Animals As A Therapeutic Modality A Curriculum Model For Occupational Therapy

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UMI
ANIMALS AS A THERAPEUTIC MODALITY:
A CURRICULUM MODEL FOR
OCCUPATIONAL THERAPY
DONNA M. LATELLA, Ed.D
BA, Southern Connecticut State University, 1983

MA, University of Connecticut, 1985
Post-Baccalaureate Certificate, Quinnipiac University, 1991
Mentor
Robert Kirschmann, Ph.D.
Readers
Larry Burlew, Ph.D.
Lori Noto, Ph.D.
DISSERTATION
SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE

OF DOCTOR OF EDUCATION IN THE SCHOOL OF EDUCATION
THE UNIVERSITY OF BRIDGEPORT
CONNECTICUT
2003
UMI Number: 3079367
Copyright 2003 by
Latella, Donna M.
All rights reserved.
UMI*
UMI Microform 3079367
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UNIVERSITY OF BRIDGEPORT
COMMITTEE APPROVAL
o f a dissertation submitted by
Donna Latella
I have read this dissertation and have found it to be o f satisfactory quality for a doctoral degree
ft 2 L> ^O o 5
Date y Robert Kirschmann, Ph.D.
Chairperson, Dissertation Committee
Date,
X Larry Burlew, Ph.D
Member, Dissertation Committee
Date 7 Lori'NOto, Ph.D.

Member, Dissertation Committee
ABSTRACT
ANIMALS AS A THERAPEUTIC MODALITY: A CURRICULUM MODEL FOR

OCCUPATIONAL THERAPY
Donna Latella
This dissertation addressed the use of animals as a therapeutic modality within occupational
therapy practice. Much information is available in the literature on the history of the human-
animal bond, the benefits of using animals as a therapeutic modality, as well as the link of the
modality to occupational therapy theory and clinical practice. Although, there are limited
research studies involving occupational therapists and the use of animals as a therapeutic
modality. This information led to the inquiry as to whether, or not, occupational therapy
programs are teaching this topic within their curriculum.
Specifically, quantitative and qualitative analysis were used in order to survey and interview,
occupational therapy faculty in accredited entry-level master’s degree programs. The results of
this research contributed to the culminating project of a curriculum model on the use of animals
as a therapeutic modality in occupational therapy.
This study found that very few occupational therapy programs surveyed are teaching this
topic within their curriculum. Few surveyed faculty are interested in this topic. Interviewed
subjects, although, appear to have an interest in animals which has begun before entering the
profession. Many students are interested in this topic and are choosing to learn more about it
through the use of assignments which offer choice, such as service learning, volunteering,
presentations, and research projects.
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Certification Pet Partner Team workshops are available, such as through the Delta Society
(2000), although these are designed for anyone who is an interested animal handler. These
workshops are very general in nature and do not directly link the practice of occupational therapy
intervention and animals.
Because of the above findings, the curriculum model created for this dissertation includes a
syllabus for an elective course on the use of animals as a therapeutic modality, as well as
assignments/activities which may be included in existing curricula.
Further research is needed specifically by occupational therapists, in order to identify
outcomes of using this modality, further educate faculty and spark interest in this topic, not only
because of its therapeutic value, but also due to high student interest.
Acknowledgements
I would like to acknowledge the many individuals who have provided assistance, support, and
encouragement throughout this project:
First and foremost, thank you to my committee chairperson. Dr. Robert Kirschmann,
Professor, Department o f Education, University o f Bridgeport. Also to the readers, Dr. Lori
Noto and Dr. Larry Burlew, both o f the University o f Bridgeport. Thank you also to Dr. Jack
Mulcahy, director o f the program in Educational Leadership, University o f Bridgeport.
Many thanks to all o f my colleagues and friends who have been at my side and always
available, especially in difficult times. There are too many to name, although some include: Jen
Cosgrove and all 11 cohorts at the University o f Bridgeport; the entire faculty o f the
Occupational Therapy Department o f Quinnipiac University including Kim Hartmann, Beth
O'Sullivan, Roseanna Tufano, Marcy Sanders, and Marli Cole Schiraldi; Bobbi Siegel, secretary
in the Department o f Occupational Therapy, Quinnipiac University; Dr. Kathy Livingston,
Quinnipiac University; and Genevieve Karbowski, Quinnipiac University. Also, thank you to Dr.
Karen Sladyk, program director and occupational therapist. Bay Path College.
Special thanks to my fam ily who not only have provided support and assistance, but have
also been patient throughout this project: To my husband Domenic, daughter Kristy, and son
Dylan. Also, thank you to my parents who are always there to help with the children and have
encouraged me to be a ‘perpetual student'.
Dedication
Through the years, I have learned a great deal from the unconditional love and happiness
given to me from my pets.
This extraordinary project is dedicated to my beloved Golden Retriever, Cody, who passed on
to dog heaven on September 27, 2002, before completion o f this dissertation. Ay a fam ily member
and Pet Partner Team providing animal-assisted therapy, Cody inspired my passion fo r this
project. He was able to interact with, and give to others, in a way I could never imagine an
animal could be capable of. Cody had an untiring desire to love, work, and give. I will never
forget his outstanding ability to make others happy and feel loved. I only hope his memory will
live on through this dissertation.
