TB MED 4
TECHNICAL BULLETIN
DOD HUMAN-ANIMAL BOND
PRINCIPLES AND GUIDELINES
APPROVED FOR PUBLIC RELEASE;
DISTRIBUTION IS UNLIMITED
HEADQUARTERS, DEPARTMENT OF THE ARMY
16 JUNE 2003
*TB MED 4
This bulletin contains copyright material
Technical Bulletin ^
Med No. 4 J
HEADQUARTERS
DEPARTMENT OF THE ARMY
Washington, DC, 16 June 2003
DOD HUMAN-ANIMAL BOND PRINCIPLES AND GUIDELINES
Approved for public release; distribution is unlimited
PREFACE
The U.S. Army Veterinary Corps, Department of Defense (DOD) Executive Agent for Veterinary
Services, has long been actively involved in human-animal bond (HAB) programs throughout the DOD.
Based upon that experience, this publication has been prepared to provide guidance for others interested
in utilizing HAB principles and programs in their own areas of operation.
Paragraph Page
Chapter 1. BACKGROUND
Introduction 1-1 1-1
Historical perspectives 1-2 1-1
Chapter 2. MODERN MILITARY APPLICATIONS OF HAB
PRINCIPLES (THREE MAIN CATEGORIES)
Therapy 2-1 2-1
Family and individual 2-2 2-1
Utility 2-3 2-2
Chapter 3. PROCEDURES FOR IMPLEMENTING HAB PROGRAMS AND APPLICATIONS
Diagnosis and referral, family and individual, and utility HAB applications 3-1 3-1
Therapy programs 3-2 3-1
Appendix A. REFERENCES A-l
B. THE U.S. ARMY VETERINARY CORPS— PROVIDING DIRECTION, LEADERSHIP, AND
COORDINATION FOR HAB PROGRAMS IN THE DOD B-l
C. THE PET IN THE MILITARY FAMILY AT TRANSFER TIME: IT IS NO SMALL MATTER C-l
D. HAB RESEARCH PROTOCOL PROCEDURES D-l
E. REQUIREMENTS FOR OFFICIALLY SANCTIONED HAB THERAPY
PROGRAMS E-l
F REQUIREMENTS FOR HEALTH ASSISTANCE ANIMALS IN
THE MILITARY F-l
G. THE ONGOING EVALUATION AND FOLLOWUP G-l
Glossary Glossary-1
Index Index-1
*This technical bulletin, medical supersedes TB MED 4, 14 February 1992.
TB MED 4
CHAPTER 1
BACKGROUND
1-1. Introduction
a. Animals' partnership with man predates writ-
ten records. Earliest petroglyphs show man and
beast hunting together. Mummified cats found in
Egyptian pyramids provide evidence of the sacred
role played by animals in this ancient culture.
b. The animal's role in the military has a long
history, from cavalry mounts to modern day mili-
tary working dogs. But in today's modern military,
does animal facilitated therapy (AFT) have a place
in our military treatment facilities (MTFs)?
Evidence strongly supports those that believe that
there is.
1-2. Historical perspectives
a. Over the years we have seen an ever rising
popularity of the animal as a companion of man.
Increasing numbers of individuals consider their
pet animal to be their best friend and/or helper and
many families consider their pet to be an integral
part of their family.
b. Recently, animals have found their place in
assisting the human healthcare professional. Such
interspecies teamwork has been referred to as
"animal facilitated therapy," "pet assisted psy-
chotherapy," "pet therapy," or variations thereof.
c. The first documented example of an animal
facilitated therapy program in the United States
occurred in a military setting. This was in the
1940's at Pawling Air Force Convalescent Center
in Pawling, New York. The center's farm and the
nearby forest provided numerous animals for the
veterans to interact with during their convales-
cence. This interaction was purposefully encour-
aged as a part of the treatment milieu. In 1942, a
planned program involving dogs began at the
facility.
d. Following World War II, the next document-
ed contribution to the human-animal bond (HAB)
field occurred in the mid-1960's when Boris
Levinson, a PhD psychologist, used his own dog as
a "cotherapist" during individual counseling ses-
sions. His results were so remarkable that he pub-
licized his findings to what was then a skeptical
group of colleagues. In the mid-1970's Drs. Sam and
Elizabeth Corson initiated animal visitation pro-
grams in hospital psychiatric wards and in geri-
atrics facilities. Their results were also published
to an audience that, although still skeptical, was
slowly seeing the possibilities being presented by a
promising new treatment modality.
e. During the late 1970's a few notable profes-
sionals, led by Dr. Michael McCulloch, organized a
group dedicated to the better understanding of the
interactions between people, animals, and the envi-
ronment. Interest then expanded to the point that
in 1981 the group became the Delta Society with
Dr. Leo K. Bustad as its first president. Since then,
its international membership and influence have
expanded dramatically; the benefits of human-ani-
mal interaction have become increasingly better
known and accepted by the healthcare community.
/. The U.S. Army Veterinary Corps, DOD
Executive Agent for Veterinary Services, has
taken the lead in gaining a better understanding of
human-animal relationships and in actively pursu-
ing ways this knowledge can contribute to the mil-
itary community. (See app B.) Since 1984, their
efforts in the HAB field have resulted in the
following:
(1) Legal opinions have been given that AFT
presents no greater liability concern than does any
other form of treatment when "delivered in such a
manner that it meets the prevalent standard of
care." (See fig 1-1.)
(2) "Exploration of HAB applications to the
Army Medical Department (AMEDD) mission"
has been an official part of the AMEDD study pro-
gram since 1985.
(3) A Veterinary Corps officer has been desig-
nated as the HAB Adviser to The Surgeon General
of the U.S. Army in 1986.
(4) Numerous HAB programs are now in var-
ious stages of implementation throughout the
DOD.
1-1
TB MED 4
KKFKIiKNCEOftOKFlCKSYMHOI.
HSVS-P
SIUJKCT
Legal Implications of Animal Facilitated Therapy (AFT)
Utilization in AMEDD and Related Military Health Care Programs
10 SJA kuom DVS I)atk 9 Sep 85 OMTi
ATTN: COL Dud2ik CPT(P) Anderson/mo/6522
1. During the meeting between yourself and CPT Lynn J. Anderson of this office on 6 Sep 85
the referenced subject was discussed. The conclusions reached are summarized as follows:
a. Treatment in any form, including medicines, if improperly utilized can do more harm
than good, but when utilized properly, the treatment becomes therapeutic.
b. As established by civilian studies, Animal Facilitated Therapy (AFT) has proven to be
in fact therapeutic.
c. when reasonable veterinary professional precautions are taken to ensure that animals
utilized in AFT are both behaviorally and medically appropriate, there would be no more
negative legal implications with this than with any other form of treatment.
2. Request your comments on the above summary relative to its accuracy. Any elaborative
comments would also be welcome.
/S/George H. Wyckoff, Jr.
GEORGE H. WYCKOFF, JR.
Colonel, VC
Director of Veterinary Services
TO DVS FROM SJA DATE 17 Sep 85 CMT 2
COL Dudzik/al/3400
Once you determine the appropriateness of the treatment, then furnishing that treatment has
the same legal implications and liabilities as any other treatment, namely that it must be
delivered in such a manner that it meets the prevalent standards of care. Thus, while one
treatment may have a higher risk factor than another, the liability is neither more or less
when the standard of care is met.
/S/ Joseph A. Dudzik
JOSEPH A. DUDZIK
Colonel, JA
Staff Judge Advocate
Figure 1-1. Legal opinion correspondence
1-2
TB MED 4
CHAPTER 2
MODERN MILITARY APPLICATIONS OF
HUMAN-ANIMAL BOND PRINCIPLES
(THREE MAIN CATEGORIES)
2-1. Therapy
a. These programs involve the use of animals to
facilitate the recovery from physical, mental, or
social illness. For patients suffering from terminal
illness, these programs can increase the quality of
the patient's remaining life. A few examples of
therapy programs are —
(1) Animal visitation to MTF patients. (See fig
2-1 for one example of a working local regulation.
This example may serve as a template for a local
regulation. Other facilities may require a different
format or greater or lesser attention to certain
details.)
(2) Animal residents in appropriate MTF
wards.
(3) Animal utilization in facilitating intake
interviews and individual and/or group therapy
sessions.
(4) Therapeutic horsemanship for handi-
capped family members or disabled military mem-
bers.
b. Regular animal visitation to pediatric wards
can decrease anxiety among children who are wor-
ried, anxious, and fearful. In many instances the
animal can function as a "social lubricant" easing
the child's fears and providing the staff with a
"bridge" to reach the child.
c. It may be beneficial for the patients' own ani-
mals to visit them in the MTF during their stay.
These visits are often beneficial not only to
patients but also to pets, the patients' families, and
the hospital staff. The requirements for this type of
visit are essentially the same as for those involving
an ongoing regularly scheduled visitation animal;
however, they must be managed on a case-by-case
basis.
d. Therapy, as defined in Dorland's Medical
Dictionary, is "the treatment of disease." Dorland's
defines treatment as "the management and care of
a patient for the purpose of combating disease or
disorder." Experience gained by military health-
care treatment teams strengthens the premise
that AFT is, in many cases, a potent kind of thera-
py and/or treatment that is unavailable through
any other source.
2-2. Family and individual
a. A survey of military personnel showed that
about half of the U.S. military families owned pets.
The vast majority of these families considered
their pet to be "a part of the family." (See app C.)
This being the case, it becomes apparent that it is
impossible to conceptualize the family as a whole
without including the family pet. This factor should
always be considered when family disruptions
occur. A family pet has the potential to be either a
cause of, or a cure for, problems. To illustrate, a
young boy was diagnosed by a military psychia-
trist as having an extremely disruptive behavioral
disorder. It was determined that "the boy had lost
his best friend," having been forced to leave his pet
behind when the family had been transferred to
Hawaii* In this instance, replacing the boy's best
friend with another helped the boy cope with his
loss.
b. The impact of pets on families at transfer time
is frequently significant. One survey demonstrated
that 30 percent of all military families in Hawaii in
1984 had left a pet behind when transferred. Of
these, 96 percent expressed that they had experi-
enced at least some degree of disruption or sad-
dening as a direct result of this separation. (See
app C.)
c. Many military families utilize day care servic-
es. AR 608-10 provides for the direction of these
facilities in the U.S. Army. One section addresses
the "use and care criteria" of pets in these facili-
ties. The U.S. Army veterinarian should play an
important role in ensuring that these criteria are
met. Paragraph B-lc summarizes the applicable
principles of AR 608-10 and discusses the implica-
tions for military veterinarians. Although the ref-
erenced regulation is of U.S. Army origin, the prin-
ciples are similar for all branches of service and
should be implemented DOD-wide.
d. Pets in a family or with an individual have
been shown to provide unconditional affection,
stimulus for exercise, humor, security, companion-
ship, and constancy to mention only a few of the
positive benefits. However, pets in a family can
also contribute to increased financial burdens,
unhappy neighbors when owners are irresponsible,
unfriendly competition for the pet's attention,
2-1
TB MED 4
increased potential for exposure to zoonotic dis-
ease, and family and individual disruption at the
death of the pet. Military veterinarians and com-
munity agencies should work with pet owners to
help them maximize the benefits, while minimizing
the liabilities, of pet ownership.
