Assessment of occupational therapists' attitudes and knowledge of animal-assisted therapy

Transcription

1 The University of Toledo The University of Toledo Digital Repository Master s and Doctoral Projects Assessment of occupational therapists' attitudes and knowledge of animal-assisted therapy Robyn M. Hightower The University of Toledo Follow this and additional works at: This Scholarly Project is brought to you for free and open access by The University of Toledo Digital Repository. It has been accepted for inclusion in Master s and Doctoral Projects by an authorized administrator of The University of Toledo Digital Repository. For more information, please see the repository's About page.

2 Attitudes and Knowledge of Animal-Assisted Therapy 1 Assessment of Occupational Therapists Attitudes and Knowledge of Animal-Assisted Therapy Robyn M. Hightower, B.S. Research Advisor: Barbara Kopp Miller, Ph.D. Department of Occupational Therapy Occupational Therapy Doctorate Program The University of Toledo Health Science Campus May 2010

3 Attitudes and Knowledge of Animal-Assisted Therapy 2 Abstract Objective: The purpose of this study was to assess the attitudes and knowledge of occupational therapists of animal-assisted therapy. Method: A three-part questionnaire was mailed to 1000 randomly selected occupational therapists licensed to practice in the state of Ohio. The questionnaire consisted of three sections: a demographics sheet, the Animal-Assisted Therapy Knowledge Test, and the Attitudes Toward Animal-Assisted Therapy scale. Among the participants who completed the questionnaire, the majority were female (93%) and were Caucasian (94%). Participants reported working in the occupational therapy field for an average of 14.4 years. Over half of the participants highest degree held was a Bachelor s degree (58%), while 39% had a Master s degree. Results: A total of 375 valid questionnaires were obtained. The response rate was 38%. Participants mean knowledge score was out of a possible 15 questions. Also, the participants mean score for the attitude section was , which shows that participants surveyed had a relatively positive attitude of animal-assisted therapy. Practitioners who use animals had an overall more positive attitude of animal-assisted therapy than practitioners who did not use animals (z = -3.93, p = 0.000). There was no relationship between attitude and knowledge with regards to practitioners who use animals. Practitioners who use animals did not have a greater knowledge of animal-assisted therapy than practitioners who did not use animals. Conclusion: This study illustrates that occupational therapists are knowledgeable about animalassisted therapy and have positive attitudes toward it. Continued research in this area, especially regarding the effectiveness of animal-assisted therapy, is warranted.

4 Attitudes and Knowledge of Animal-Assisted Therapy 3 Assessment of Occupational Therapists Attitudes and Knowledge of Animal-Assisted Therapy Therapists are continuously searching for alternative interventions that will promote greater performance in their patients. There have been numerous studies on the healing properties of animals ranging from children with special needs (Oakley & Bardin, n.d.) to older adults in a nursing home (Roth, 2000). Considering that therapists are responsible for developing a treatment plan that will produce the greatest results in their patients, it is important that they are aware of the potential benefits that can be provided from the therapeutic use of animals. Although there have been many studies involving animals in therapy, there have been a limited number of studies that acknowledge therapists attitudes towards using animals to facilitate patients treatment. The present study attempts to address how occupational therapists respond to animal-assisted therapy, as well as, how knowledgeable they are about the subject. The history of animal-assisted therapy will be discussed, as well as, the known advantages of human-animal contact. Also, there will be a summary of the current literature on the use of animals in therapy. Finally, the present study will be discussed. History of Animal-Assisted Therapy The basic concept of animal-assisted therapy is the use of animals as a therapeutic tool to help people that are afflicted with a disability (Arkow, 2004; Roth, 2000). Specifically, it is a goal directed intervention in which an animal meeting specific criteria is an integral part of the treatment process (Arkow, 2004, p. 10). The animals are screened, trained, and certified. Following this, the therapy is directed by a health service provider. The health service provider is licensed and/or recognized by a separate professional discipline. Also, he or she is knowledgeable about animals and has expertise in incorporating animals into a treatment plan. Services can be billed to third party payers (Arkow, 2004; Sievert, 2003).

5 Attitudes and Knowledge of Animal-Assisted Therapy 4 Animal-assisted therapy, sometimes referred to as animal-facilitated therapy, may seem like a relatively new therapeutic approach, but it actually has historical roots that reach back to the late 1700s. In 1792, the York Retreat in England, which was founded by the Society of Friends, was one of the first places that treated people who were mentally ill humanely instead of cruelly. This retreat had the first documented case of animals being used therapeutically. William Tuke, who was a Quaker merchant, commented on the fact that rabbits, chickens, and other farm animals helped to enhance the humanity of the emotionally ill (Pichot & Coulter, 2007, p. 9). Later, Florence Nightingale studied the use of animals in health care. She is credited as the first known clinician to do so. She discovered that her patients who were chronically ill benefited from small companion animals (Pichot & Coulter, 2007). The movement that started in Europe made its way to the United States in the 1940s. Pawling Air Force Convalescent Hospital in Pawling, New York encouraged their patients to work with animals when they convalesced. In 1942, Pawling began a planned program that involved dogs (Netting, Wilson, & New, 1987). Following World War II through the early 1950s, Boris Levinson, who was a psychologist, investigated animal-facilitated therapy by designing projects and conducting research experiments. His ground breaking work led others to take a closer look at what animal-facilitated therapy had to offer (Netting et al., 1987; Sievert, 2003). The 1960s brought more awareness to animal-assisted therapy and by 1970, the American Humane Education Society reported that approximately 48 percent of all institutions surveyed were using animals in facilitating the treatment of patients (Netting et al., 1987). Over the past thirty years, the status of animal-assisted therapy has increased to where it is commonly found among hospitals, schools, and nursing homes (Pichot & Coulter, 2007). A study by Lechner, Kakebeeke, Hegemann, and Baumberger (2007) compared the