Thank you, Cody. We love and miss you deeply.
vi
Table of Contents
Abstract............................................................................................................................iii
Acknowledgements......................................................................................................... v
Dedication.........................................................................................................................vi
Table of Contents.......................................................................................................... vii
List o f Tables....................................................................................................................x
Chapter 1: Introduction
■ Introduction/Background............................................................................. 1
■ Statement of the Problem.............................................................................. 7
■ Research Questions.......................................................................................7
■ Hypothesis...................................................................................................... 8
■ Definition of Term s.......................................................................................8
■ Significance of the Study..............................................................................11
■ Limitations of the Study............................................................................... 12
■ Organization of the Study............................................................................. 13
Chapter 2: Review o f the Literature
■ History of the Human-Animal Bond...........................................................15
■ History of Using Animals as a Therapeutic Modality...............................19
■ Description of Specific Uses of Animals as a Therapeutic M odality.. ..23
■ Benefits, Negative Implications of Using Animals as a Therapeutic
Modality.......................................................................................................... 29
vii
■ Related Laws and Other Legal Issues....................................................... 55
■ Referrals and Reimbursement.................................................................... 58
■ Related Surveys by Occupational Therapists............................................59
■ Related Theories.............................................................................................61
■ Concluding Statements..................................................................................72
Chapter 3: Design of the Study
■ Subjects: Population/Sample.....................................................................75
■ Materials: Survey and Interviews............................................................. 76
■ Procedures: Data Collection Plan andData Analysis Plan..................... 78
■ Research Questions/Hypothesis.................................................................81
■ Summary....................................................................................................... 85
Chapter 4: Analysis o f Findings
■ Quantitative Analysis/Results of Survey..................................................86
■ Qualitative Analysis/Results of Interviews............................................. 107
■ Synthesis of Quantitative and Qualitative Findings............................... 117
■ Description of Curriculum Model.............................................................119
■ Summary...................................................................................................... 120
Chapter 5: Conclusions and Recommendations
■ Summary.......................................................................................................121
■ Conclusions.................................................................................................. 126
■ Recommendations for Further Research.................................................. 127
■ Other Findings and Considerations........................................................... 128
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References....................................................................................................................... 132
Appendices
A. Standards for an Accredited Educational Program for the Occupational
Therapist................................................................................................. 142
B. Accredited Entry-Level Master’s Degree Programs...............................165
C. Cover Letter, Survey, and Reminder Post Card...................................... 178
D. Survey Review Letters................................................................................ 184
E. Interview Introduction Statement
Field Interview Data Sheet
Compiled Interview Data
Individual Interview Data...........................................................................189
F. Coding of Survey Questions
Data Collection in Excel............................................................................ 209
G. Curriculum M odel...................................................................................... 214
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List o f Tables
Table 1. Summary Table o f Benefits from the Literature......................................................... 29
Table 2. Summary Table o f Conditions and Environments Involved
in Animal Therapies........................................................................................................ 32
Table 3. Summary Table o f Negative Implications from the Literature..................................53
Table 4. Research Questions, Hypotheses, and Statistical Analysis.........................................81
Table 5. Within the OT program, is the use o f animals as a therapeutic modality taught?..SI
Table 6. Is it offered in an elective course, or imbedded in a required course?.................... 88
Table 7. What is the name o f the course in which it is taught?................................................ 89
Table 8. In what year o f the curriculum is the use o f animals as a therapeutic modality
taught?..............................................................................................................................90
Table 9. Is the subject taught with a theoretical approach, clinical approach, both, or within
fieldw ork?......................................................................................................................... 91
Table 10. I f a theoretical approach is taught, which theories are incorporated ?...................92
Table 11. Which clinical experts are referred to?........................................................................ 92
Table 12. What are your curricular goals fo r teaching this course?........................................93
Table 13. Our students have expressed interest in learning about this topic......................... 94
Table 14. Have students been involved in programs outside o f the classroom using animals
as a therapeutic modality?........................................................................................... 95
Table 15. I f yes, how?..................................................................................................................... 96
Table 16. Are faculty members involved in programs outside o f the classroom using animals
as a therapeutic modality ?.............................................................................................. 97
Table 17. I f yes, do faculty hold a certification?........................................................................97
Table 18. What do you perceive as barriers to implementing programs using animals
as a therapeutic modality within your curriculum?.................................................98
Table 19. Our program views the use o f animals as a therapeutic modality as a valued
component o f the OT profession...............................................................................100
Table 20. Our program views the use o f animals as a therapeutic modality as a valued
component o f the OT curriculum............................................................................ 100
Table 21. Our faculty is interested in teaching about this topic............................................ 101
Table 22. Cross-tabulation o f SQ8a & S Q M ..........................................................................102
Table 23. Cross-tabulation o f S Q II & S Q l............................................................................ 103
Table 24. Cross-tabulation o f SQ l 2 & S Q I............................................................................ 104
Table 25. Cross-tabulation o f SQI3& S Q l..............................................................................105
Table 26. Cross-tabulation o f SQ M & S Q l.............................................................................106
Table 27. Summary Table o f Common Themes........................................................................ 116
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CHAPTER 1
Introduction
As occupational therapy has moved into the 21s*century, the profession has grown in
many positive ways. An emphasis on meaningful occupation, evidenced-based practice,
changes in the healthcare system, a client-centered focus, and functional outcomes have
impacted how occupational therapists view the delivery of service. Although the medical model
remains an important focus, the development of emerging practice areas such as
wellness/prevention programs and community models have also contributed to the diversity of
the profession. Therefore, the use of animals as a therapeutic modality seems to fit into the wide
scope of the profession and have important implications as an adjunct to occupational therapy
practice.
Because of this diversity in the profession, occupational therapy faculty and clinical educators
are responsible for preparing students for the many new and interesting intervention techniques.
For many clients, a successful, meaningful occupation or intervention may be through the use of
animals in therapy, as well as their daily lives.
This topic, although, has been minimally explored by occupational therapists who include:
Casey (1996); Alfano (1998); Hanebrink and Dillon (2000); Camp (2000); and Winkle (2003).
With this in mind, it is questioned as to whether therapists value this modality within the
intervention process, and/or if additional education is needed. Therefore, this study will attempt
to survey occupational therapy programs in regards to their use of animals as a therapeutic
modality and establish the need to create a curriculum model for use by interested professionals.
