biomechanical analysis, modifications, and safety for human and dog. This book caters to those who use dogs in discipline specific sessions. DOGWOOD DOGA is the first book in a series that offers an occupational therapists perspective on having a canine co-therapist or co-educator work with clients, patients or students to reach functional goals including health maintenance, neuromusculoskeletal and motor skills, sensory and cognitive functions, communication and interaction skills, and more. The book includes pictured demonstrations, instructions, activity analysis, and modification ideas. Each activity in DOGWOOD DOGA also offers information about incorporating the dog and intermediate dog training requirements. It is recommended that users have experience with biomechanics/yoga, and have dogs with solid obedience and interaction skills.

Covering principles of therapy dog team training, assessment, skills, and ongoing monitoring, Canine-Assisted Interventions provides guidance on the most evidence-based methods for therapy dog team welfare, training, and assessment. The authors offer a linear approach to understanding all aspects of the screening, assessment, and selection of dog-handler teams by exploring the journey of dog therapy teams from assessment of canines and handlers to the importance of ongoing monitoring, recredentialing, and retirement. In addition to reviewing key findings within the field of human-animal interactions, each chapter emphasizes skills on both the human and dog ends of the leash and makes recommendations for research-informed best practices. To support readers, the book culminates with checklists and training resources to serve as a quick reference for readers. This book will be of great interest for practitioners, in-service professionals, and researchers in the fields of canine-assisted interventions and counseling.

This is a book for anyone who wants to learn more about what a social working dog is. Maybe you’re curious about what it might be like to work in a school or some form of health care together with your best friend? Maybe you’ve already done an assessment test and are looking for or have already started the course that best suits you? Or maybe you have a family member who you think would benefit from sessions with a dog team but want to know a little more before you propose it? The authors have based the contents of this book on the situation in Sweden and cover everything from why dogs function so well with people who are in need of support, to how to select a suitable dog for the job. They give you tips on how to start training basic skills, finding the course that suits you best, and what you should think about when you have a certified social working dog. You will also read about important things to keep in mind when introducing a certified dog into the workplace. Thirteen dog handlers tell their stories about a day at work with their best friend and colleague. The book also contains quotes from employers who have invited a dog team into their workplace. Animal Assisted Interventions – Professionals Embrace the Power of the Dog is simply a book that educates as well as moves you. Together, Sara Karlberg and Helena Eriksson have a great deal of experience in both training and working with social working dogs. They are both dog handlers, and Sara runs Svenska Terapihundskolan where Helena has been working as a teacher since the very beginning. Sara’s background is in communication and public health sciences. Helena is a social worker and the manager of a recreational therapy facility. In this book, they share their collective knowledge of and love for the dog, both as best friend and colleague.

"Animal-Assisted Interventions are goal-oriented and structured interactions that incorporate the human-animal bond. By including animals in health and human services, unique and significant therapeutic gains can be achieved. However, Animal-Assisted Interventions involve so much more than simply having a dog or horse present during therapy. For the sake of both the animals and humans involved, the health professional must be cognizant of a profusion of information in order to deliver ethical and effective services. Animal-Assisted Interventions for Health & Human Service Professionals provides physical therapists, occupational therapists, speech-language therapists, audiologists, psychologists, psychiatrists, social workers, nurses, and other health and rehabilitation specialists with the core knowledge required to effectively introduce dogs and horses into their practice. Wide-ranging and up-to-date content is provided by expert clinicians and researchers in the field of Animal-Assisted Interventions to produce the only comprehensive text to address topics relevant to all health professionals. Explicit direction is also provided separately for dog-human and horse-human therapy teams. Finally, discipline-specific attention is given to the latest in research and development, application, and best practice of including animals in healthcare and human services. This book is essential reading for any health and human service provider who is currently working with animals or who is considering expanding their practice to include the help of animal co-workers"--

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.

Encyclopedia of Mental Health, Second Edition, tackles the subject of mental health, arguably one of the biggest issues facing modern society. The book presents a comprehensive overview of the many genetic, neurological, social, and psychological factors that affect mental health, also describing the impact of mental health on the individual and society, and illustrating the factors that aid positive mental health. The book contains 245 peer-reviewed articles written by more than 250 expert authors and provides essential material on assessment, theories of personality, specific disorders, therapies, forensic issues, ethics, and cross-cultural and sociological aspects. Both professionals and libraries will find this timely work indispensable. Provides fully up-to-date descriptions of the neurological, social, genetic, and psychological factors that affect the individual and society Contains more than 240 articles written by domain experts in the field Written in an accessible style using terms that an educated layperson can understand Of interest to public as well as research libraries with coverage of many important topics, including marital health, divorce, couples therapy, fathers, child custody, day care and day care providers, extended families, and family therapy

Since the first edition of Between Pets and People in 1983, the authors' then-startling contention that pets benefit our mental and physical health has found wide acceptance. Evidence in our daily lives - in television pet food ads, in doctor's offices outfitted with aquaria - attests to how widely the belief in pets' therapeutic influence is now held. This revised edition of Between Pets and People, with additional data and case studies and expanded references - including a listing of Internet resources - and a foreword by Elizabeth Marshall Thomas, analyzes the surprisingly complex relationships we have with our pets. This book contains an important lesson for everyone - to accept ourselves and others in the uncritical way that pets accept us, and come to terms with our own animal nature.