2-3. Utility
a. Many animals possess certain abilities that
far exceed those of their human counterparts.
People have been able to team up with these ani-
mals and put their abilities to great use, as for
example the military working dog's ability to
locate explosives, drugs, and other contraband.
Other examples include seeing eye dogs, hearing
ear dogs, and service dogs that can be invaluable
aids for individuals with physical disabilities. In
each case there is great utility value of an animal in
increasing people's abilities, and in minimizing
their disabilities.
b. Mascots, when utilized properly, can greatly
enhance the functioning of individuals and groups.
General Eisenhower once said of his Scottish
Terrier mascots that were with him during part of
World War II, "I especially appreciate my Scotties
because they are the only 'people' I can turn to
without the conversation returning to the subject
of war." Obviously, we see therapeutic relief for an
individual in this instance.
c. It has been documented that many units have
utilized a mascot to help build a sense of pride and
unity. An Air Force unit in Thailand during the
Vietnam conflict tells of a mascot that accompanied
them to the airfield at the beginning of each mis-
sion. There the dog stayed until each of the men
had returned. When tragedy occasionally occurred
and a plane failed to return, the dog displayed obvi-
ous signs of sorrow for the loss of a friend. During
those times the animal gave extra attention to each
of the mourning aviators and they responded back
to the dog in the same way. This mascot did much
to help a group of men to know that they were
important as individuals and it helped to draw
them together as a unit with common interests and
goals.
2-2
TB MED 4
MEDDAC Reg 40-4
DEPARTMENT OF THE ARMY
Headquarters, U.S. Army Medical Department Activity
Fort Blank. VA . 22193 -0000
MEDDAC Regulation Date
No. 40-4 20 September 2002
Medical Services
ANIMAL VISITATION POLICY
SAMPLE
1. PURPOSE. This regulation outlines the necessary provisions that must be taken to allow animal visita-
tion within the medical activity (MEDDAC) for the purposes of animal facilitated therapy, reducing isola-
tion and loneliness of patients, and assistance to handicapped visitors and/or patients or visitors requiring
seeing eye dogs, hearing ear dogs, or other certified handicap assistance animals.
2. APPLICABILITY. This regulation applies to Smith Army Community Hospital, Fort Blank , VA and
its satellite medical treatment facilities.
3. REFERENCES
a. Required publication, A Guide for Involvement in Human-Animal Bond (HAB) Programs in the
Department of Defense (DOD). This publication may be obtained from the U.S. Army Veterinary
Command, ATTN: MCVS, Fort Sam Houston, TX 78234-6000.
b. Referenced form. DD Form 2209, Veterinary Health Certificate.
4. RESPONSIBILITIES
a. Medical staff. The patient's attending physician must approve the visitation to the patient.
b. Nursing staff. The ward nurse will verify that the owner or handler has a current DD Form 2209
(Veterinary Health Certificate) for the visiting animal and will also identify any patients on the ward that
should not be exposed to the animal due to allergy or fear related problems.
c. Veterinarian. The veterinarian must certify that at the time of examination the animal is healthy,
free of apparent infection or contagious disease, immunizations are current, and it is free of apparent par-
asites, such as fleas, ticks, and worms. The animal's temperament must also be evaluated and certified to
ensure that it is a suitable candidate for visitation (that is, not excessively shy, nervous, aggressive, or over-
ly sensitive to other people) . This certification should be scheduled as close as possible to the time of the
actual visit but will not be more than 15 days prior to the first visit. A DD Form 2209 will be issued at that
time. The animal must be recertified annually. In the event that any question exists as to whether a hand-
icap assistance animal is from a recognized certification program, the veterinarian will ascertain the valid-
ity of the claim.
d. Owner or volunteer animal handler. The owner or volunteer animal handler must maintain a cur-
rent DD Form 2209 in his or her possession while the animal is present in the MEDDAC. However, it must
be remembered that a health certification is actually only valid at the exact moment that it is performed by
the veterinarian; that is, disease conditions can occur at any time. Therefore, it is critical that the owner or
handler retain primary responsibility of ensuring that the animal is clean, groomed and in good health. If
there is any reason to suspect otherwise, the animal must be cleared by a veterinarian before further vis-
itations can occur.
5. PROCEDURES
a. Animals may visit in the patient's room, the lobby, the courtyard, or other predesignated areas.
Animals are not permitted in food preparation and storage areas, clean or sterile supply storage areas,
nursing stations, or any areas where exceptional sanitary precautions are necessary.
Figure 2—1. Example of a pet visitation regulation
2-3
TB MED 4
MEDDAC Reg 40-4
b. Visitation (excluding certified handicap assistance animals such as seeing eye and hearing ear dogs)
will be scheduled ahead of time with the ward nurse and attending physician.
c. Visitation within the MEDDAC should not exceed 1 hour or as so designated by the ward nurse.
d. The visitor or handler is responsible for any elimination by the animal.
e. Animals will be under constant control by the owner or handler. All dogs must be on a leash when
visiting any area of the facility. All cats and other small animals must be carried in suitably clean pet car-
rying devices.
f. The nurse, physician and/or other involved healthcare professional should document the animal's
visit and the patient's reaction in the patient's medical record.
6. HANDICAP ASSISTANCE ANIMALS. (This includes seeing eye dogs, hearing ear dogs and other
certified handicap assistance animals.)
a. The owner has full responsibility for the handicap assistance animal while visiting the MEDDAC.
b. DD Form 2209 is not required for a handicap assistance animal to enter the MEDDAC. However, if
either the owner and/or the MEDDAC staff have any reason to question the good health of the assistance
animal (that is, vomiting, diarrhea, coughing, dirty, ungroomed) it should not be allowed to enter the MED-
DAC until cleared by a veterinarian.
MCFB-AVP 19 Sep 02
(Office symbol and abbreviated date)
FOR THE COMMANDER:
Distribution:
A
/S/ John J. Doe
JOHN J. DOE
COL, MS
Deputy Commander for Administration
Figure 2-1. Example of a pet visitation regulation — Continued
2-4
TB MED 4
CHAPTER 3
PROCEDURES FOR IMPLEMENTING
HAB PROGRAMS AND APPLICATIONS
3-1. Diagnosis and referral, family and
individual, and utility HAB applications
(See paras 2-2, 2-3, and 2-4.)
a. "Diagnosis and Referral" refers to the knowl-
edge that veterinary services personnel are play-
ing an increasingly important role as members of
the human healthcare team. "Family and individ-
ual" refers to the concept that a pet animal plays a
powerful role in the lives of pet owning families
and individuals and must be considered when
meeting their needs. "Utility" refers to the fact
that animals' abilities have been extremely useful
in helping people to function better than would
have otherwise been possible; that is, seeing eye
dogs, hearing ear dogs and other handicap assis-
tance animals.
b. Although not as clearly identifiable as actual
"programs" as is the therapy application, these
aspects make up a significant portion of the HAB
field. Commanders, families, individuals, allied
healthcare professionals, and in some cases, even
veterinary personnel are not always aware of the
positive or negative impact that animals can have
on the well-being of the military family or individ-
ual military member. All can benefit from a better
understanding of these concepts.
c. The key to providing this better understand-
ing is an organized education program. (See para
B-l.) Staff meetings, inservice presentations,
newspaper articles publicizing the programs, and
the circulation of applicable articles to appropriate
key personnel are only a few of the numerous
avenues open to accomplish this objective. The
HAB Adviser to The Surgeon General of the U.S.
Army is one resource for suggestions or as a speak-
er at inservice presentations when his or her
schedule permits. The Adviser can be contacted
through Office of the Chief, U.S. Army Veterinary
Corps, ATTN: DODVSA, 5109 Leesburg Pike,
Falls Church, VA 22041-3258 (DSN 761-3056).
3-2. Therapy programs
(See para 2-1.) In common with all other HAB
applications described above, the therapy pro-
gram's success depends first upon the proper edu-
cation of all personnel that have potential for
involvement in or association with the program.
Additional specific guidelines are necessary since
many of these programs occur in the hospital set-
ting. The following procedural outline is provided:
a. Present early concepts of a proposed therapy
HAB program to the local military veterinarian
who will coordinate the proposal through the chain
of command. This will minimize duplication of
efforts and help to ensure that a high professional
standard is maintained for the program in anticipa-
tion of it becoming an officially sanctioned HAB
therapy program. (See app E.)
b. Educate personnel as to the applications of
HAB programs in their own areas of operation.
c. Identify interested or committed persons from
appropriate departments or organizations. Obtain
their help and leadership in developing and main-
taining the HAB program.
d. Assess needs.
(1) Consider all people-related factors.
Determine specific desires and needs of each
department (patient, staff, and administration)
expressing . interest. Determine what is to be
accomplished by involvement in the program and
how this is to be done. Is there enough staff and
administrative support to enable the program to
work?
(2) Consider all animal-related factors.
(a) What species is best and how many
should be utilized?
(b) Should the animal be on a visiting or res-
ident basis? Where will the animal be acquired and
where will it stay?
(c) What are the physical facility's limita-
tions relative to an animal being present?
(d) How will the good health and welfare of
the animal be maintained?
e. Prepare a written plan.
(1) If a research project: Prepare the plan in
the protocol format required by the individual
MTF or installation. (See app D.)
(2) If a nonresearch program: Prepare a
detailed written plan for implementation and fol-
lowup in accordance with local requirements.
/. Obtain approval to implement the plan.
(1) If a research protocol: Follow the protocol
approval procedure required by the individual
MTF or organization. (See app D.)
(2) If a non-research written plan, obtain
approval of —
3-1
TB MED 4
(a) The infection control officer.
(6) Department and MTF or organization
administration.
g. Clear selected health assistance animals for
use. They must be both physically and behavioral-
ly acceptable. (See app F.)
h. Implement the plan or protocol.
i. Provide ongoing monitoring and followup.