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2
Background Research
The positive effect of animals has been well documented throughout the research (Keil,
1990). Positive effects can be categorized into physical and psychological/emotional aspects.
Physical aspects include: higher survival rate post myocardial infarction (Friedmann, Katcher,
Lynch & Thomas 1980; Friedmann &Thomas, 1995), decreased systolic blood pressure
(Friedman, Katcher, Thomas & Messant, 1983), having a calming effect/decreased stress levels
(Bardill & Hutchinson, 1997), and a stimulus to exercise (Katcher, 1985).
Psychological/emotional aspects include: acceptance, feelings of being needed and loved,
development of trust, decreased loneliness, a link with reality, increased self-respect,
independence, confidence, and promotion of social interaction (Corson, Corson, & Gwynne,
1975; Corson & Corson, 1978).
In addition, animal interactions have also been shown to have positive effects on prisoners
(Moneymaker & Strimple, 1991), individuals with terminal illnesses (Sawicki, 1998; Chinner &
Dalziel, 1991), and individuals with chemical addictions (Campbell-Begg, 2000). Roenk and
Mulligan (1998) stated that basic needs of love, belonging, and self-esteem might be achieved
through animal interactions, thereby minimizing the negative effects of institutionalization such
as feelings of loss and isolation.
As a result o f these positive health effects, the concept of using animals as a therapeutic
modality within the framework of client-centered care has become increasingly supported
through the literature in recent years. Organizations such as the Delta Society (2000), Canine
Companions for Independence, and Therapy Dogs International have provided a means of
formalizing the process through workshops and certifications. These programs train and assess
the suitability o f the potential animal, as well as the handler for participation in therapy. Animals
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as a therapeutic modality may be considered in the following areas: animal-assisted activities,
animal-assisted therapy, companion animals, facility-trained animals, hippotherapy/therapeutic
riding/equine-assisted therapy, and service animals. (The terms pet therapy and pet-facilitated
therapy have also been used. They will not be referred to in this document unless in a citation, as
they are no longer accepted terminology of prominent organizations such as the Delta Society.)
Literature and teaching methods using animals as a therapeutic modality, specifically within
the occupational therapy profession, is minimal. However, Alfano (1998) stated animals
participating in occupational therapy sessions could often elicit responses from clients when
other attempts have not succeeded. Animals in occupational therapy may also assist in the
client-therapist relationship, while improving the client’s participation in the intervention
process.
The use o f animals as a therapeutic modality is generally justified within the Standards of the
Accreditation Council for Occupational Therapy Education of the American Occupational
Therapy Association (1998,). Section B: 5.12 (Appendix A) states that the student/therapist will:
“Demonstrate the ability to teach compensatory strategies such as use of technology, adaptations
to the environment, and involvement of humans and nonhumans in the completion of tasks”
(p.l 1). This standard simply states therapists need to teach clients daily strategies to enhance
independence, which may not involve the assistance of a person. For example, if a person with a
disability lives alone or will be alone during an extended period of time, attempts should be
made for an alternative means of achieving as much independence and safety as possible.
Therefore, strategies such as computers, electric wheelchairs or service animals may afford the
individual sufficient independence to be alone.
4
Within the occupational therapy profession, Allen, Kellegrew, and Jaffe (2000), Hasselkus
(2002), and Yerxa (1998) described meaningful occupation as being the core of influencing
health and client-centered focus. The term ‘occupation’ is defined by Christiansen and Baum
(1997) as “the ordinary and familiar things that people do everyday” (p.75), and by Kielhofner
(1995) as “doing culturally meaningful work, play or daily living tasks in the stream of time and
in the contexts of one’s social world” (p.50). Meaning is a motivator, gives significance to
situations, and quality to life. Roenke and Mulligan (1998) discussed how through using animals
as a therapeutic modality, the basic foundations of occupational therapy are paralleled by
supporting the values of health through doing and engaging in meaningful activity. Therefore,
meaningful occupation is an essential consideration within the therapy process. For example,
Allen et al (2000) studied the meaning of pet ownership for seven men diagnosed with human
immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and found for
those who value pet ownership as an occupation, intervention incorporating the client’s animal
enabled occupation, which includes physical, affective, motivational and satisfaction domains.
The Person-Environment Occupational Performance Model (Christiansen & Baum, 1997)
looks at the above concepts and the term occupational performance. Christiansen and Baum,
(1997) defined occupational performance as the doing of occupation, which can range in a
hierarchy from actions to life roles. Occupations have a purpose, such as for work, pleasure, or
self-maintenance. In the early 1900’s, Meyer observed occupations and found they are necessary
to our existence. As an example, he noted how persons in psychiatric institutions lost the
temporal order and structure of their daily lives, as they were not engaged in their typical daily
occupations while in hospital.
5
Kielhofner and Burke’s theory (1980), the Model of Human Occupation focused on factors
which produce occupational behavior. They described the human open system, its subsystems,
and the influences of the environment on the human system. When humans fail to engage in
healthy patterns of occupation, dysfunction occurs. Animals as a therapeutic modality can offer
clients the opportunity to care for, and engage in, a healthy and meaningful occupation (Allen et
al., 2000).
Yerxa (1998) commented on the importance of discovering more about our clients in their
own environments and daily occupations. Specifically, the author discusses how occupational
therapists need to broaden the vision of activities of daily living beyond self-care to include daily
routines which occupy individuals in real life contexts. As an example, there are many instances
where an elderly individual must give up a beloved pet in order to be placed in a long-term care
facility. Offering animal-assisted activities in this environment has shown helpful in decreasing
potential feelings of loss and loneliness (Bruck, 1999; Fick, 1993; Gammonley & Yattes, 1991;
Perelle & Granville, 1993).