6 Attitudes and Knowledge of Animal-Assisted Therapy 5 effects of hippotherapy to other interventions on 12 people who had experienced a spinal cord injury. Hippotherapy involves treatment with the help of a horse. It is a specialization of equine-assisted therapy, which is a subtype of animal-assisted therapy (Macauley & Gutierrez, 2004). Hippotherapy is not therapeutic riding instruction. Instead, it uses the natural rhythm of the horse to grade sensory and motor input to the rider as an intervention strategy (Latella & Langford, 2008). The amount of spasticity and the patients mental well-being were of special interest to the authors of the study. They concluded that hippotherapy is more efficient than the other interventions in reducing spasticity temporarily. Also, it had a positive short-term effect on the participants mental well-being (Lechner et al., 2007). A study by Macauley and Gutierrez (2004) also researched the effects of hippotherapy, but used children with language learning disabilities. Three children with language learning disabilities received both clinic-based therapy, as well as, hippotherapy. Both the participants and their parents completed a client satisfaction questionnaire. The results showed that the parents reported that their children made greater improvements in speech and language abilities, motivation, and self-concept following the hippotherapy sessions when compared to results from traditional clinic-based therapy. One reason that animal-assisted therapy has become a beneficial part of one s treatment is due to the human-animal bond. This can be defined as the attachment between a human and an animal that can be interpreted as friendly, affectionate, and companionable (Vriend, 1996). Many people are very attached to their pets, which can sometimes lead them to be considered a part of the family. Research studies have shown that people can lower their blood pressure, release strain and tension, and can be drawn out of depression and loneliness as a result of holding or petting an animal (Therapy Dogs International, n.d.). Animals have been found to

7 Attitudes and Knowledge of Animal-Assisted Therapy 6 not only have positive physiological effects on individuals, but can also help people with regards to activities that are meaningful and purposeful. The Therapeutic Use of Animals with Occupational Therapy Occupations refer to everyday tasks that are deemed meaningful and purposeful (Nelson, 1994). When caring for an animal, a person is required to feed, clean, and play with them on a daily basis (The Use of Animals in Occupational Therapy, n.d.). To many, spending time with animals can be considered very meaningful. The visual stimulation of an animal can elicit feelings of affection, acceptance, interest, and unconditional love. Petting the animal s fur can elicit sensory meanings (Vriend, 1996). Additionally, a person can have a greater sense of purpose in an occupation when animals are present. For example, he or she may want to give or receive affection from the animal. The added purpose could further motivate the person to engage in the occupation (Vriend, 1996). Furthermore, it should not be overlooked that both animal-assisted therapy and occupational therapy have historical roots in the Quakers York Retreat and Society of Friends. Their humane treatment of people who were mentally ill led to the birth of occupational therapy (Kielhofner, 2004). There are many occupational therapists who rely on animals to be an integral part of the treatment session. Dogwood Therapy Services, Inc., in Albuquerque, New Mexico, was founded for this exact reason. Melissa Winkle started her own practice so she could use dogs as an assistive technology option (Strzelecki, 2007). An assistive technology device can include any item, piece of equipment, or product system, whether it is acquired commercially, modified, or customized. It is used to increase, maintain, or improve functional capabilities of individuals with disabilities. For some it may be difficult to view a living, breathing animal as technology. However, through specialized training, a dog can learn to do tasks that a person with a disability

8 Attitudes and Knowledge of Animal-Assisted Therapy 7 needs to maximize independence (Hanebrink & Dillon, 2000). For example, when she works with children who need to improve their anti-gravity prone extension, she asks them to punch out bug shapes using a hole punch, and she then instructs them to place the paper bugs on the dogs. They are able to utilize bilateral and fine motor skills. Finally, the children lie on their stomachs on a swing that is suspended over the dog. They pick the bugs off the dog using tweezers or chopsticks (Strzelecki, 2007). St. Mary s Hospital for Children began an animal-assisted therapy program in During a therapy session, an occupational therapist works with a child in his or her wheelchair or on a mat arranged in a circle. There are a variety of treatment techniques used that encourage the child to work on specified goals when he or she interacts with an animal. For example, a child that had recovered from a traumatic brain injury experienced a loss of function in one of his arms. The treatment plan included the child reaching out with his weak arm to brush the dog, using a brush with a modified handle. Furthermore, the therapist added a wrist weight to the weak arm in order to develop strength (Oakley & Bardin, n.d.). In summary, when animals are used in therapy sessions, children become excited about therapy and are motivated to accomplish their treatment goals. There have been studies that pertained specifically to occupational therapy and the therapeutic use of animals. Sams, Fortney, and Willenbring (2006) compared language use and social interaction in 22 children with autism while they were receiving two different forms of occupational therapy. One involved the use of standard techniques and the other incorporated animals into the treatment. Researchers reported that there was greater social interaction and use of language among the children when animals were used as opposed to the standard occupational therapy techniques. The findings of this study imply that children with autism may be more