(See app G.) This should include altering the pro-
gram as indicated by results, revising the protocol
if indicated (for example, see the protocol amend-
ment in app D), and publicizing results for the ben-i
efit of future programs. (Results should be report-'
ed by various news media and published in applica-
ble journals when appropriate.) Also, the contin-
ued health and well-being of the animal must be
monitored and ensured.
3-2
TB MED 4
APPENDIX A
REFERENCES
A-l . Army Regulations
AR 40-905/SECNAVINST 6401.1/AFR 163-5 Veterinary Health Services
AR 608-10 Child Development Services
A-2. Unnumbered Publications
Lee, Zeglam, Ryan, Gowing, and Hines, Guidelines: Animals in Nursing Homes (Revised edition),
Delta Society, 1987. (This publication is available from The Delta Society, RO. Box 1980, Renton, WA
98057-1080. Phone (206) 226-7357.)
Marriage and Family Review, Vol 8, Nos. 3/4, Summer 1985, pp 205-22.
Pets and the Family, New York, Haworth Press, 1985.
A-3. Form
DD Form 2209 Veterinary Health Certificate
A-l
TB MED 4
APPENDIX B
THE U.S. ARMY VETERINARY CORPS— PROVIDING DIRECTION,
LEADERSHIP, AND COORDINATION FOR
HAB PROGRAMS IN THE DOD
B-l. Education
The U.S. Army Veterinary Corps has the responsi-
bility to —
a. Educate military personnel at all levels on the
important roles of animals in the lives of military
members and dependents. Those to be educated
should include all mental and physical healthcare
providers, line commanders and supervisors, poli-
cymakers, public affairs personnel, animal han-
dlers and owners. Among those important items to
be taught are the —
(1) Role of animals in providing a form of
therapy (AFT).
(2) Utilitarian contributions of animals (mili-
tary working dogs, handicap assistance animals,
mascots, etc.). Guide dogs for the blind, hearing
dogs and other specialty handicap assistance ani-
mals can be valuable assets to many specially chal-
lenged military family members. The U.S. Army
veterinarian provides leadership in gaining proper
recognition, acceptance, and support for these
animals throughout the DOD.
(3) "Family Member" role of animals.
(Approximately 50 percent of all military families
have pets, and over 98 percent of these families
consider their pets to be a "part of the family.")
(4) Importance of pet animals to many single
military members.
b. Educate owners on responsible pet ownership
and on the role their pets play, or have the poten-
tial to play, in their lives.
c. Assist as required in educating child day care
providers on proper animal care and control where
animals are involved or owned (AR 608-10).
(1) Assist in providing education to individual
home day care providers prior to certification of
the home, and at least annually thereafter when
animals receive "required" vaccinations and a
health check.
(2) Assist in providing education to the per-
sonnel of installation day care centers where
animals visit or live.
d. Educate volunteers involved in DOD pet visi-
tation programs. This should be done at least every
6 months during the required semiannual examina-
tion for privately owned animals involved in these
programs.
e. Educate veterinary personnel on HAB princi-
ples. These principles include euthanasia issues,
death and dying, proper client relations, animal
behavior, etc.
B-2. Management of Health Assistance
Animals in the Military
Veterinarian Corps officers will ensure that all
requirements for health assistance animals in the
military (HAAMs) are followed. (See app F.)
B-3. Research on HAB
Veterinary personnel will act as resource or sup-
port to other DOD personnel involved in HAB
research.
B-l
TB MED 4
APPENDIX C
THE PET IN THE MILITARY FAMILY AT TRANSFER TIME:
IT IS NO SMALL MATTER*
C-l. Statement of the Problem
a. Disruption of friendship and associative
bonds occurs every time a military transfer occurs.
It was suspected that one constancy amidst this
otherwise changing and stressful situation could be
the family pet. But what if these pet-owning mili-
tary families decided to leave this "member of the
family" behind at transfer time?
b. It was an assumption of this study that many
families were faced with decisions about pets at
transfer time and that many were actually forced
to leave them behind due to factors such as
expense, health of the animals, etc. This would be
especially so in the case of this study in which the
families had been transferred to the State of
Hawaii with its lengthy and expensive rabies quar-
antine. It was also assumed that such disruption of
bonds could further contribute to family problems
at an already disruptive time. Conversely, it was
suspected that when the pet goes with the family it
could be beneficial to the family. Finally, it was sus-
pected that the number and proportion of military
families directly affected by pets during transfer
time was not small.
c. The purpose of this research then was two-
fold—
(1) To determine whether the pet factor was
pertinent for a substantial number of military
families, and
(2) If it was, to provide information that could
inform families, human-services professionals, and
also military policymakers of the impact of pet
involvement in the lives of military families.
d. Families could better weigh their decisions
regarding whether or not to take their pet knowing
how similar decisions had affected others, human-
services professionals could better consider the pet
factor as it affects their client's and/or subject's
mental health, and military policymakers could be
*This summary includes only a sampling of the findings
available in the complete study. The complete study by MAJ
Lynn J. Anderson is published in Marriage and Family
Review, Volume 8, Nos. 3/4, Summer 1985, pp 205-22. It is also
published as a chapter in the textbook Pets and the Family,
New York: Haworth Press, 1985.
better informed when making decisions concerning
care and assistance allowable for these nonhuman
"family members."
C-2. Methods
During February and March of 1984, 184 military
families currently living in Hawaii were surveyed
in person and their pet involvement at transfer
time and shortly thereafter was ascertained.
Comprising the 184 families were 3 stratified ran-
dom samples made up of 93 junior enlisted families,
48 officer families, and 43 senior enlisted families.
As a very early study in this specific subject, a
major portion of the study explored and identified
by rank, frequencies relating to type of pet
involvement, species of pet, reasons for pet owner-
ship, reasons for leaving the pet behind, and effects
noted from either leaving, bringing, and/or acquir-
ing a pet. Secondly, weighted and speculative
tables were presented giving an idea of the large
numbers of pet involved families that exist in the
population from which the samples were drawn.
Finally, early hypothesis testing using chi-square
was used in establishing differences and/or similar-
ities between the rank groupings in their pet
involvement and effects derived therefrom.
C-3. Findings and Conclusions
a. A substantial number of military families in
Hawaii were involved with pets at transfer time
(45.7 percent) Further, an overwhelming majority
of those families with pet involvement at transfer
time considered their pet to be a part of the family
(98.8 percent). Even so, many of these families left
their pets behind for various reasons that were
often beyond their control. Those families leaving
their pets behind constituted a substantial portion
of the entire population with or without pets (29.9
percent) . Of these, 96.4 percent had experienced
or were still experiencing notable saddening
effects directly related to leaving their pets
behind.
b. All rank groupings (junior enlisted, senior
enlisted, and officer) were similar in effects noted
from leaving the pets behind, and in the status
given by the family to their pets. Also significant
was the finding reached that confirmed the
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expectation that junior enlisted families far more c. Finally then, for those concerned with mili-
often than the other groups leave their pets behind tary families at transfer time, this study presents
as a result of the expense factor. Senior enlisted significant evidence that the pet as a factor is per-
also left a great many of their pets behind but for tinent to a great many families in Hawaii and that
them it appeared that the effects on their animals its impact is no small matter to these families,
were being considered more than the effects on
their pocket books.
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APPENDIX D
HAB RESEARCH PROTOCOL PROCEDURES
D-l. Initial Stage
Accomplish planning, coordination, education, and
recruitment and needs assessment. (See paras 3-2a
through S-2d.)
D-2. Protocol Preparation
Prepare a written protocol for the proposed
research program. (See fig D-l.)
a. Identify and use existing protocols when pos-
sible (local, command, branch or defense-wide) that
would encompass the scope of the proposed
research program.
b. If an existing protocol covers most of your
program, but not all of it, an amendment to the
existing protocol is a possibility. (See fig D-2.)
c. If no applicable guidelines exist, originate a
new written protocol. It should be specific enough
to define the proposed research but general
enough to allow for expansion and/or flexibility in
the future.
D-3. Obtain Approval to Implement
a. If it is possible to utilize an existing protocol,
approval may be obtained by routine staffing of the
proposal through the involved departments and
the MTF's main administration office.
b. If a new protocol is required, then follow the
procedures required by the MTF. In most cases,
this will first involve obtaining approval of the
MTF infection control officer. Then the protocol
must be approved by required committees that
may involve all or part of the following or their
equivalents: Animal care and use committee,
human use committee, and the institutional review
board. This final committee approved protocol
will then be staffed through the MTF main
administration office for final approval.
c. If an amended existing protocol is used, the
clinical investigation activity (or its equivalent)
will determine which committees, if any, need to
reconsider the amended protocol.
D-4. Clearance
Clear the selected HAAM for physical and be-
havioral acceptability through the military
veterinarian. (See app F)
D-5. Implement Protocol
Provide assistance, management, and ongoing edu-
cation as needed.
D-6. Followup
Provide ongoing followup to include the publishing
of findings as appropriate. (See app G.)
D-7. Example of a Local Protocol
Figure D-l is an example of a local protocol. This
protocol is not necessarily to be used as a model
protocol, but is an example of an excellent one that
was approved at one location. Other facilities may
require a different format or greater or lesser
attention to certain details.
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APPLICATION FOR CLINICAL INVESTIGATION PROJECT
ANIMAL FACILITATED THERAPY (AFT) IN THE
BROOKE ARMY MEDICAL CENTER
PEDIATRICS DEPARTMENT
SAMPLE
7 February 2002
1 . Principal Investigators: Ch (CPT) Michael D. Mantooth, BAMC, Hospital Chaplain; and MAJ Lynn J.
Anderson, Veterinary Directorate.
Associate Investigators: COL Terry B. Pick, BAMC, Pediatric Hem/One; MAJ James R.Hillard, BAMC, Pediatric
Nursing; and MAJ Janetta R. McFarland, BAMC, Pediatric Nursing.
2. Project Title: Animal Facilitated Therapy (AFT) in the Brooke Army Medical Center Pediatrics Department.
3. Objectives: (1) Determine patient and staff opinions of animal facilitated therapy before and after such thera-
py has been utilized, (2) educate staff, subjects, and subjects' families of the potential values of AFT to them, (3) eval-
uate specifically: (a) the distractive value of an animal to a child during a stressful examination or test, and (b) the value
of an animal as a cotherapist in mental health counseling sessions, and (4) identify other potential studies for future
evaluation.
4. Medical Application: In the civilian medical community, animals have been found to facilitate psychother-
apy. Additionally, the ability to distract from the discomforts of medical treatment and hospitalization has been demon-
strated. These applications have yet to be evaluated for military feasibility.