Personal interest in using animals as a therapeutic modality began in 1992 when my husband
and I observed our two dogs' (a Golden Retriever and a Cocker Spaniel) quick and positive
responses to obedience training as well as socialization techniques. 1 observed and read about
animal-assisted therapy (then called ‘pet therapy’) and immediately considered our dogs to be
good candidates for participation in animal visitations.
During this time, I observed the positive impact our dogs had on my elderly grandparents,
particularly when they shared in their care. Often, the dogs slept at their home waking up my
grandparents in order to go out for a walk and be fed. I often found them taking naps together,
sharing food, and allowing the dogs to lick their faces. It was clearly evident that this mutual
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relationship filled with non-conditional acceptance and affection helped my grandparents with
companionship, as well as feelings of security and safety.
Concurrently, while working as an occupational therapist in the nursing home part of a
hospital which welcomed animal visitations. I, then, began weekly volunteer visitations with
both dogs. The visits were successful and the dogs became American Kennel Club Canine Good
Citizen Certified (a precursor to the actual certification for providing animal-assisted therapy
(AAT) and animal-assisted activities (AAA)). A few years later, my Golden Retriever, Cody
and I became a certified Pet Partner Team through the Delta Society (2000).
After becoming an assistant professor in occupational therapy in 1996,1 have found many
students to have an interest in learning about the use of animals as a therapeutic modality. Many
students have accompanied Cody and I during our visits, have created several projects, literature
searches, and poster presentations on this topic.
However, in considering any adjunct to occupational therapy education and intervention, such
as the use of animals as a therapeutic modality, a theoretical foundation and an educational
template would seem to create a stronger curriculum. This foundation normally begins in
academia, preparing students to use a particular modality properly and safely. Therefore, after
searching the literature, this study surveyed entry-level graduate occupational therapy programs
in order to determine whether or not this topic is being addressed within their curriculum, and
how. In addition, faculty who are teaching about this topic were asked to participate in an
interview process. As a culminating endeavor, this dissertation established the need for, and
developed, a curriculum model which is specific for occupational therapists using animals as a
therapeutic modality. This curriculum may be used by occupational therapy programs, clinics, or
7
those in private practice, who may be interested in starting a program using animals as a
therapeutic modality, and potentially involving occupational therapy students.
Statement of the Problem
The purpose of this study was to survey entry-level graduate occupational therapy programs
who are teaching the use of animals as a therapeutic modality, in order to research the need for a
curriculum model.
Research Questions
Specifically, this study sought to answer the following research questions:
1. Are occupational therapy programs teaching the use of animals as a therapeutic
modality? How many?
2. Where in the curriculum is the topic being taught?
3. Are the programs teaching this topic focusing on clinical application, theory,
or both? Which theories/theorists are linked to the topic?
4. What are the perceived outcomes of teaching about animals as a therapeutic
modality?
5. Have students expressed an interest in this topic?
6. Are occupational therapy programs involving students in AAA/AAT?
7. Does occupational therapy faculty have an interest and/or certification in
providing AAA/AAT?
8. Is occupational therapy faculty using AAA/AAT as part of their clinical
practice?
9. What are the barriers to teaching this topic ?
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10. Does occupational therapy faculty view this topic as an important adjunct to
the intervention process?
11. What is an example(s) of a current curriculum or lecture series ?
Hypotheses
1. A limited number of occupational therapy programs are teaching the use of animals
as a therapeutic modality within their curriculum.
2. O f the occupational therapy programs teaching the use of animals as a therapeutic
modality, most are not linking occupational therapy theory to the clinical practice.
3. Occupational therapy faculty perceives students as being interested in this topic.
Definition of Terms
(alphabetical order)
Accreditation Council fo r Occupational Therapy Education (ACOTE)- Accredits
educational programs for the occupational therapist and occupational therapy
assistant.
American Occupational Therapy Association (AOTA)- The nationally recognized
professional association for occupational therapists and occupational therapy
assistants. The association is concerned with the quality, availability, use, and
support of occupational therapy.
Animal-Assisted Therapy (AAT)- A goal-directed intervention utilizing animals in the
therapeutic process in which a certified therapist sets the therapeutic goals,
supervises the interaction between the client and the animal, measures progress,
and evaluates the process (Delta Society, 2000).
9
Animal-Assisted Activities (AAA)- Goal-directed activities, which are designed to improve
the client’s quality of life. Animals and their handlers are screened and trained.
Following a successful training period, the animal visits the facility with its
handler, often a volunteer. The activities are conducted by the volunteer and do
not involve measurable intervention or direction from a credentialed therapist
(Delta Society, 2000).
Barriers- Obstacles or hindrances.
Clinical Application- The action of putting theory and classroom knowledge to practice.
Companion Animal- An animal that is frequently in the company of, or accompanies
others and/or lives with another (Jorgenson, 1997).
Entry-level Occupational Therapist- An individual with less than one year experience
who is prepared to begin occupational therapy practice as a generalist after the
completion of the educational and certification process (Accreditation Council of
Occupational Therapy Education, 2001).
Facility-trained Animal- An animal who has been specifically trained and certified for
residence, or daily involvement in the therapy process (Winkle & Williams, 2002).
Occupation- Engagement in activities, tasks, and roles for the purpose of productive
pursuit, maintaining oneself in the environment, and purposes of relaxation,
entertainment, creativity, and celebration; activities in which people are engaged to
support their roles (Christiansen & Baum, 1997).
Occupational Performance- Accomplishment of a task related to self-care/self-
maintenance, work/education, play/leisure, and rest/relaxation; defined specifically
by occupational therapists to describe function as it relates to the individual’s
10
engagement in daily occupations within the environment (Christiansen & Baum,
1997).
Occupational Therapy (OT)- A health discipline concerned with enabling function and
well-being (Christiansen & Baum, 1997).