9 Attitudes and Knowledge of Animal-Assisted Therapy 8 motivated to work towards achieving their goals if animals are present. Also, by incorporating animals into treatment, it could improve the relationship between the therapist and the child. Vriend (1996) studied the level of performance among 27 healthy children while they completed a rote exercise, as well as, an occupationally embedded exercise with a dog. The occupationally embedded exercise involved each child petting the dog until he or she became fatigued. The rote exercise consisted of the children making the same arm motion without the dog being present. The author reported that children in the animal condition performed significantly more repetitions than in the rote condition. This study reinforces the theory that animals can provide a greater sense of meaning and purpose in an occupation, which can increase the level of performance. If therapists incorporate animals into the therapy session, their patients might be more inclined to perform. Occupational Therapists Response to Animal-Assisted Therapy There have been some studies that assessed the attitudes of occupational therapists in response to animal-assisted therapy, as well as, where they gathered knowledge of the subject matter. Alfano (1998) distributed 200 surveys to randomly selected occupational therapists across the United States to determine how animal-assisted therapy is being used in occupational therapy, occupational therapists views on its use as a treatment modality, and its perceived effectiveness. One hundred thirty five surveys were returned. The results showed that 98% of occupational therapists were familiar with animal-assisted therapy or the use of animals in therapy. Their knowledge of animal-assisted therapy came from professional journals, magazines, and other therapists. Many of the therapists agreed that animal-assisted therapy could be utilized as an effective modality in occupational therapy. Furthermore, only 7% of the participants reported that they were currently including animal-assisted therapy in their treatment

10 Attitudes and Knowledge of Animal-Assisted Therapy 9 sessions, but many of them stated that it was most effective in improving motivation and social interaction skills. Ferrese, Forster, Kowalski, and Wasilewski (1998) interviewed six occupational therapists and three occupational therapy assistants. The study s focus was to determine the therapists views on animal-assisted therapy and its impact, if any, on elderly people in long-term care facilities. The outcome of the study indicated that therapists viewed animal-assisted therapy as follows: (1) It was a way to increase motivation in the residents when taking part in a therapy session; (2) It resulted in increased alertness; (3) It enhanced the emotional well-being of the residents; (4) There was more social interaction during sessions that involved animals; (5) It created a home-like environment; and (6) It provided an opportunity for nurturing that was not common at a long term care facility. The results of the study are important because it shows that not only children can benefit from animal-assisted therapy, but the elderly population can benefit, as well. A study by Darrah (1996) identified uses of animal-facilitated therapy by mailing 150 questionnaires to the administrators of various nursing facilities. The questionnaire addressed such issues as: (1) Are animals used therapeutically at the facility?; (2) If so, what kinds were used and what purpose did they serve?; (3) Who supervised the therapy sessions involving animals, occupational therapists being included?; (4) What conditions are common at the facility?; and (5) Do the animals have an effect on the patient s treatment? The results showed that sensory stimulation, social interaction, stress reduction, and companionship were the four most common therapeutic purposes for using animals in the nursing home. Furthermore, the therapeutic benefits of animal-facilitated therapy were as follows: increased muscle strength and range of motion; pain management; reduction of blood pressure and heart rate; increased

11 Attitudes and Knowledge of Animal-Assisted Therapy 10 responsibility for another living creature; increased self-esteem of the patients; patient independence; and improved patient-therapist interaction. Similar to the study by Ferrese et al., the results showed the importance of animal-assisted therapy with the elderly population when dealing with social interaction, motivation, and companionship. Additionally, animals that are a part of a therapeutic treatment can benefit one s physical health. Animal-assisted therapy has shown to be a beneficial intervention when it comes to occupational therapy. OT Practice, which is an occupational therapy magazine, has recently started to print a regular column pertaining to animal-assisted therapy which shows that there is a greater interest in using animals as a therapeutic tool. Also, there are therapists such as Darrah (1996), Ferrese et al. (1998), and Alfano (1998) that are aware of the benefits of animal-assisted therapy and are promoting it as an effective tool. However, what about the other therapists across the country? How do they respond to this form of therapy? Are most therapists even aware of animal-assisted therapy and its potential benefits? If so, what are their attitudes towards it? In an effort to answer these questions, the purpose of this descriptive study was to assess the attitudes and knowledge of occupational therapists with regards towards animal-assisted therapy. Methods Participants Participants solicited for this study were certified occupational therapists licensed in the state of Ohio. A request was made to the Ohio Occupational Therapy Board of Licensure to obtain a list of all registered therapists within Ohio, and 1,000 of them were randomly chosen for the study. Only occupational therapists licensed in the state of Ohio were chosen to participate in the study.