5. Status: Literature Review.
Pets and children go together as naturally as do peaches and cream. Although there are certainly exceptions to
this statement, they are, in fact, exceptions rather than the rule. The advertising industry gives ample evidence that
the public accepts this premise, as we see a great emphasis of the child-pet relationship, not only in pet food advertis-
ing but in the selling of numerous other products and/or concepts.
In spite of this "common sense" acceptance of the idea that there is something special between children and pets,
the scientific community has been slow to evaluate its potential. Not until the late 1960's did the first such effort occur.
The late Dr. Boris Levinson stumbled upon the power of the pet-child relationship in his clinical psychology office when
a mother and a child patient arrived early for an appointment. Fortunately, Dr. Levinson had not yet removed his pet
Jingles from his office. The young patient's interaction with the dog eventually aided in his recovery, and Dr. Levinson
knew he had something of value. His subsequent works with pets, people, and psychology (1969, 1972), although pri-
marily anecdotal in nature, have provided the foundation for all that has followed in the modern study of the human-
animal bond.
In 1973, Yates reported a resident pet at Children's Psychiatric Hospital, University of Michigan Medical Center.
Skeezer, the resident pet, provided an unlimited source of unconditional love and acceptance for the disturbed children
residing at the hospital. The assigned mental health professionals credited Skeezer with great value in speeding the
recovery of many of their patients (Yates, 1973).
Robin et al., 1983, described a questionnaire study of 507 adolescents in which they were asked to identify and/or
describe the role of pets in their lives. Their findings revealed that pets helped to meet the needs of these youth for
unconditional acceptance, and for someone to be around who does not make excessive demands and does not criticize.
The following quote was typical of many received in this study: "My favorite pet was my dog Bell... Some times she was
the only person I could talk to."
Condoret (1983), a French scientist, reported a research project on the relationship between children, companion
animals and speech therapy in a nursing school in Bordeaux, France. As compared with performances before the intro-
duction of the companion animals into the therapy, the children showed marked improvement in speech following the
intervention.
Figure D—l. Sample written research protocol
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The autistic child has long posed an extremely difficult challenge for therapists. With the advent of animal utiliza-
tion in therapeutic situations, the question naturally arises concerning the value of animal facilitated therapy in these
cases. Smith (1984) began a study in 1981 in which she used dolphins to facilitate the development of appropriate com- .
municative behavior from a diagnosed autistic adolescent boy. The study demonstrated that greatly improved commu-(
nicative skills were not only learned, but were also retained over a significant period of time in a variety of settings.
It is apparent from this brief literature review that there is much potential for human-animal bond utilization in
the pediatric field. However, to date there has been no attempt to explore this potential in the military medical system.
The purpose of this proposed study would be to begin to fill this void.
The first phase will be to survey staff, patients, and families to determine their fears and/or expectations of such
a program. After the program is implemented, the same subjects will be surveyed and the results compared with the
pretest to determine any change in opinion occurring over the course of the study.
The second phase will introduce the concept of animal assisted therapy to the staff, patients, and families. This will
be done at staff meetings, parent support groups, and at individual meetings with the patients and parents as needed.
The third phase will look at two questions: (1) Can an animal provide a worthwhile distraction to pediatric patients
involved in repetitive and painful procedures? (2) Can an animal effectively function as a cotherapist with chaplains or
other mental health professionals in helping the young patients and their families?
The final phase will identify potential studies for future evaluation. As an animal becomes available for utilization
by the staff assigned to and/or associated with the BAMC Pediatrics Department, it is felt that many suggestions for
studies will surface. Each of these will be screened and those with the greatest potential will be further evaluated.
6. Plan:
Objective 1 is to determine patient and staff opinions of AFT before and after such therapy has been utilized. To
accomplish this, a staff and patient expectation survey (annex A) will be administered prior to the arrival of any ani-
mals on the premises. Then at the conclusion of the study, the same survey will be administered, but in this case will
be adjusted to measure realization of expectations. Differences will be measured for statistical significance.
Objective 2 is to educate staff, subjects, and subjects' families of the potential values of AFT. This will be accom-
plished through group presentations wherever possible. The majority of the parents of children in the Pediatric
Oncology Ward attend a regular support group. This will provide an excellent opportunity to educate the parents of the
children. The staff will be educated during a regularly scheduled staff meeting. MAJ Anderson, one of the principal
investigators of this study, will be available to provide these briefings. As the Adviser to the U.S. Army Surgeon
General on Human- Animal Bond issues, MAJ Anderson is the logical and optimal person to make such briefings.
Objective 3a is to evaluate the distractive value of an animal to a child during a stressful examination or procedure.!
An example of one such procedure is the repeated withdrawal of blood samples from young patients being evaluated
for diabetes. It is hypothesized that the presence of an animal during those times would distract the patient from the
procedure, thus making the procedure easier for the patient and also for the staff involved. The patients selected for
this study would be those children that have responded negatively (crying, pulling their arm away, etc.) during previ-
ous administrations of the procedure. In this way the patients would serve as their own controls. An instrument will
be standardized that can be used to obtain the staff's and parents' evaluation of the patient's responses. Additionally,
the patients themselves will be asked to provide their subjective evaluation of their experiences with and without the
animal.
Objective 3b is to determine if there is any value in having an animal as a cotherapist in mental health counseling
sessions. It is hypothesized that an animal's presence can, in fact, facilitate the efforts of the mental health profession-
al in certain instances with some patients. To test this hypothesis, it is proposed that on an individual basis, Chaplain
Mike Mantooth will select those patients for whom counseling is indicated and who have proven to be somewhat resist-
ant to other forms of counseling. Following the establishment of a 2-weeks' baseline for each subject, using an anxiety
and/or depression index yet to be determined, Chaplain Mantooth will implement weekly AFT with these subjects that
will last 4 to 6 weeks. Since this study is a first in the military medical field and will serve primarily as an indicator for
future studies, a single systems approach with a repeated measures methodology was chosen as being most feasible in
that it allows for each subject to serve as his or her own control (Bloom & Fischer, 1982) . The repeated measures will
be the weekly measurement using the same index used to establish the baseline. If analysis of these repeated meas-
ures, compared with the baseline, indicate a positive value of AFT, groups of subjects will be selected and larger con-
trolled studies will be proposed for future implementation.
Objective U is to identify other potential studies for future evaluation. It is strongly felt that during the accom-
plishment of objectives 1 through 3 above, the presence and visibility of a therapy animal will stimulate much interest
and discussion concerning AFT. Consultation expertise will be provided to supplement this interest resulting in valu-
able future studies and/or programs.
The subjects will be selected from children currently being treated by BAMC Pediatrics Department. They will
be chosen on the basis of their desire to be involved in the program. "Pet Partners for Kids" (annex B) is an informa-
tion and release form that must be signed by the child's parent or legal guardian before the child is allowed to become a
involved. Additionally, the child's pediatrician must approve of the child's involvement. I
Figure D—l. Sample written research protocol — Continued
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To ensure that any animal that is utilized is behaviorally and medically appropriate for this program, it will first
be examined by a U.S. Army Veterinary Services Officer using the well-established criteria of Lee et. al. (1983) .
Maintenance of the animal will be at the same high standard.
Since at this time any animal will be a privately owned pet, the pet owner must sign a release form acknowledg-
ing that (1) he or she is aware of and accepts responsibility for liabilities involved in his or her participation in this pro-
gram, and (2) that while in the program the owner agrees to maintain the pet in accordance with guidelines established
by the U.S. Army Medical Command (annex C). The pet will continue to live with its owner during and after the study.
At the present time only one animal is planned for utilization in this early program. However, more volunteer animals
may be carefully recruited according to the above criteria if program expansion so indicates.
7. References:
Bloom, M., & Fischer, J. Evaluating Practice: Guidelines for the Accountable Professional. Englewood Cliffs, NJ:
Prentice Hall, 1982.
Condoret, A. Speech and Companion Animals: Experience with Normal and Disturbed Nursery School Children. In
A.H. Katcher & A.M. Beck (Eds.), New Perspectives on Our Lives with Companion Animals. Philadelphia:
University of Pennsylvania Press, 1983.
Lee, R.L., Zeglen, M.E., Ryan, T, & Hines, L.M. Guidelines: Animals in Nursing Homes. Booklet published by
California Veterinary Medical Association, 1024 Country Club Dr., Moranga, CA, 1983.
Levinson, B.M. Pet-Oriented Child Psychotherapy. Springfield, IL: Charles C. Thomas, 1972.
Levinson, B.M. Pets and Human Development. Springfield, IL: Charles C. Thomas, 1972.
Robin, M., ten Bensel, R., Quigley, J.S., Anderson, R.K. Childhood Pets and the Psychosocial Development of
Adolescence. In A. H. Katcher & A. M. Beck (Eds.), New Perspectives on Our Lives with Companion Animals.
Philadelphia: University of Pennsylvania Press, 1983.
Smith, B.A. Using Dolphins to Elicit Communication from an Autistic Child. In R.K. Anderson, B.L. Hart & L.A.
Hart (Eds.), The Pet Connection. Minneapolis, MM, 1984.
Yates, E., Skeezer, Dog with a Mission. New York: Harvey House, 1973.
8. Facilities to be used: Pediatric Intensive Care Unit (42-C), and Pediatric Ward (42-D).
9. Time Required to Complete:
Expected Start Date: March 2002.
Expected Completion Date: March 2003.
10. Personnel to Conduct Project:
Chaplain (CPT) Michael D. Mantooth; BAMC Chaplain; ext 7105/6334
CPT(P) Lynn J. Anderson, DVM, MSW; C, Vet Med Br, HQ VETCOM; ext 6519/6522
LTC Terry E. Pick, MD; C, Pediatric Hem/One, BAMC, ext 3047/5007
MAJ James R. Hilliard, RN; Head Nurse, 42-D Pediatrics, BAMC; ext 4230/3838
MAJ Janetta R. McFarland, RN, Pediatric Clin Nurse Spec, BAMC, ext 3047/3832
1 1 . Funding Implications:
a. Personnel: None.
b. Equipment: None.
c. Consumable Supplies:
Feed for one 16-pound dog for 1 year $50
Veterinary support for one 16-pound dog to include heartworm preventative, medical/surgical support during ill-
ness and injury, required laboratory support and vaccinations. (This will be on a cost basis at the BAMC
Veterinary Treatment Facility.) $40
d. Travel: None.
e. Modifications of Facilities: None.
f. Other: Reprints 1200
TOTAL $290
Figure D—l. Sample written research protocol — Continued
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1 2. Date Prepared: 7 February 2002.