Occupational Therapy Curriculum Design- A group of assumptions used to describe how
the curriculum is planned, implemented, and evaluated. The curriculum design
may include educational goals and rationale for the selection, scope, and sequence
of the content. A curriculum design is typically consistent with the mission and
philosophy of the program and the institution (Accreditation Council of
Occupational Therapy Education, 2001).
Occupational Therapy Faculty- An occupational therapist who is a paid employee of a
university or college and holds an appointment that is considered by that institution
to constitute full-time service and is responsible for teaching specific content in an
accredited professional occupational therapy educational program in the United
States (Accreditation Council of Occupational Therapy Education, 2001).
Occupational Therapy Program- A program which is sponsored by an accredited
institution to provide postsecondary education in a senior college, university, or
medical school. The program provides classroom teaching and supervised
fieldwork practice under the responsibility of the sponsoring institution
(Accreditation Council of Occupational Therapy Education, 2001, p.2).
Occupational Therapy Program Director: An occupational therapist who is a paid
employee of a university or college and holds an appointment that is considered by
that institution to constitute full-time service and is responsible for management
11
and administration in an accredited professional occupational therapy educational
program in the United States.
Occupational Therapy Student- An individual who has met the standards for admission to
the occupational therapy educational program (Accreditation Council of
Occupational Therapy Education, 2001, p.3-4).
Service Animal- Animals who are specifically trained to assist individuals in overcoming
the limitations of their disabilities. These animals may replace humans in
performing tasks specifically tailored to the needs of their owner such as for
seizure alert, hearing and guide assistance (Robinson, 1995).
Therapeutic Modality- The means by which the therapeutic effects are transmitted (Reed,
1986).
Significance of the Study
This study is intended to contribute to the common body of knowledge in occupational
therapy theory and clinical application. Much of the research found on using animals as a
therapeutic modality has been performed by other healthcare professionals such as nurses and
psychologists (Chinner & Dalziel, 1991; Cole & Gawlinski, 1995; Gammonly & Yates, 1991). In
addition, these journal articles and textbooks on the topic (Bernard, 1995; Delta Society, 2000)
address the clinical (verses the educational) aspects of using animals as a therapeutic modality.
With the exception of the master’s thesis by Alfano (1998), there is no mention in the literature
of the potential link between occupational therapy education, theory, and clinical application of
using animals in occupational therapy intervention. As mentioned, existing occupational therapy
theory and standards suggest caring for and handling animals is, for some individuals, a
12
meaningful daily occupation and need fulfillment, which should not go ignored in a client-
centered environment (Roenke & Mulligan, 1998).
It is clear that in this client-centered environment, the occupational therapist has the skill
required to educate and administer nonhuman compensatory strategies, although, additional and
specific training is needed when working with animals. In order to introduce the important
educational and theoretical pieces to this intervention, the study intended to identify components
and threads necessary in creating a curriculum which combines occupational therapy theory and
clinical application when using animals as a therapeutic modality. In achieving this goal, it is
also intended to benefit and educate the entire healthcare team, administrators of healthcare
facilities, animal certification agencies, veterinarians, breeders and the public at large, in order to
foster support of animal involvement.
There is no doubt that much more research, evidence-based practice, and functional outcomes
are needed on this topic, specifically from the occupational therapy profession. It is the intent of
this study, and the development of a curriculum regarding the use of animals as a therapeutic
modality in occupational therapy, to encourage others to implement the strategy, as well as
continue with the research process.
Limitation of the Study
The research population and random sample was limited to the 103 accredited, entry-level
graduate occupational therapy programs as listed by the website of the American Occupational
Therapy Association (www.aota.org). The term ‘entry-level’ is used to delineate a graduate level
program from that of an advanced masters degree. (The entry-level graduate program in
occupational therapy has been recently converted from a bachelor’s level degree, as mandated by
our profession.)
13
Additionally, the scope of the study in terms of using animals as a therapeutic modality will
be limited to the following categories:
■ Animal-assisted activities
■ Animal-assisted therapy
■ Companion animals
■ Facility-trained animals
■ Hippotherapy/Therapeutic Horseback Riding/Equine-assisted therapy
■ Service animals
Specifically, the study only mentioned, but did not focus on, guide animals for individuals
with visual impairments, signal animals for individuals with hearing impairments, and medical
alert animals. It must also be stated that much of the literature describes pet therapy, animal-
assisted therapy or pet-facilitated therapy as encompassing many or all of the above categories
mentioned. This dissertation describes all of the above categories as using animals as a
therapeutic modality, in order to keep each specific category clearly defined.
Organization of the Study
This study is organized into five chapters. Chapter I, Introduction, gives a general
explanation of the study through background research, definition of terms, statement of the
problem, research questions, hypothesis, significance, and limitations of the study. Chapter 2,
Review of the literature, describes the human animal bond, history and benefits of using animals
as a therapeutic modality, categorization of using animals as a therapeutic modality, legal issues,
related occupational therapy theories, as well as related occupational therapy surveys. Chapter 3,
Methodology, discusses the subjects, materials, and procedures of the study. Chapter 4, Data
analysis, discusses the findings of the quantitative and qualitative components of the study,
14
synthesizes the findings of both techniques, and presents the curriculum model. Chapter 5,
Conclusions, summarizes the findings of the study, suggests recommendations for future
research, and discusses additional considerations which surfaced as a result of this study.
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CHAPTER 2
Review of the Literature
This chapter, in nine sections, will review the literature related to the use of animals as a
therapeutic modality. Although limited, where possible, the review will specifically focus on
research and writings of occupational therapists incorporating animals as a therapeutic modality,
into their practices.
Section One
History of the Human-Animal Bond
The bond between humans and companion animals may be considered a two-way,
interspecies relationship. The success of this relationship is explained by the fact the two species
do not compete for the same physiological needs, such as food. Thus, providing a non
threatening environment in which the two species can positively interact. Odendaal (2000)
described this as the establishment of a positive feedback cycle of need and fulfillment.