12 Attitudes and Knowledge of Animal-Assisted Therapy 11 Instruments The questionnaire consisted of three sections (see Appendix A). All three sections of the questionnaire were developed by the authors because no present scale exists for measuring the attitudes and knowledge of occupational therapists with regards to animal-assisted therapy. Similar past surveys were reviewed in order to develop the survey (Velde, Cipriani, & Fisher, 2005; Delta Society, 2008A; Delta Society, 2008B). Content validity was assessed by an animal-assisted therapy professional who reviewed the survey prior to mailing it out to the participants. The first section requested personal information about the participants such as race, gender, degree held, work setting, and populations frequently seen in practice. The second part of the questionnaire contained the Animal-Assisted Therapy Knowledge Test that consisted of fifteen true and false questions. Questions were developed by gathering information from Winkle and Canfield (2008). The purpose of the Animal-Assisted Therapy Knowledge Test was to assess the level of knowledge of animal-assisted therapy a practitioner possesses. Participants were asked to answer each question to the best of their ability. Scoring involved adding up the number of correct responses a participant gave. A higher score on the Animal-Assisted Therapy Knowledge Test correlated with a greater awareness and understanding of animal-assisted therapy. The final section of the questionnaire was the Attitudes Toward Animal-Assisted Therapy, which was compiled of nineteen statements that assessed the participants attitudes toward animal-assisted therapy. Content validity was also assessed by an animal-assisted therapy professional. Participants were asked to rate their agreement of each of the statements on a seven point Likert scale. They marked one if they strongly disagreed and seven if they strongly agreed. Scoring involved adding the participant s assigned numbers of each statement.

13 Attitudes and Knowledge of Animal-Assisted Therapy 12 The minimum possible score was 19 while the maximum possible score was 133. Questions two through seven and nineteen were reverse scored items. Higher scores indicated a more positive attitude of animal-assisted therapy. Procedures Surveys were mailed out to one thousand occupational therapists randomly chosen from the Ohio Occupational Therapy Association database. The mailing contained a cover letter (see Appendix B), the three part questionnaire, and a return envelope with postage. A reminder postcard was sent to all possible participants approximately three weeks after the initial mailing in hopes of increasing the rate of responses (see Appendix C). Results Demographics Three hundred and seventy five questionnaires were completed and returned. Two surveys were returned by the post office because of outdated address information. Therefore, the number of possible participants for this study was 998, which gave a response rate of 38%. Prior to analyzing the data from the surveys, the p level was set at 0.05 for all statistical tests. Of the 375 participants in the study, 350 were female (93%) while the remaining 25 were male (7%). With regards to race, the majority of the participants were Caucasian (94%), while 2% were Asian, 1% were African American, 1% were Hispanic, and 2% were listed as Other. Participants reported working in the occupational therapy field for an average of 14.4 years (SD = 9.61). Over half of the participants highest degree held was a Bachelor s degree (58%), while 39% had a Master s degree, 1% had a Doctoral degree, and 3% were listed as Other. The majority of the participants did not use animals in therapy (72%). Of the 28% participants who did use animals in therapy, volunteers were the main handlers of the animals

14 Attitudes and Knowledge of Animal-Assisted Therapy 13 (76%), followed by therapists (22%), other (16%), families (9%), and aids (3%). Additionally, 37% of the participants stated that although animals are currently not used at their facility, animals were used in the past. The settings varied among the participants of the survey. The majority of the practitioners worked in a school (25%), outpatient clinic (21%), or long term care setting (18%). Of the participants who use animals in therapy, the most frequent settings included long term care (29%), rehab (26%), and acute (23%). The conditions most commonly treated also varied among the participants of the survey. These included stroke (50%), arthritis (44%), and injuries (43%). Among the practitioners who use animals, the most common conditions included stroke (67%), arthritis (59%), cardiopulmonary (54%), cognitive (52%), and Alzheimer s disease (50%). Additionally, the populations varied among the participants of the survey. The majority of the participants worked with older adults (46%), adults (39%), and children (38%). These three populations were also the most common among practitioners who use animals: older adults (65%), adults (40%), and children (26%). Data Analysis of Knowledge Test The mean knowledge score was out of a possible 15 questions (SD = 1.92). The minimum score was 4 correct, while the maximum score was 15 correct. Ninety nine percent of respondents answered correctly that animal-assisted therapy can be offered in a variety of settings, such as nursing homes, rehabilitation centers, acute care, and psychiatric centers. A second question answered correctly by 98% of respondents was animal-assisted therapy is used to motivate individuals to engage in therapeutic occupations that will improve their performance skills, and thus their ability to participate in things that are meaningful to them. A third