13. Sponsors:
/S/ Janetta R. McFarland
JANETTA R. McFARLAND
MAJ,AN
Pediatric Clinical Nurse Specialist
BAMC
/S/ James R. Hilliard
JAMES R. HILLIARD
MAJ,AN
Head Nurse, 42-D Pediatrics
BAMC
/S/ Terry E. Pick
TERRY E. PICK
COL, MC
Chief, Pediatric Hem/One
BAMC
/S/ Michael D. Mantoofch
MICHAEL D. MANTOOTH
Ch(CPT), USA
Hospital Chaplain
BAMC
/S/ Lynn J. Anderson
LYNN J. ANDERSON
MAJ.VC
C, Veterinary Medicine Branch
HQ VETCOM
/S/ James L. Moody
JAMES L. MOODY
Ch(LTC), USA
Chief, Department of
Ministry and
Pastoral Care
BAMC
/S/ George H. Wyckoff, Jr.
GEORGE H. WYCKOFF, JR.
COL, VC
Director of Veterinary Services
HQ VETCOM
Figure D—l. Sample written research protocol — Continued
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ANNEX A
PRE-SURVEY FOR STAFF CONNECTED
WITH PET VISITATION PROGRAMS
SAMPLE
Personal Pet History
1. Do you currently have a pet/s? Yes If yes, what kind/s? Dog — Cockerspaniel and Cat — Domestic Shorthair.
2. Other than at present time, have you had other pets in the past? Yes. If yes, what kind/s? Dog — Standard
Poodle, Miniature Poodle and Cats — Domestic Shorthair (2). If not due to the death of the pet/s, what are the rea-
sons you no longer have these pets? Was due to death.
3. If you currently own a pet/s, what are your reasons for having it/them? Companionship in both cases — The cat
was adopted after finding her on our doorstep.
4. If you do not own a pet, what are your reasons for not having one? NA.
Institution Pet Opinion Survey
5. I think we should consider having a pet visitation program,
(a) Strongly agree (b) Agroo (o) Neutral
$&) Dioagroo (e) Strongly dioagrco
If you agree, what animal/s? Dog.
If you disagree, list major objection/s. NA.
6. I think we should consider having a permanent resident pet.
{») Strongly Agree (b) Agree (c) Neutral
^4) Dioagroo (e) Strongly disagree
If you agree, what animal/s? NA.
If you disagree, list major objection/s. No adequate facilities.
Questions 7 to 23 relate to a pet visitation program. Answer these questions using the following choices:
1 = Strongly agree
2 = Agree
3 = Neutral
4 = Disagree
5 = Strongly disagree
7. I think a visiting pet would be too noisy. 4
8. I think a visiting pet would provide company and friendship. 1
9. I think a visiting pet would provide love and affection. 1
10. I think a visiting pet would be too messy. 3
11. I think a visiting pet would cause bad smells. 4
12. I think a visiting pet would provide enjoyment and fun. 2
13. I think a visiting pet would frighten people. 4
14. I think a visiting pet would provide outside interest. 3
15. I think a visiting pet would provide experiences to share. 1
16. I think a visiting pet would damage property. 3
17. I think a visiting pet would be cruel to the pet. 4
18. I think a visiting pet would be a talking point between patients, staff, and volunteers. 1
19. I think a visiting pet would make the ward more like home. 3
20. I think a visiting pet would cause many complaints. 2
21. I think a visiting pet would cause more work. 2
22. I think a visiting pet would get in the way. 4
23. I think a visiting pet would decrease staff workload. 2
24. Please list other problems not described above. Transportation and kenneling.
25. Please list other benefits not described above. Publicity for the installation and hospital.
Figure D—l. Sample written research protocol — Continued
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ANNEX B
PET PARTNERS FOR KIDS (BAMC) '
SAMPLE
The BAMC Pediatrics Department has embarked on a new and innovative pilot program called "Pet Partners for Kids"
which involves the use of animals that have been screened for behavioral and physical acceptability. The pets are
allowed to visit and interact with children confined in the hospital. The program is designed to assist the child in adjust-
ing to the stress of hospitalization by having a familiar object such as a family pet in the environment.
A visit from one of the pets requires prior written approval from the patient's parent or legal guardian. Below is the
authorization for your child's participation in the program. The interaction between the child and the pet will last
approximately 10 to 20 minutes and may include petting and holding, playing fetch with a ball, or having the animal
perform tricks.
CONSENT FOR PARTICIPATION IN PET PARTNERS FOR KIDS (BAMC)
I understand that participation in the Pet Partners for Kids program means —
1. My child will be holding or petting the pet.
2. The resident pediatrician on my child's ward must approve of my child's participation in the program.
3. All pets used in the program have received physical and behavioral examinations by a doctor of veterinary med-
icine.
4. My consent does not guarantee my child will receive a pet visit due to scheduling limitations.
5. Photographs may be taken of my child with the visiting "Pet Partners."
6. The results of this program, including photographs, may be reported in military and/or civilian news media
and/or professional literature.
I also understand that the BAMC Pediatrics Department has taken all reasonable steps to minimize the risks that may
arise from participation in this program, but there are still potential risks (for example, scratching and biting). I feel j
the benefits of my child's participation in the program outweigh these risks and hereby release U.S. Army DOD and/or '
participating Government personnel from any and all responsibility and liability from any and all related injuries or
damages arising from my child's participation in this program.
I have read this consent, understand its content, and give my permission as the parent or legal guardian of Jane for his
or her full participation in all aspects of the Pet Partners for Kids Program as described above.
/S/ John Q. Jones
JOHN Q. JONES, Father 23 Jul 02, 10:00 AM
(Parent or Legal Guardian) (Date and Time)
/S/ Mary C. Helper
MARY C. HELPER, Pediatric Nurse
(Witness)
Brooke Army Medical Center (Medical Card Imprint)
Dept of Pediatrics
Ft Sam Houston, TX 78234-6200
Figure D—l. Sample written research protocol — Continued
D-8
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ANNEX C
RELEASE STATEMENT FOR VOLUNTEERS IN
U.S. ARMY MEDICAL COMMAND APPROVED
HUMAN-ANIMAL BOND PROGRAMS
SAMPLE
You and your pet are greatly appreciated by the residents and staff of Womack Army Hospital. We acknowledge
your sacrifice of time and resources in volunteering for our pet visitation program. Thank you very much!
The following release is required for participation in this program:
On initial evaluation by a U.S. Army Veterinary Services Officer, my pet Fluffy was found to be acceptable for par-
ticipation in the pet visitation program at Womack Army Hospital. I agree to abide by the ongoing requirements set
forth in "Requirements for Volunteer Pets in MEDCOM Approved Human-Animal Bond Programs." (See attached
list.)
I also understand that Dr. Know, Commander, has taken all reasonable steps to minimize the risks to the hospital
patients that may arise from participation in this program. Nevertheless, the minimal risks of incidental bites or
scratches still exist. These patients are willing participants of this program and it is extremely unlikely that any law
suits would result from these very rare incidents; however, I have been informed of this risk and am either covered by
personal liability insurance or have elected not to be.
I further release Womack Army Hospital, the U.S. Army, the Department of Defense, or any of the personnel par-
ticipating in this program from any and all responsibility and liability arising from my pet's and/or my participation in
this program.
/S/ John L. Person 23 Jul 02, 11:00 AM
JOHN L. PERSON, Catowner (Date/Time)
(Pet Owner's Signature)
fSf Mary C. Helper
MARY C. HELPER, Pediatric Nurse
(Witness)
Figure D—l. Sample written research protocol — Continued
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ANNEX C-Continued
REQUIREMENTS FOR VOLUNTEER PETS IN MEDCOM APPROVED ,
HUMAN-ANIMAL BOND PROGRAMS* '
A. On initial evaluation (and at least annually thereafter**) animals must be found acceptable according to the follow-
ing criteria as determined by a military veterinarian:
1. Behavioral characteristics (obedient, friendly, nonaggressive)
2. Physical examination.
a. Size acceptable for purpose.
b. Skin should be free from fleas, ticks, lice, mites, and dermatitis.
c. Teeth should be clean and healthy.
d. All immunizations must be current. The military veterinarian will inform volunteer pet owners of the vaccina-
tions required for the species of pet being considered.
e. Fecal examination must be performed to demonstrate that animal is free from intestinal parasites.
f. Annual heartworm check must be negative and animal must be on a heartworm preventative as recommended
for local area.
g. Animal should be free from any other medical problems (diarrhea, oculo-nasal discharge, etc.).
h. Other tests as indicated for the particular program.
B. On each and every visit, institution staff involved in the animal visitation program will monitor participating ani-
mals' acceptability for the program as follows:
1. The animal must have a Veterinary Health Certificate (DD Form 2209) certifying that the veterinary examina-
tions noted in paragraph A have been performed within the past year.**
2. The animal must be acceptable to residents.
3. The animal must be obedient, friendly, nonaggressive and in all ways behaviorally acceptable for the program.
4. The animal must be clean and groomed.
5. The animal must be free of any kind of illness. If there is any question, it should not be utilized until it has been
examined and cleared by a veterinarian.
|
*To be an approved Human-Animal Bond Program, it must have been so designated by MEDCOM.
**The annual examination is a minimal requirement. Frequency may be increased depending upon the particular MEDCOM
approved Human- Animal Bond Program.
Figure D—l. Sample written research protocol — Continued
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PROTOCOL AMENDMENT
SAMPLE
TO: Department of Clinical Investigation, ATTN: Clinical Research Protocol Coordinator, BAMC, Ft Sam Houston,
TX 78234-6200
SUBJECT: Proposed Modification of Protocol Entitled, "Animal Facilitated Therapy (AFT) in the Brooke Army
Medical Center Pediatrics Center."
1. It is proposed that the current protocol entitled "Animal Facilitated Therapy (AFT) in the Brooke Army Medical
Center (BAMC) Pediatrics Department" (pages to of the protocol) be expanded to include other selected
departments. This would be done only upon receiving the approval of appropriate department heads and of the BAMC
Infection Control Officer. The new title of the protocol would then read "Animal Facilitated Therapy (AFT) at Brooke
Army Medical Center."
2. Objective 4 of the original proposal was to "identify other potential studies for future evaluation." Such is the case
with Chambers Pavilion (2nd floor) Psychiatric Ward. LTC Jesse Delacruz, head nurse on that ward, has expressed an
interest in a resident animal on his ward. He has received tentative approval of the department heads involved. The
BAMC Veterinary Service will be involved in the selection of the animal, in the provision of its health care, in the edu-
cation of personnel and patients in proper animal care, and in monthly sanitary inspections of the ward where the ani-
mal will be staying. With these provisions, MAJ Jeanne Chudy, BAMC Infection Control Officer, has also given her
approval for the Chambers Pavilion involvement in the BAMC AFT program.