Animals appropriate for companionship are typically highly social animals who exhibit the
need for attention and social behavior. When these qualities are noted, the bonding between the
human and animal is successful (Odendaal, 2000). Odendaal also speculated that the
relationship between man, dogs and cats developed without coercion on behalf of humans. Thus,
the relationship between humans and companion animals is not a modem phenomenon, but one
with a long history, which has developed into a beneficial and meaningful interaction. The
present-day interaction does not appear to differ much from its earliest recording.
Domestication of animals dates back over 12,000 years (All, Crane & Loving, 1999; Brodie
& Biley, 1999). Historically, animals have had an important role in the lives of human beings
within our customs, legends, and religions. Primitive people found the human-animal
16
relationship vital to survival with pet-keeping common in hunter-gatherer societies (Jorgenson,
1997).
Robinson (1995) is one of few authors to write about the history of the human-animal bond.
He discusses how pet-keeping within these societies did not produce conflict as all animals were
treated with respect. Cave paintings which depicted wolves and cavemen around campfires
documented the earliest relationship between humans and animals. The first evidence of a bond
between humans and animals was in Israel, 12,000 BC, where a human was buried with his
puppy. Ancient Egyptians demonstrated reverence to their companion cats by being entombed
with them. Chinese emperors kept dogs who were tended to by their own servants. Greek and
Roman nobility were also avid pet keepers (Robinson, 1995). During the middle ages, horses
and dogs accompanied their masters during travel and hunting (Gammonley and Yates, 1991).
In the United States, from the Native American tribes to police officers, horses, specifically,
were held in high esteem. For example, in the Crow tribe of Montana horses represented
prestige and wealth, and became the primary currency exchange (Robinson, 1995). Robinson
also referred to the American mounted police and the effects of their presence reducing street
crime. The mounted police spend much time with their horse developing a trusting relationship
while caring for the animal. Robinson (1995) discussed how many studies of people living and
working with horses have shown how riding elevates the status of the rider both literally and
symbolically, giving increased power and an increased sense of power. This increased sense of
power and status is thought to work positively with the use of horses as a therapeutic modality.
Negative attitudes toward companion animals also existed. For example, in medieval Europe,
the Christian church suggested these animals should be given to the poor for food. Pet-keeping
among the lower class was considered an inappropriate luxury and should be saved for the
17
privileged elite who could afford a non-working animal. During the Inquisition, close association
with animals was linked to witchcraft. Reasoning that affectionate relationships with animals
were immoral and against the natural order of life, also contributed to negative attitudes
throughout history (Robinson, 1995).
Today, animals remain an important part of our society and daily lives, although attitudes
vary across the world. For example, in India the cow is a sacred animal and its slaughter and
consumption are forbidden. Conversely, in western cultures cows are used for milk, meat and
leather. While in some parts of the Far East cats and dogs are used for food, western culture
treats cats and dogs somewhat similar to that of India’s cows. (Robinson, 1995)
Individuals have various reasons for developing relationships with animals, although
Robinson (1995) stated in western societies the most common reason for pet ownership is
companionship. Robinson also stated that the relationship is comparable to humans and varies in
intensity. Differences in the type of relationships and bonding may be due to various conditions
such as: behavioral characteristics, socialization, positive experiences, communication systems,
and physical and sensory contact. Unfortunately, a common perception of pet ownership on the
part of non-owners is explained as pets being child substitutes or replacements of human contact.
Robinson discussed, however, although this may be true in a few cases, many studies have
shown the majority of pet owners are people whose companion animals improve existing social
relationships.
For example, Adams (2000) wrote about the bond between humans and dogs as seen through
the life and works of Emily Bronte (1818-1848), author of Wuthering Heights. In looking
closely at the life of Emily Bronte, she did not form close attachments outside of her family,
although developed a close bond with her dog Keeper. It is speculated that Emily’s withdrawn
18
behavior and separation anxiety began in her young years which were filled with the traumatic
loss of her mother and two older sisters while she was at boarding school. As a result, Emily
grew up reclusive and engrossed in her writing. Adams (2000) discussed a reciprocal bond
between Emily and Keeper where the dog helped to change Emily, particularly in becoming a
link to the outside world.
Attachment did not come easy to either Emily or Keeper, but grew slowly through proximity
and touch. For example, Emily and Keeper, according to Adams (2000), developed small, daily
rituals which are important to the human-dog bond. Keeper helped Emily develop relationships
with others, especially through her drawings of Keeper. Adams (2000) discussed how dogs often
act as bridges between people, especially for those who, like Emily, may have little social
contact. Conversely, Keeper also was a protective barrier between Emily and others.
Adams (2000) stated how even close to her death, Emily cared for Keeper. In turn, Keeper
followed her funeral into the church and walked first among the mourners. It is also accounted
Keeper moaned by the door of her empty room each night. Adams wrote how the bond between
the two continued even after Emily’s death, when Keeper comforted the grieving family. “The
history of one individual bond between a human and a dog offers insight into the dynamics of
any human-dog bond. Because Emily wrote freely and lived unconventionally, she has much to
teach us about the human-dog bond, especially the possibility for transformation that lies within
it” (Adams, 2000, p. 168).
There are many benefits of companion animals, as well as using animals as a therapeutic
modality. These benefits will be discussed in depth later in this chapter.
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Section 2
History o f Using Animals as a Therapeutic Modality
The history of using animals as a therapeutic modality dates back to the first century. Pliny
the Elder, and later John Keyes, in the 16th century, spoke of the benefits of a lap dog as a
comforter. In ancient times, it is reported a person who felt in danger of going insane would
carry a dog with him (Robinson, 1995).