15 Attitudes and Knowledge of Animal-Assisted Therapy 14 question answered correctly by 96% of respondents was horses, cats, and dogs can be used for animal-assisted therapy. Forty five percent of respondents answered incorrectly that animals that participate in animal-assisted therapy are granted access to all of the same establishments that allow assistance dogs or service animals. Thirty six percent of respondents answered incorrectly that if following specified guidelines, it is possible for animal-assisted therapy to be billed to third party payers. Twenty eight percent of respondents answered incorrectly that a woman who is prone to seizures has her golden retriever accompany her to work. This would be an example of animal-assisted therapy. For a comprehensive list of the Animal-Assisted Therapy Knowledge Test outcomes see Appendix D. Data Analysis of Attitude Section Internal consistency for the attitude section was determined by Cronbach s alpha. There was high internal consistency ( = 0.85). The mean score for the combined nineteen statements was This score shows that participants surveyed had a relatively positive attitude of animal-assisted therapy. The minimum score was 72, while the maximum was 128. Participants mostly disagreed with the following statement: Animals should never be used as a therapeutic intervention. Participants agreed the most with the following statement: More studies need to be done to demonstrate the efficacy of animal-assisted therapy. For a comprehensive list of outcomes for the Attitudes toward Animal-Assisted Therapy scale, see Appendix E. Relationship between Attitude and Knowledge on Practitioners Who Use Animals A Spearman s Rho was conducted to examine the relationship between the total knowledge score and total attitude score. The results showed that there was no relationship between attitude and knowledge for all participants ( 0.09, p = 0.095).

16 Attitudes and Knowledge of Animal-Assisted Therapy 15 A Mann Whitney U statistic test was used to compare practitioners who use animals to those who do not use animals with regards to attitudes towards animal-assisted therapy. The results found that practitioners who use animals had an overall more positive attitude of animal-assisted therapy (mean = , SD = 10.90) than practitioners who did not use animals (mean = 99.33, SD = 11.60; z = -3.93, p = 0.000). A Mann Whitney U statistic test was also used to compare practitioners who use animals with those practitioners who do not use animals. The results showed that practitioners who use animals did not have a greater knowledge of animal-assisted therapy (mean = 12.38, SD = 2.00) than practitioners who did not use animals (mean = 12.64, SD = 1.89; z = -1.20, p = 0.229). Discussion There are few studies that pertain to animal-assisted therapy from an occupational therapy stand point. There are even fewer studies that assess occupational therapists attitudes and their understanding of animal-assisted therapy. The current study evaluated the amount of knowledge occupational therapists had of animal-assisted therapy and therapists attitudes toward the use of animals in therapy. Demographics of Practitioners who Use Animal-Assisted Therapy Overall, 28% of the participants in the current study reported using animals in therapy. On the other hand, only 7% of the participants in Alfano (1998) reported that they were currently including animal-assisted therapy in their treatment sessions. Among the participants in the Darrah (1996) study, 73% from the California survey reported currently using animal-assisted therapy. Only 36% of the participants from the South Dakota survey reported using animalassisted therapy for treatment purposes.

17 Attitudes and Knowledge of Animal-Assisted Therapy 16 For the current study, the most frequent setting among participants who use animals in therapy included long term care (29%). There was no comparable literature on this statistic. The most common condition treated among practitioners who use animals was a cerebral vascular accident. Cerebral vascular accident was the leading condition reported among the participants in Alfano (1998) when using animal-assisted therapy. When compared to Darrah (1996), the condition most commonly treated among practitioners using animal-assisted therapy was Alzheimer s disease for South Dakota. Alzheimer s disease, cerebral vascular accident, and cancer were equally common conditions treated when using animal-assisted therapy in California. Sixty five percent of the participants in the current study who use animals in therapy reported that older adults were the most common population treated. Older adults were the most common age group reported by participants in Alfano (1998) as well. Knowledge of Animal-Assisted Therapy No other studies have been found that assess therapists knowledge of animal-assisted therapy. As a result, there is no literature to compare results of the current study. The results of the current study found that occupational therapists surveyed had a high knowledge of animalassisted therapy. Occupational therapists scored higher on questions regarding the definition of animal-assisted therapy, the type of settings where animal-assisted therapy can be offered, and the animals that can be used. Ninety nine percent of the participants correctly stated that animalassisted therapy can be offered in a variety of settings. Ninety eight percent of the participants correctly stated that animal-assisted therapy can be used to motivate individuals to engage in therapeutic occupations that will improve their performance skills, and their ability to participate