/S/ Norman G. Whiz
NORMAN G. WHIZ, MD, PhD
Chief, Pediatrics
Womack Army Hospital
(Signature blocks of principal
investigators)
Figure D—2. Sample protocol amendment
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APPENDIX E
REQUIREMENTS FOR OFFICIALLY SANCTIONED
HAB THERAPY PROGRAMS
To be an officially sanctioned HAB therapy program in the DOD, the program must meet all of the fol-
lowing conditions:
a. Utilize only certified HAAMs. (See app F.)
b. Be directed by a team comprised of at least one Veterinary Corps officer and one other person so des-
ignated by the department or organization that is being served by the certified HAAMs — a specific pro-
gram director with overall responsibility for each HAB program will be designated by the team from its
membership.
c. Meet all of the standards as set forth in the tri-service regulation AR 40-905/SECNAVINST
6401.1/AFR 163-5.
d. Have been coordinated through the MACOM veterinarian for final sanctioning. This will minimize
duplication of efforts and maintain a high professional standard for all officially sanctioned military HAB
therapy programs.
E-l
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APPENDIX F
REQUIREMENTS FOR HEALTH ASSISTANCE ANIMALS
IN THE MILITARY
F-l. General Requirements
a. A U.S. Army veterinarian will ensure that all
animals utilized in officially sanctioned HAB ther-
apy programs are selected and maintained at an
appropriate level of physical and behavioral
acceptability. Such animals are certified as
HAAMs by the local military veterinarian.
(Requirements for certification must be coordinat-
ed through the MACOM veterinarian.) This certifi-
cation will remain in effect only as long as the
animal is in one of the following categories:
(1) Category 1: Owned by the Government for
use as a HAAM.
(2) Category 2: A privately owned animal that
meets minimum standards of participation (as deter-
mined by the MACOM veterinarian) in officially
sanctioned HAB therapy programs. (See app E.)
(3) Category 3: A specialty animal that is
owned by and essential to the improved function-
ing of a military family member that is enrolled, or
eligible for enrollment, in the Army Exceptional
Family Member Program (or its equivalent in
other branches of service). These animals include
guide dogs for the blind, hearing dogs, and other
handicap assistance animals that have been spe-
cially trained and certified by an approved organi-
zation. (A list of these approved organizations will
be maintained by Office of the Chief, U.S. Army
Veterinary Corps, DODVSA, ATTN: Adviser to
the U.S. Army Surgeon General on Human- Animal
Bond Issues.)
b. Animals in Category 1 are entitled to the
same veterinary medical and surgical care as pro-
vided for other Government owned animals.
c. Routine medical care (vaccinations, worm-
ings, heartworm checks, flea control, etc.) for ani-
mals in Category 2 will remain the responsibility of
the owner. However, any extra testing, proce-
dures, or treatments incidental to certification as a
HAAM will be provided through the U.S. Army
Veterinary Treatment Facility, utilizing appropri-
ated funds from the involved MTF, as time and
resources permit.
d. Animals in Category 3 may be provided the
same medical and surgical care as provided for
Government owned animals but only as time and
resources permit. Charges for supplies and
services will be at the same fee schedule as for
privately-owned animals.
F-2. Specific Requirements for HAAMS
that Regularly Visit or Reside in an MTF
as a Part of an Ongoing HAB Program
a. On initial evaluation (and at least semi-
annually thereafter) animals must be found accept-
able according to the following criteria as deter-
mined by a U.S. Army veterinarian:
(1) Behavioral characteristics (obedient,
friendly, nonaggressive). Utilize guidelines pro-
vided in paragraphs F-4 through F-9.
(2) Physical characteristics.
(a) Size should be acceptable for the purpose.
(&) Skin should be free from fleas, ticks, lice,
mites, and dermatitis.
(c) Teeth should be clean and gums healthy.
{d) Immunizations should be current.
(e) A fecal examination should be performed
to demonstrate that the animal is free of intestinal
parasites.
(/) An annual heartworm check (dogs only)
must be negative and the animal must be on a
heartworm preventive as recommended for the
local area.
(g) An annual feline leukemia test (cats
only) must be negative.
(h) The animal should be free of any other
medical problems (diarrhea, oculo-nasal discharge,
etc.).
b. On each and every visit by a HAAM to any
MTF utilizing them in one of their regularly sched-
uled visitation HAB programs, specifically desig-
nated MTF staff (so designated by the program's
director (see app E)) will monitor the participating
animal's acceptability for the program as follows.
The animal must —
(1) Have a Veterinary Health Certificate (DD
Form 2209) certifying that the veterinary exami-
nations noted in a(2) above have been performed
within the past 6 months.
(2) Be acceptable to residents and patients.
(3) Be obedient, friendly, nonaggressive, and
must always be behaviorally acceptable for the
program.
(4) Be clean and groomed.
(5) Be free of any kind of illness. If there is
any question, the animal should not be allowed into
the MTF until it has been examined and cleared by
a veterinarian.
F-l
TB MED 4
c. In addition to all of the above described
requirements, resident animal programs should
also meet the following criteria:
(1) An Army veterinarian will perform sani-
tary inspections of the facility where the HAAM
resides. Monthly inspections will be required only
as long as it takes for the Veterinary Corps officer
to determine that the sanitary procedures being
followed are adequate. Then the inspections should
continue on at least a quarterly basis. (For animals,
birds, or fish permanently confined to cages or
aquariums, the ongoing frequency of inspection
may be more or less than quarterly, as determined
by the veterinarian.)
(2) The program director will ensure that a
specific individual or individuals are designated to
be responsible for feeding, exercising, and other-
wise meeting all of the needs of the animal.
Appropriate follow-up should be maintained also
by the program director and will be an item of
interest when the sanitary inspections are per-
formed by the Army Veterinary Corps officer.
(3) Residents, patients, and staff of institu-
tions where resident animals live must be educat-
ed on animal health, sanitation, and HAB princi-
ples. This will be performed no less than semian-
nually by a military veterinarian. In cases where
there is a frequent turnover of staff and/or resi-
dents and patients, the frequency of education
sessions should increase accordingly.
F-3. Specialty Animals in the DOD
Certain specialty animals are essential to the
improved functioning of some military family
members. These specialty animals include guide
dogs for the blind, hearing dogs, and other handi-
cap assistance and/or service animals. The military
medical departments of all branches of service
should provide leadership in gaining proper recog-
nition, acceptance, and support of these animals
throughout the DOD.
F-4. Temperament Evaluation for Dogs
to be used in HAB Programs
*a. For dogs to be placed in resident HAB pro-
grams, the program director should obtain and fol-
low the guidance in Guidelines: Animals in
Nursing Homes. See appendix A.
*b. For dogs to be utilized in visitation HAB pro-
grams, the following tests (1 through 9) are pro-
vided. They are especially applicable for animals
with unknown backgrounds but are also valuable
in evaluating other dogs as well. The great vari-
ances in therapy use and animal behavior do not
allow these tests to guarantee a correct selection.
In fact, the response categories that are listed with
the tests do not include every possible behavior
that might occur. Tail and ear positions are not list-
ed in the responses since they have many interpre-
tations. A wagging tail does not always, for exam-
ple, indicate a friendly dog. It is therefore ab-
solutely necessary to utilize an experienced con-
sultant, such as an animal behaviorist, trainer, or
veterinarian when assessing the final animal candi-
dates for an animal facilitated therapy program.
*Frora Guidelines: Animals in Nursing Homes, A JOINT
PROJECT OF THE DELTA SOCIETY AND CALIFORNIA
VETERINARY MEDICAL ASSOCIATION.
(1) Test 1: Initial Observation. A room or fenced yard with minimal distractions is an appropriate
testing area. The dog should not be familiar with the area nor should anyone the dog knows be in the vicin-
ity. Allow the dog to investigate the testing area for a few minutes without the tester present. The tester,
previously unknown to the dog, should then enter the area, stand still at a discreet distance and observe
the dog for approximately 15 seconds. Record on figure F-l below the very first response.
Holds ground
Approaches tester
Hackles normal
Flews (lips) normal f Acceptable
Sniffs tester
Retreats
Crouches
Hackles up
Flews (lips) "puffing"
Moves about "stiff-legged"
Growls
Barks
Avoids eye contact
Stares at you
Whines
Questionable
F-2
Figure F—l. Chart 1, Initial Observation
TB MED 4
No response
Is dog housebroken
(for indoor test site)
Other
observations
Figure F—l. Chart 1, Initial Observation — Continued
(2) Test 2: Approaching the Dog. After initial, brief observations, approach the dog with a level hand
extended at dog's nose, palm and fingers pointed downward. Do not "rush" in, but do not approach the dog
in a cautious or apprehensive manner. Walk up to the dog in a normal stride until your hand is within 6 to
12 inches of the dog's nose. Say nothing, and wait for the dog to make the next move.
Extends head or steps forward
to sniff hand
Seeks attention by nudging or
leaning into tester
Acts playful by barks or actions
Licks hand
Acceptable
Turns head away or tries to
ignore hand
Pulls back or retreats
Growls
Raises hackles
Barks (not to be
confused with playful barking)
Flews (lips) "puffing"
Overly exuberant
Bares teeth (don't confuse with grin)
Questionable
Stares at you
No response
Other
observations
Figure F—2. Chart 2, Approaching the Dog
(3) Test 3: Handling the Dog. If the dog has not been eliminated by Tests 1 and 2, attempt to pet the
dog, starting with the top of the head. Use the same attitude described in Test 2. Then pet and brush the
dog to determine its overall response on especially sensitive areas, such as ears and mouth.
Enjoys the attention
Tries to make friends
Becomes playful
Enjoys brushing
}
Acceptable
Pulls back or retreats
Growls
Flews (lips) "puffing"
Raises hackles
Quivers
Barks
Cowers
Rolls over on back
Submissively urinates
Snaps, bites
Overly exuberant (jumps up;
not calm by end of test)
Shows whites of eyes
Overly sensitive to grooming
of certain areas
Aloof
)
Questionable
Figure F-3. Chart 3, Handling the Dog
F-3
TB MED 4
Meets you, but with head ^
lowered, averted eyes K Other
Attempts to lick your face J observations
Figure F—3. Chart 3, Handling the Dog
(4) Test W- Interacting with the Dog. If the dog has not been eliminated by Test 3, interact with him
for a few minutes and record your observations. This interaction could include the following:
(a) See if it will retrieve a ball (a good test of future trainability). Walk away briskly, sit on the
floor and call the dog (a good test of social attraction)
(b) Lay the dog down, then roll it over, rub its belly. (Will it allow this subordinate position?)