As early as the 9th century, in Gheel, Belgium, family care of persons with disabilities
involved animals for therapeutic purposes. In 1699, John Lock advocated for the nurturing
relationships, which animals such as dogs and birds could serve in promoting socialization,
especially for children. Specifically, he discussed how animals could help in the development of
feelings and sense of responsibility toward others. As a result, compassion and concern for
animal welfare became a popular theme within children’s literature during the 18th and 19th
centuries. In the late 18th century, theories regarding the relationship between socialization and
animal companionship also began to be considered in the treatment of individuals with mental
illness (Fine, 2000).
The earliest documentation of the therapeutic use of animals occurred at the Quaker
Psychiatric Retreat, York, England, by William Tuke, a tea merchant (All et al., 1999; Connor &
Miller, 2000a). Founded in 1792 by the Society of Friends, this institution was an alternative to
the subhuman conditions of the lunatic asylums of the time (Perelle and Granville, 1993). The
treatment methods in this psychiatric facility were considered state of the art as the clients were
allowed to wear their own clothes, engage in crafts, writing activities, and read books. Clients
received compassionate care, concern, love, understanding, and a trusting environment. Within
the retreats courtyards and gardens were small domestic animals, and the clients were permitted
20
to wander freely. The primary goal of this intervention was to decrease the use of drugs and
restraints, as well as offer a calming effect to client (All et al., 1999; Casey, 1996). Casey (1996)
also stated how clients were involved in purposeful, routine activity through the successful
maintenance of companion animals.
Fine (2000) stated during the 19th century, pets became even more popular throughout
England and elsewhere. The beneficial effect of animals was also recognized in the treatment of
physical conditions. For example, the next recorded use of animals was at Bethel, a residential
treatment center for individuals with epilepsy, in Bielefeld, Germany (Connor & Miller, 2000a;
Perelle & Granville, 1993). It was believed the use of animals was a common-sense approach to
treatment and was made an integral part of client-care.
In her Notes on Nursing in 1860, Florence Nightingale wrote “a small pet is often an excellent
companion for the sick, for long chronic cases especially. If he can feed and clean the animal
himself, he ought always to be encouraged to do so” (in All et al., 1999, p. 49). She suggested a
person confined to the same room for many years might benefit from the presence of a caged
bird.
Unfortunately, for the following 50 years, scientific medicine primarily eliminated animals
from hospitals. Although, in recent years, an interest in the human-animal bond has developed
due to society attempting to re-establish links with nature. Specifically, Brodie and Biley (1999)
state among 500 people surveyed in hospitals, nursing and residential homes, the most frequently
missed item was a pet animal.
In 1919, the first therapeutic use of animals in the United States was believed to have
occurred at St. Elizabeth’s Hospital in Washington, D.C. Franklin K. Lane, Secretary of the
21
Interior wrote to the superintendent of the hospital suggesting dogs might be introduced for
clients to ‘chum and play with’, and serve as entertainment.
The second documented program was run by the American Red Cross at the Army Air Corps
Convalescent Hospital in Pawling, New York. This occurred after a recovering service man
asked for a dog to keep him company during his long recovery (Casey, 1996). As a result,
clients were encouraged to work at the hospital farm (All et al., 1999). Unfortunately, no records
were kept on the effects of this intervention strategy and, it was discontinued after World War II
(Perelle & Granville, 1993).
A children’s home in Brewster, New York, Green Chimneys, was opened in 1948 and
initiated using animals as positive reinforcement for good behavior (Connor and Miller, 2000a).
The purpose of this program was to teach children, who have experienced emotional loss and
trauma, about nurturance, healthy relationships, and communication, by raising animals and
children together (Golin, 1994).
Ockelford and Berryman (2001) reported how Freud was also aware of the value of pets as a
therapeutic modality. He would have a dog present during consultations as he believed it acted
as a catalyst and improved social interaction.
In central Norway, in 1966, a rehabilitation center named Beitostolen used innovative
approaches provided to clients with disabilities. An important component of the typical therapy
regime involved dogs and horses (Robinson, 1995).
Boris Levinson, in 1969, began to promote the health benefits of human-animal interactions
when his dog happened to be present during a session with a non-verbal child. According to
Brodie and Biley (1999), and Connor and Miller (2000a), Levinson attributed the child’s
improved communication to the presence of his dog Jingles as co-therapist. Ockleford and
22
Berryman (2001) discussed Levinson’s claims that pets reduced anxiety, provided affection and
unconditional love, while making it possible for him to establish a good relationship with his
clients. Connor and Miller (2000a) reported Levinson’s work to be considered the birth of the
present-day Animal-Assisted Therapy and at the time, Levinson formally termed his work ‘pet-
facilitated therapy’ (Perelle and Granville, 1993).
More specifically, Hippotherapy and therapeutic horseback riding, also referred to as equine-
assisted therapy, date back to the 5th century BC as horses were used in rehabilitation of
wounded Greek soldiers to raise their spirits, particularly if they were incurably ill. In the 17th
century, horseback riding was used for individuals with gout and neurological conditions (All,
Loving & Crane, 1999). More recently, in 1952 a Danish women who was paralyzed from polio
benefited from the use of horses as a therapeutic modality. Although the most widespread usage
of equine therapy is now in Germany, it did begin in the United States in the I960’s. The North
American Riding for the Handicapped Association (NARHA) began in 1969 (Benda,
Fredrickson, Flanagan, Zembreski-Ruple, & McGibbon, 2000).
Sam and Elizabeth Corson, in the 1970’s were inspired by Levinson’s work with animal
therapy and pleaded for scientific research to establish outcomes and guidelines on this topic.
Today, their research is considered classic and a foundation for justifying the use of animals as a
therapeutic modality.
As a result, animals continue to be used in therapy to increase occupational roles,
independence, function, and the quality o f our client’s lives.