18 Attitudes and Knowledge of Animal-Assisted Therapy 17 in things that are meaningful to them. Ninety six percent of the participants correctly stated that horses, cats, and dogs can be used for animal-assisted therapy. Although the occupational therapists surveyed had a general understanding of animalassisted therapy, there were certain areas where knowledge scores were lower than others. For example, 45% of the participants incorrectly stated that animals that participate in animalassisted therapy are granted access to all of the same establishments that allow assistance dogs or service animals. Also, 36% of the participants incorrectly stated that it is not possible for animal-assisted therapy to be billed to third party payers if following specified guidelines. Additionally, 28% of the participants misidentified an example of animal assisted therapy. They believed that if a woman, who is prone to seizures, brought her golden retriever to work; it would be considered animal-assisted therapy. The implications of these scores are that there needs to be more education available to occupational therapists in areas where knowledge is lower. For example, occupational therapists should be provided information about the differences between animal-assisted therapy, assistance dogs, and service dogs. There should be examples provided for each area so occupational therapists have a better understanding of what each entails. Also, there should be more information on billing options. Some occupational therapists may be deciding against animal-assisted therapy because they feel it cannot be reimbursed. Attitudes toward Animal-Assisted Therapy Participants surveyed had a relatively positive attitude of animal-assisted therapy. Forty one percent of the therapists surveyed in this study felt that animals are an effective tool in treating people with various conditions. Past research has provided evidence of this. For example, Lechner et al. (2007) concluded that the therapeutic use of horses is a more effective

19 Attitudes and Knowledge of Animal-Assisted Therapy 18 tool than other interventions in reducing spasticity temporarily, while Macauley and Guttierrez (2004) showed that hippotherapy can be a valuable tool when used to improve speech and language deficits among children. Also, the results of the study by Vriend (1996) illustrated that using dogs as a therapeutic tool can increase the occupational performance level among healthy children. Ninety four percent of those surveyed in the Alfano (1998) study reported being familiar with animal-assisted therapy or the use of animals in therapy. The occupational therapists surveyed in the current study, however, stated that they were not as familiar with animal-assisted therapy. Only 2% strongly agreed that they were familiar with animal-assisted therapy, even though their scores on the knowledge test indicated otherwise. The participants in the study by Ferrese et al. (1998) reported that there were many benefits to animal-assisted therapy. Some of these included increased motivation, increased alertness, enhanced emotional well-being, and increased social interaction. The occupational therapists surveyed in the Alfano (1998) study also reported that animal assisted therapy was most effective in improving motivation and social interaction skills. The participants surveyed in this study reported that the therapeutic use of animals could increase motivation and social interaction among the patients. Additionally, the participants reported that animal-assisted therapy could result in decreased stress and provide sensory stimulation. Increased social interaction, stress reduction, and sensory stimulation were benefits reported by Darrah (1996). Furthermore, Vriend (1996) stated that the visual stimulation of an animal can elicit feelings of affection, acceptance, interest, and unconditional love. Petting an animal s fur can elicit sensory meanings.

20 Attitudes and Knowledge of Animal-Assisted Therapy 19 Twenty one percent of occupational therapists surveyed felt that there needs to be more studies done to demonstrate the efficacy of animal-assisted therapy. The implications of these results are that occupational therapists are receptive to the use of animals in therapy. However, there should be more research studies done that show the effectiveness of animal-assisted therapy. Relationship Between Attitude and Knowledge There were no significant findings when comparing attitude and knowledge scores, as well as, when analyzing knowledge scores. There was no relationship between attitude and knowledge. Also, practitioners who use animals did not have a greater knowledge of animalassisted therapy than practitioners who did not use animals. There was a significant finding when analyzing attitude scores. Practitioners who used animals had an overall more positive attitude of animal-assisted therapy than practitioners who did not use animals. As mentioned previously, no other studies have been found that assess therapists knowledge of animal-assisted therapy. Therefore, there is no literature comparing attitude and knowledge scores. Additionally, the studies reviewed for the current study did not discuss the differences between practitioners who use animals and those who do not. Overall, the occupational therapists surveyed in Darrah (1996) and Alfano (1998) had a positive view of animal-assisted therapy, which was similar to the current study. Implications of Current Study Animal-assisted therapy has increased in popularity over the past thirty years, to where it is commonly found among hospitals, schools, and nursing homes. The results from this study begin to assess if occupational therapists are prepared to work with their clients using animalassisted therapy in these settings. Although scores on the knowledge test were high, the majority

21 Attitudes and Knowledge of Animal-Assisted Therapy 20 of the participants did not feel that they were familiar with animal-assisted therapy. Although many participants denied being familiar with animal-assisted therapy, they do have a general understanding of the therapeutic use of animals. Also, the results of the study illustrate how receptive occupational therapists are to the therapeutic use of animals. Seventy eight percent of therapists strongly disagreed that animals should never be used as a therapeutic intervention. However, only 31% of the participants agreed that animal-assisted therapy should be utilized more at various settings across the country. Only 19% strongly agreed that therapists enjoy working with animals. Overall, occupational therapists are receptive to the therapeutic use of animals, but they do not feel there is a need to establish more programs across the country. The results of the current study imply that there needs to be more targeted education available to occupational therapists about animal-assisted therapy. Specifically, occupational therapists should be provided information about the differences between animal-assisted therapy, assistance dogs, and service dogs, as well as, more information on billing options. Furthermore, by assessing the attitudes of occupational therapists with regards to animalassisted therapy, it shows therapists level of interest with the therapeutic use of animals. As mentioned previously, the participants had an overall positive attitude of animal-assisted therapy. As a result, this can provide topics for future continuing education courses. Practitioners could provide Continuing Education Units (CEUs) on the topic of animal-assisted therapy for occupational therapists already in the field who are interested in learning more about this therapeutic intervention. Limitations A limitation of the current study involves the participant population. Occupational