(c) Have an assistant place a novel stimulus such as a large stuffed animal or mirror close behind
the dog when it is distracted. Encourage the dog to investigate. (Does it have self-confidence?)
(d) Attempt to play tug-of-war with a rag. (Does it play this game aggressively?) How does the
dog react to sudden arm movement?
(5) Test 5: Sound Sensitivity. While casually interacting with the dog, have an assistant make a very
loud noise without warning; for example, hitting a metal pan with a spoon.
Notices, but continues
previous activity
Notices and investigates f Acceptable
Startles, but recovers quickly
)
Flees
Cowers
Freezes
Trembles [ Questionable
Urinates
Moves as if to attack
Other
observations
Figure F~-4. Chart 4, Sound Sensitivity
(6) Test 6: Pain Threshold. While playing with the dog, briefly pinch the webbing between its toes
or pull a hair from its side to determine pain tolerance. (You will want to know a dog's reaction to sudden
pain if its tail is accidentally rolled over by a wheelchair, for instance.)
Tries to pull away, but shows
forgiveness
Yelps, but is not aggressive f Acceptable
Trusts you and allows further petting
)
Growls
Snaps
Acts fearful
Acts distrustful
Questionable
Other
observations
Figure F-5. Chart 5, Pain Threshold
(7) Test 7: Reacting to Unexpected Events. (Choose (a) or (&).)
(a) Have the assistant hide around a corner, out of sight, with a noisy utility or shopping cart. Walk
with the dog toward the intersection, as the assistant rolls the cart in front of the dog as close as possible.
Record the dog's reactions.
(b) While the dog is playing with you and distracted, have the assistant hide in a closet or behin
a door. Lead the dog to within 6 feet of the hiding place and have the assistant suddenly jump out at the
dog and open an umbrella. Record its reactions.
F-4
M
TB MED 4
(8) Test 8: Manners. No attempt is made in this test to obedience train the dog. The object is to
determine if the dog is mannerly enough for a 30-minute visit to the prospective nursing home. If you are
not knowledgeable in dog training techniques, it may be helpful to have the assistance of a trainer for these
exercises. The dog's response to these exercises will be an indication of its future trainability. The follow-
ing are not the only methods to teach these exercises; different dogs may require different techniques. An
experienced trainer should assist in the eventual training of the dog.
(a) Equipment: The dog should have a properly fitting collar and be on a leash, preferably one of
leather or cotton webbing. A buckle collar is probably acceptable for a small or gentle dog, but a larger or
more exuberant dog may benefit from a slip collar. If a slip collar is used, do not leave it on the dog while it
is unattended.
(6) The sit-stay: The dog is placed in a standing position at the left side of the trainer and the leash
gathered in the right hand so there is just a little slack. The dog is commanded to sit, using the dog's name
if known, for example, "Rover, Sit!" At the same time, the trainer pulls up and back on the leash and press-
es down on the dog's hips with the left hand. The dog should be praised for complying. Hold it in the sitting
position for a few seconds, continuing praise, and using the word "stay" occasionally. Release it after no
longer than 15 seconds and praise it again. Be consistent with your release words; for example, use "OK."
Repeat this procedure once or twice, with rest and attention in between.
(c) Heeling: With the dog sitting at the trainer's left side and the leash gathered up in the right
hand, command, "Heel." Stepping out with the left foot, walk briskly about, encouraging the dog to stay in
the area of the left leg. If it fights the leash, slow up and keep encouraging it with pats on your leg and kind
words of inducement. If it moves ahead or lags behind, get it back into position with little tugs and releas-
es of the leash. Repeat the command now and then. At one point back up and call the dog, gently tugging
it to you with the leash to see if it is willing to come when called. Be sure to praise the dog for any success.
The leash should never be taut for more than a second. If the dog pulls on the lead, use the tug and release
method, along with praise and encouragement until it complies. Spend no more than 30 seconds on the heel-
ing drill at a time. Repeat the exercise once or twice, with rest and attention in between. Before and after
each heeling exercise, place the dog into a sitting position for a few seconds by the method described under
"sit-stay."
Observations :
SAMPLE
Did the dog fight the lead? Yes No X
Did it start to assume the heel position after several 30-seeond sessions? Yes X No
Was it happy to sit, without struggle, even though you had to hold it in position? Yes X No
Does it seem willing to please and cooperate? Yes X No
Did it require much encouragement to come when called? Yes No X
Is the dog mannerly enough at this point for a half-hour visit? Yes X No
Other comments:
Rover loves children!
Figure F—6. Chart 6, Manners (sample)
F-5
TB MED 4
(9) Test 9: Interaction. Overall evaluation of interaction: Rate the dog by your subjective impres-
sions.
SAMPLE
Observation
No Yes
Traits 12 3 4 5 6 7
Aloof (maintains distance, self-assured) X
Apprehensive (anxious, fearful, shows alarm) X
Assertive (expresses own needs, noses or paws for attention) X
Calm (tranquil, composed, not agitated) X
Dignified (noble, poised, manifests appropriate behavior and manner) X
Extroverted (interested in others and surroundings) X
Exuberant (unrestrained high spirits) X
Gentle (tame, easily handled) X
Noisy (barks, whines) X
Playful (willing to initiate or participate in fun and attention) X
Responsive (reacts to involvement, interacts readily with people) X
Sociable (enjoys being with people) X
Trusting (confident with people) X
Willing to be handled (readily accepts body contact) X
Figure F—7. Chart 7, Interaction (sample)
F-5. Temperament Evaluation for Cats to be used in HAB Programs
*a. For cats to be placed in resident HAB programs, the program director should obtain and follow the
guidance in Guidelines: Animals in Nursing Homes. See appendix A.
*b. For cats to be utilized in visitation HAB programs, the following tests (1 through 10) are provided.
These tests will assist in evaluating the cat's general levels of sociability, aggressiveness, and adaptability;
but patience is a critical element of the feline evaluation. The cat will require more time than a dog to
become accustomed to a new environment, so ensure that the cat is given adequate time to become com-
fortable in the testing area. As with the dog, it is absolutely necessary to utilize an experienced consultant,
such as an animal behaviorist, trainer, or veterinarian when assessing the final animal candidates for an
AFT program.
(1) Test 1: Initial Approach. The cat should be taken from its cage (if caged) and placed in an aver-
age-sized room for several minutes. The tester should wear ordinary clothes and enter the room in a calm
manner. The tester should squat down about 5 to 6 feet away and call the cat several times. One hand should
be extended.
Makes eye contact
Vocalizes
Approaches slowly ^ Acceptable
Watches you and rolls submissively
Comes and sniffs hand
Avoids eye contact
Retreats or assumes defensive
position ( Questionable
Watches you but does not approach
Other
observations
Figure F—8. Chart 8, Initial Approach
*From Guidelines: Animals in Nursing Homes, A JOINT PROJECT OF THE DELTA SOCIETY AND CALIFORNIA VET-
ERINARY MEDICAL ASSOCIATION.
F-6
TB MED 4
(2) Test 2: Followup Approach. If the cat does not approach, move closer to the cat (3 feet away) and
call again.
Makes eye contact
Vocalizes
Approaches slowly y Acceptable
Comes and sniffs hand
Watches you and rolls submissively
)
Avoids eye contact
Retreats or assumes defensive
position
Watches you but does not approach
Arches back and/or hisses
Questionable
Other
observations
Figure F-9. Chart 9, Followup Approach
(3) Test 3: Friendliness. After approaching or getting the cat to come, extend a hand to the cat.
(Squat so that the hand is at a lower level than the cat's head.)
Sniffs hand
Licks or rubs body against hand
Rubs head against hand } Acceptable
Rolls submissively
Vocalizes
)
Retreats or assumes defensive position
Strikes hand
Threatens to strike hand
Bites or attempts to bite hand
Questionable
Other
observations
Figure F—10. Chart 10, Friendliness
(4) Test A: Interaction.
(a) If the cat has been approached and shown no aggressive or defensive postures, proceed.
Otherwise, try the approach procedure patiently and slowly again. It may be necessary to stay in the room
and wait until the cat initiates interaction. In any case, if interaction cannot be initiated within 10 to 15 min-
utes, the cat is probably too shy, fearful, or unhealthy to be a successful placement.
(b) While talking to the cat, begin to stroke the cat along the head, back, and sides.
Rubs against your legs or hand
Begins to purr or meow or chirrup
Head bumps \. Acceptable
Circles around you attentively
Shows initial fear but relaxes soon
)
Assumes a threatening or defensive
position
Attempts to strike or strikes with paw
Attempts to bite or bites
Withdraws
Questionable
Other
observations
Figure F—1J. Chart 11, Interaction
F-7
TB MED 4
(5) Test 5: Play Initiation. Move away from the cat and move a piece of string along the floor slow-
ly to initiate play (or toss a ball, though some cats do not know ball games).
Comes back for more stroking
Watches the string or ball
intently
Chases the string or ball
)
Acceptable
Ignores the string (or ball)
Attends something else in the
room and avoids eye contact
)
Questionable
Other
observations
Figure F-12. Chart 12, Play Initiation
(6) Test 6: Sociability, Level I. Call the cat again until it approaches or approach it slowly yourself.
Begin to stroke it again and if the cat is calm, pick up the cat gently and cradle it against your chest.
Relaxes
Makes eye contact
Extends its paw affectionately
to your neck and shoulder J Acceptable
Struggles to escape
Attempts to strike or strikes
with paw
Attempts to bite or bites
Questionable
Other
observations
Figure F—13. Chart 13, Sociability Level I
(7) Test 7: Sociability, Level II. Sit down and place the cat on your lap, facing you. Stroke the cat.
Purrs or rubs against hand
Makes eye contact
Rolls submissively
Stands up to smell face or places
paw on neck
Acceptable
Sits on lap tensely
Threatens or becomes
aggressive (bites or scratches)
)
Questionable
Other
observations
Figure F-14. Chart 14, Sociability Level II
(8) Test 8: Adaptability. Place the cat on the floor next to chair. Call and motion with your hands.
Jumps
Makes eye contact but remains
on floor \ Acceptable
Gets up on hind legs and makes
contact
Figure F-15. Chart 15, Adaptability
F-8
TB MED 4
Ignores calls and you | Questionable
Moves away f
Other
observations
Figure F- 15. Chart 15, Adaptability — Continued
(9) Test 9: Aggressiveness or Fear, Level I. Place the cat on the floor. Grab its tail firmly and pull with
a steady pressure.
Rolls submissively
Shows no reaction
Tries to escape or struggle
}
Acceptable
Attempts to strike hand
Growls or hisses
)
Questionable
Other
observations
Figure F—16. Chart 16, Aggressiveness or Fear, Level I
(10) Test 10: Aggressiveness or Fear, Level II. Place the cat on the floor (not in a carpeted room) .