22 Attitudes and Knowledge of Animal-Assisted Therapy 21 therapists registered with the state of Ohio were the only population solicited to be participants in the current study. This decreases the number of potential participants available for the study. It also decreases the variability of the subject pool due to all the participants being from a small geographical area. Additionally, the subject pool was not diverse. The majority of the participants were female and Caucasian. Another limitation of the study, which is common with survey research, was the fact that it is difficult to assess the information received as the true knowledge of the participant. Participants were asked to not use any outside sources, but the researcher cannot be sure that all information is an accurate portrayal of the therapist s knowledge. An additional limitation was the knowledge scale that was used. The authors of the study created the Animal-Assisted Therapy Knowledge Test. Although the test was found to have content validity, the questions were too simplistic. The test should be modified using harder questions in order to more accurately assess occupational therapists knowledge of animalassisted therapy. Future Research Future research that focuses on occupational therapists knowledge and attitudes toward animal-assisted therapy could include participants from a more diverse subject pool. The study should be completed again, but surveying occupational therapists from a wider geographical area. A National data collection would diversify the data. Also, it would allow the findings to be better generalized to the population of occupational therapists. There needs to be more information on how animal-assisted therapy is being used by occupational therapists. To further understand this, surveys could be utilized to help quantify how frequently and in what way occupational therapists provide animal-assisted therapy.

23 Attitudes and Knowledge of Animal-Assisted Therapy 22 As mentioned previously, many occupational therapists feel that there needs to be more research done to demonstrate the efficacy of animal-assisted therapy. Researchers could use different types of animals with various conditions in a wide variety of settings, while exploring the impact animal-assisted therapy has on occupational performance. Conclusion The results from the current study demonstrate that occupational therapists have a general understanding of animal-assisted therapy, and have positive attitudes regarding animal-assisted therapy. Areas where knowledge is lacking include reimbursement options, and specific guidelines that differentiate it from assistance dogs or service dogs. Occupational therapists that use animals in therapy have more positive attitude of animal-assisted therapy than occupational therapists that do not use animals. The concept of animal-assisted therapy has been around for over two hundred years. In that time, it has shown to have a positive impact on people of various ages and disabilities, even when being used in different settings. Although many health care practitioners are using this therapeutic modality with their patients, and are promoting it as beneficial intervention, more studies are needed to determine the efficacy of animal-assisted therapy. As a result, animalassisted therapy can continue to grow, and be utilized among new populations.

24 Attitudes and Knowledge of Animal-Assisted Therapy 23 References Alfano, T. R. (1998). A survey of the use of animal assisted therapy as a modality in the field of occupational therapy. Unpublished master s thesis, D Youville College, Buffalo, New York. Arkow, P. (2004). Animal-assisted therapy and activities: A study, resource guide and bibliography for the use of companion animals in selected therapies (9th ed.). Stratford, NJ: Author. Darrah, J. P. (1996). A pilot survey of animal-facilitated therapy in Southern California and South Dakota nursing homes. Occupational Therapy International, 3(2), Delta Society. (2008A). Animal assisted therapy FAQS. Retrieved April 23, 2008, from Delta Society. (2008B). Introduction to animal-assisted activities and therapy. Retrieved April 23, 2008, from Ferrese, L., Forster, B., Kowalski, R., & Wasilewski, L. (1998). Occupational therapists: Perspectives on using animal-assisted therapy with an elderly population. Unpublished master s project. Dallas: College Misericordia. Hanebrink, S., & Dillon, D. (2000, July 3). Service dogs: The ultimate assistive technology. OT Practice, 5(14), Kielhofner, G. (2004). Conceptual foundations of occupational therapy (3rd ed.). Philadelphia: F. A. Davis Company. Latella, D., & Langford, S. (2008, February 4). Hippotherapy: An effective approach to occupational therapy intervention. OT Practice, 13(2),

25 Attitudes and Knowledge of Animal-Assisted Therapy 24 Lechner, H. E., Kakebeeke, T. H., Hegemann, D., & Baumberger, M. (2007). The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 88, Macauley, B. L., & Gutierrez, K. M. (2004). The effectiveness of hippotherapy for children with language-learning disabilities. Communication Disorders Quarterly, 25(4), Nelson, D. L. (1994). Occupational form, occupational performance, and the therapeutic occupation. In C. B. Royeen (Ed.), AOTA self study series: The practice of the future: Putting occupation back into therapy, Lesson 2 (pp.9-48). Rockville, MD: American Occupational Therapy Association. Netting, F.E., Wilson, C. C., & New, J. C. (1987). The human-animal bond: Implications for practice. Social Work, 32(1), Oakley, D., & Bardin, G. (n.d.). The potential benefits of animal assisted therapy for children with special needs. Retrieved February 18, 2008, from Pichot, T., & Coulter, M. (2007). Animal-assisted brief therapy: A solution-focused approach. Binghamton, NY: The Haworth Press. Roth, J. (2000). Pet therapy uses with geriatric adults. The International Journal of Psychosocial Rehabilitation, 4, Sams, M. J., Fortney, E. V., & Willenbring, S. (2006). Occupational therapy incorporating animals for children with autism: A pilot investigation. The American Journal of Occupational Therapy, 60(3), Sievert, D. (2003). Development of an animal assisted therapy program for an intensive care unit. Unpublished scholarly project, Medical College of Ohio, Toledo.

26 Attitudes and Knowledge of Animal-Assisted Therapy 25 Strzelecki, M. V. (2007). Pawsitive strides in occupational therapy. OT Practice, 12(21), 7-8. Therapy Dogs International: A brief history. (n.d.). Retrieved February 6, 2008, from The use of animals in occupational therapy. (n.d.). Retrieved November 5, 2007, from Velde, B. P., Cipriani, J., & Fisher, G. (2005). Resident and therapist views of animal-assisted therapy: Implications for occupational therapy practice. Australian Occupational Therapy Journal, 52, Vriend, M. (1996). The use of an animal in occupationally embedded exercise to promote performance in children. Unpublished scholarly project, Medical College of Ohio, Toledo. Winkle, M., & Canfield, K. (2008, March 31). Considerations for using animals in practice. OT Practice, 13(5),

27 Attitudes and Knowledge of Animal-Assisted Therapy 26 Appendix A Occupational Therapists Attitudes and Knowledge of Animal-Assisted Therapy Questionnaire Part A: Please answer the following questions regarding your demographics and therapy practice: 1. What is your gender? Male Female 2. What is your race? Hispanic Asian-American Caucasian African-American Other (Please Specify) 3. How many years have you been in the occupational therapy field? 4. What is your highest level of occupational therapy education completed? Bachelor s Degree Master s Degree Doctoral Degree Other 5. What setting do you work in the majority of the time? Acute Home Health Care Private Practice Rehab Long Term Care Clinical Outpatient School Community Based Day Program Residential setting Other (Please Specify) 6. What conditions do you most commonly treat? (Please check all that apply) Alzheimer s Disease Spinal Cord Injury Psychosocial Arthritis Stroke Injuries Depression Traumatic Brain Injury Infectious disease Mental Retardation Parkinson s Disease Nervous System Cognitive Sensory Cardiopulmonary Developmental Delay Developmental Disability Other (Please Specify)

28 Attitudes and Knowledge of Animal-Assisted Therapy What population do you provide intervention for the majority of the time? Infants Children Adolescents Adults Older Adults 8. Does your facility currently use animals as a therapeutic treatment? Yes No 9. Who is the main handler of the animals? Therapists Volunteers Aids Families Other (Please Specify) 10. What species are used for AAT in your setting? 11. What percentage of therapists in your practice use animal-assisted therapy? 12. Has your facility ever introduced animals in the past? Yes No

29 Attitudes and Knowledge of Animal-Assisted Therapy 28 Part B: Please answer the following questions to the best of your ability, without the use of reference material. Please mark each of the statements as being true (T) or false (F). T 1. Animal-assisted therapy is used to motivate individuals to engage in therapeutic occupations that will improve their performance skills, and thus their ability to participate in things that are meaningful to them. F 2. Animals that participate in animal-assisted therapy are granted access to all of the same establishments that allow assistance dogs or service animals. T 3. Animal-assisted therapy must be administered while under the supervision of a health/human service professional who is practicing within the range of his or her expertise. F 4. Animal-assisted therapy involves training animals that will be permanently placed with individuals that have disabilities. T 5. If following specified guidelines, it is possible for animal-assisted therapy to be billed to third party payers. T 6. Horses, cats, and dogs can be used for animal-assisted therapy. F 7. Therapists (Occupational, Physical, and Recreational) are the only professionals that can be responsible for directing animal-assisted therapy. T 8. The Delta Society is an organization that provided the first comprehensive training in animal-assisted therapy to volunteers and health care professionals. T 9. The first documented therapeutic use of animals was during the 1790 s at an asylum in England for patients who were mentally ill. T 10. Animal-assisted therapy can be offered in a variety of settings, such as nursing homes, rehabilitation centers, acute care, and psychiatric centers. T 11. Animal-assisted therapy is a goal-directed intervention. The animal is a tool that the therapist incorporates into his or her treatment plan. T 12. A woman recovering from a stroke is asked by an occupational therapist to stand at a raised table and brush a dog s back and head. This would be an example of animalassisted therapy. F 13. A woman who is prone to seizures has her golden retriever accompany her to work. This would be an example of animal-assisted therapy. T 14. In order to improve fine motor skills, a child is instructed by an occupational therapist to open a container of treats and feed small pieces of food to a cat. This would be an example of animal-assisted therapy. F 15. An individual brings her dog to a children s long term care facility to play or visit with residents. The staff has not set treatment goals for the interactions, but is involved in the visits. No records are kept. This would be an example of animal-assisted therapy.