Drop a metal box or other object on floor behind the cat when the cat is not looking. If the room is carpet-
ed, make a loud noise by vocalizing, banging together two objects (like pots) or using some other object in
the environment.
Startles but quickly relaxes ^
Ignores the noise I Acceptable
Does not appear to hear the noise |
Startles then runs to hide
Startles and then shows a ^ Questionable
defensive or aggressive
posture
Other
observations
Figure F~l 7. Chart 17, Aggressiveness or Fear, Level II
F-6. Selecting Other Species
Selection of birds and animals other than dogs and cats should be done under the direction of the U.S. Army
veterinarian. As with the dog and cat, Guidelines: Animals in Nursing Howies, is an excellent resource on
this subject.
F-9
TB MED 4
APPENDIX G
THE ONGOING EVALUATION AND FOLLOWUP
G-l. General Philosophy
a. It is important to establish within the initial
project objectives, a method or methods for meas-
uring the progress of the AFT program(s). These
objectives can be measured in many forms, from
positive feedback to emphatic negative feedback
from the families; or they could be very simple
such as "to provide companionship," "to facilitate
interactions," or "to provide sensory stimulation."
It could be measured in specific actions, such as
when an autistic child progresses to the point that
he or she will cross a strange room to pet their
companion animal, when previously they would not
even venture into a strange room.
b. The objective or goal measurements should
be considered at the onset, should prevent over-
looking minor changes, or should lead to the devel-
opment of a sliding scale of parameters. It is impor-
tant to maintain uniformity in the evaluation
method and the evaluator's involvement with the
therapy. Followup on animals placed with patients
is critical on a weekly basis initially, extending to
biweekly, and then monthly as the human-animal
bond develops.
c. Visiting animal programs should be periodi-
cally reexamined for effectiveness; it is best to use
an impartial but informed, pre-briefed evaluator
for these evaluations, since the new eyes will usu-
ally see the things the staff take for granted. The
chief goals or objectives for any AFT followup
evaluation are to determine how well the animal is
being integrated into daily activities (socially,
behaviorally, and physically) and how effective the
animal has been in facilitating the achievement of
the original goals and objectives.
G-2. Resident Animals
a. The initial period of placement for a resident
animal may be critical to a good adaptation. Even
the most carefully chosen and suitable animal may
develop physical or behavioral problems in adapt-
ing to a specific healthcare program environment.
The late Dr. Leo K. Bustad, past President
Emeritus of the Delta Society and world authority
on the human-animal bond, had repeatedly report-
ed that often, regardless of the expertise and
screening, multiple animals had had to be placed
with a specific patient before a therapeutic
partnership was finally achieved.
b. Creating a predictable environment for the
animals, as well as giving prompt attention to any
emerging problems, can facilitate the transition.
That is why frequent evaluation visitations should
be made, especially during the early stages of the
placement. A patient may not have the expertise to
identify the signs of an emerging problem, but a
trained (and impartial) evaluator would not only
identify the signs, but also initiate the preventa-
tive actions so the problem would never occur in
the first place. The guidance of a veterinarian, vet-
erinary technician or other qualified representa-
tive will be essential in monitoring placements by
the designated program director. (See app E.) It
should be remembered that "too much, too soon"
can be very stressful for some animals. An animal
should be introduced to the home and allowed to
become familiar with the new territory at a pace
comfortable to that particular animal.
c. The program director should brief the admin-
istrator, staff, and patients as applicable, concern-
ing: The acceptance of the animal(s) by patients,
residents, and/or staff; the quality and quantity of
interactions with the animal; and any problems
that have developed since placement.
d. During the veterinarian's (or his or her quali-
fied representative's) visit to a resident animal's
location, the animal should be evaluated for health,
nutrition, and well-being. The evaluator should see
if the care and feeding schedules proposed are
being followed, and make recommendations if they
are not. Similarly, if there are any people-based
problems (patient or staff related), such as animal
abuse or jealousy, they need to be solved promptly.
Minor problems can often be solved on the spot.
Others require consultation with the staff, the
administrators and the patients or residents. If for
some reason the animal(s) is not adapting well, or
there are unsolvable people-based problems, dis-
continuance of the program, removal of the animal,
or an alternative course of AFT should be consid-
ered. The overall program director will take the
lead in solving these problems.
G-3. Visiting Animals
a. Monitoring the effectiveness of an animal vis-
itation program is far more difficult than the resi-
dent animal program. The visiting animal does not
have the constant healthcare reinforcement, and
the animal's health status can change between
G— 1
TB MED 4
visits if the schedule does not provide an appropri-
ate frequency of exposure. Also, often the visita-
tions do not occur when a staff member is present,
which allows for a double standard of behavior by
both the animal and the volunteer that is handling
the animal. The program director must consider
the volunteer when evaluating any visitation pro-
gram, as well as the management of the program,
the staff and patient reactions, and the achieving of
the objectives or goals.
6. Criteria for evaluation can include —
(1) Regularity in visitations.
(2) Reliability in keeping scheduled appoint-
ments.
(3) Quality of interactions with patients.
(4) Cooperation with staff.
(5) Control and care of the animal.
(6) Participation in team meetings for patient
evaluations.
c. Criteria for evaluation of the management of a
program can include —
(1) The ability to accommodate scheduled vis-
itations and requests for visits.
(2) Success in establishing mutually agreeable
rules and objectives.
(3) Effective handling of behavioral problems
as they develop.
(4) The ability to respond to changing situa-
tions while maintaining an acceptable quality of
care in the patient care delivery system.
d. Criteria for the evaluation of the visiting ani-
mal can include —
(1) Suitability of temperament.
(2) Behavior exhibited during visitations.
(3) Development of rapport with patients.
(4) Enjoyment of visit.
(5) Health status.
e. In evaluating the reactions of staff and
patients, flexibility is essential, but criteria that
may be applied includes —
(1) Support and involvement of the staff in the
program.
(2) Number of requested visits by the
patients.
(3) The number of referrals by the staff.
(4) The desire by patients for continuation of
the program.
(5) The perceived satisfaction of the patients.
(6) The satisfaction (personally and profes-
sionally) by staff members with the program.
/. Criteria for determining the effectiveness of
specific AFT programs utilizing objective meas-
ures are only limited by the imagination of
involved healthcare professionals. Consultation
with local Health Care Studies and Investigation
Activities, local universities, or with the Adviser to
the U.S. Army Surgeon General on Human-Animal
Bond Issues can help interested parties in formu-
lating meaningful objective research projects. The
Adviser to the U.S. Army Surgeon General can be
contacted through the Office of the Chief, U.S.
Army Veterinary Corps, ATTN: DODVSA, 5109
Leesburg Pike, Falls Church, VA 22041-3258,
DSN 761-3056.
G-4. Conclusion
a. A good AFT program has no conclusion; it
only has some satisfied participants that share
their existence with an animal friend. When the
healthcare facility has achieved the initial goals or
objectives of the program, the program can be
recycled, or it can be enlarged, or it can even be
curtailed. Whatever the final decision, the health-
care facility should share the final results not only
with the interdisciplinary healthcare community,
but also with the military and civilian community
as a whole.
b. There are no shortcuts to the establishment
or operation of effective programs. They all
demand careful planning, implementation, evalua-
tion, and general administrative oversight. The
outcome is worth the effort. Experience has shown
that effective programs result in a genuine patient-
animal partnership, with an improvement in the
quality of life for thousands of patients, and an
enrichment in the lives of the people and animals
involved.
G-2
TB MED 4
GLOSSARY
Section I
Abbreviations
AFT
animal facilitated therapy
AMEDD
Army Medical Department
BAMC
Brooke Army Medical Center
CDS
child development services
DOD
Department of Defense
HAAM
health assistance animal in the military
HAB
human-animal bond
MACOM
major Army command
MEDCOM
U.S. Army Medical Command
MTF
military treatment facility
VETCOM
U.S. Army Veterinary Command
Section II
Terms
Animal facilitated therapy (AFT)
The utilization of animals in facilitating the recovery of human patients from physical, mental, or social ill-
ness. In cases where recovery is not likely or possible (that is, terminal patients) animals may be utilized to
increase the quality of the patient's remaining life. AFT also includes the utilization of animals as a form of
preventive medicine for certain humans that might be otherwise at high risk for illness.
Health assistance animal in the military (HAAM)
Animals certified by U.S. Army veterinarians as meeting requirements for use in officially sanctioned HAB
therapy programs. (See app F.)
Human-animal bond (HAB)
Programs that involve the interactions between people and animals, their attachments, and the significance
of the bond in mental, social, and physical health (to include animal facilitated therapy).
Glossary-1
TB MED 4
INDEX
This index is organized alphabetically by topic and subtopic. Topics and subtopics are identified by para-
graph number.
AFT, See animal facilitated therapy
Animal assisted therapy, See Animal facilitated therapy
Animal facilitated therapy, 1-2, 2-1
Delta Society, l-2e
Diagnosis and referral, 2-2
Grief from pet loss, 2-2a, 2-26
Guide dogs for the blind, 2-3a, F-la(3), F-3
HAAMs, See Health assistance animals in the military
HAB programs. See Human-animal bond programs
Handicap assistance animals, F-la(3), F-3
Health assistance animals in the military, app F
Hearing dogs, 2-3a, F-la(3), F-3
Human-animal bond programs
Definition of, glossary-1
Family and individuals, 2-2
History of, 1-2
Official sanctioning of, app E
Procedures for involvement in, 3-1, 3~2
Research protocols for, app D
Therapy, 2-1
Utility, 2-3
Legal implications of animal facilitated therapy, l-2/(l)
Mascots, 2-36, 2-3c
Medical treatment facilities and animal visitation, 2-16, 2-lc
Mental healthcare teamwork, 2-2
Military working dogs, 2-3a
Pets in the lives of the family or individual, 2-2
Pets at transfer time, 2-26, app C
Pet assisted psychotherapy, See animal facilitated therapy
Pet therapy, See Animal facilitated therapy
Seeing eye dogs, See Guide dogs for the blind
Social lubricant, 2-16
Specialty animals, F-la(3), F-3
Therapeutic horsemanship, 2-la (4)
Therapy, 2-ld
Index- 1
TB MED 4
By Order of the Secretary of the Army:
ERIC K. SHINSEKI
General, United States Army
Chief of Staff
Official:
JOEL B. HUDSON
Administrative Assistant to the
Secretary of the Army
DISTRIBUTION:
To be distributed in accordance with Initial Distribution Number (IDN) 343481, requirements for TB
MED 4.
PIN: 069058
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