23
Section Three
Description o f Specific Uses of Animals as a Therapeutic Modality
Animals may be used as a therapeutic modality in several ways such as:
• Animal-Assisted Activities (AAA)
• Animal-Assisted Therapy (AAT)
• Companion Animals
• Facility-Trained Animals
• Hippotherapy/Therapeutic Horseback Riding/Equine-Assisted Therapy
• Service Animals
The terms Pet Therapy and Pet-Facilitated Therapy may still be seen in the literature, or used
when speaking of any o f the above titles, although the Delta Society (2000) stated they are no
longer preferred. The Delta Society, 2000, recommended the term *pet therapy’ be avoided
because it is inaccurate and misleading. This term was widely used several decades ago to refer
to animal behavior training program. The organization explained the above preferred terms to
indicate the animal is a motivating force to assist and enhance treatment provided by a trained
handler.
Animal-Assisted Activities
The Delta Society (2000) definition:
“AAA provides opportunities for motivational, educational, recreational, and/or therapeutic
benefits to enhance quality of life. AAA is delivered in a variety of environments by specially
trained professionals, para-professionals, and/or volunteers, in association with animals that meet
specific criteria” (p. 8).
Specifics of AAA:
24
• There are no specific goals planned for the visit.
• Documentation is not required by the volunteers or those providing the visit.
• The visit is typically spontaneous and does not have a specific time frame.
• A credentialed therapist is not required to conduct the visit.
• For example: A certified handler and his or her dog volunteer at a nursing home
providing visitations held in a group activity as well as one-to-one visits to client rooms.
The staff of the nursing home is available to introduce and assist the volunteer, as needed.
There are no treatment goals, billing or formal documentation for this service.
(Delta Society, 2000)
Animal-Assisted Therapy:
The Delta Society (2000) definition:
“AAT is a goal-directed intervention in which an animal that meets specific criteria is an
integral part of the treatment process. AAT is directed and/or delivered by a health/human
service professional with specialized expertise, and within the scope of practice of his/her
profession. AAT is designed to promote improvement in human physical, social, emotional,
and/or cognitive functioning. AAT is provided in a variety of settings and may be group or
individual in nature. This process is documented and evaluated” (p. 9).
Specifics of AAT:
• AAT is directed by healthcare professionals (such as OT, PT, Recreation Therapist,
Speech Therapist, Nurse, Teacher, Social Worker, Psychologist) as part of their practice
or specialty area. A volunteer may handle the animal, although the intervention must be
directed by the professional.
• The therapy process involves specific goals and objectives which are client-centered.
25
• Goals and progress are measured, documented, and re-assessed.
• For example: An occupational therapist is accompanied by her Golden Retriever pet
each day to an outpatient clinic which serves children who are neurologically and
developmentally involved. Typical goals set for a client might include increasing
functional mobility by walking the dog around the clinic, increasing right hand range of
motion and grip strength by holding the leash, and increasing sensory stimulation through
petting the dog. Progress is documented and goals re-assessed on a timely basis.
(Delta Society, 2000)
Types of animals involved in AAA/AAT according to the Delta Society (2000) include:
Dogs, cats, birds, domestic rats, horses, rabbits, llamas, cows, goats, miniature pigs, guinea pigs,
hamsters, ducks, and chickens. The Delta Society (2000) does not recommend the use of wild or
exotic animals such as snakes, ferrets, or lizards because they are not legally acceptable as pets in
many states. Although they do not mention it, dolphin-assisted therapy has become a popular
modality in recent years.
Companion Animals:
Companion animals may be categorized as those not providing a specific, goal-directed
activity or outcome, or as an assistive modality. Instead, these animals are intended to provide a
sense of relief from loneliness, sensory stimulation, safety, unconditional love and acceptance,
and overall happiness. Companion animals may be in a typical setting such as an individual’s
home, a nursing home, or a day center/clinic. Animals may include dogs, cats, caged birds,
outdoor bird feeders, rabbits, guinea pigs, fish aquariums, and gardens which may attract
butterflies or other animals. Fish aquariums are popular because they can be watched, are easy
to maintain, and provide relaxing effects. Many doctor and dentist offices use aquariums for the
26
same reason (Katcher, 1984). Robinson (1995) refered to companion animals as “Passive
Animal-Assisted Activities” (p. 61).
Facility-Trained Animals:
A facility-trained animal typically either resides at the designated facility, such as a
nursing home, or travels to work each day with its owner who works there. Usually, facility
trained animals are cats or dogs as they also provide AAA and/or AAT. Often, an employee of a
facility will acquire a dog dismissed from a service training program, due to a minor reason
which does not impact its ability to provide AAA/AAT. These animals should be certified as a
therapy animal, such as through the Delta Society. Facility-trained animals, therefore, may be
used for goal-directed activity (AAT), assistance work, animal assisted activities such as
socialization and recreation, and general companionship for residents (Winkle and Williams,
2002). These animals are typically cats and dogs.
Hippotherapy/Therapeutic Horseback Riding/Equine-Assisted Therapy:
The term Hippotherapy is from the Latin word hippos, meaning horse. Hippotherapy uses
horseback riding as a therapeutic modality incorporating the rhythmic and dynamic movement of
the horse in order to improve a client's posture, balance, mobility and psychological well-being.
The ultimate outcome of therapy is not to improve horseback riding skills, but to achieve goals
specific to the needs of the client. Hippotherapists can be trained occupational therapists or
physical therapists who use an interdisciplinary team approach. Contraindications to
hippotherapy include: unhealed pressure sores, fragile bones, hemophilia, and epilepsy
(uncontrolled by medication) (All et al., 1999).
Therapeutic Horseback Riding/Equine-Assisted Therapy is used as a play and leisure activity
in order to promote desired social, emotional and physical benefits. “Therapeutic Horseback
27
Riding encompasses various leisure and therapeutic activities such as leisure riding, vaulting, and
competitive riding. Unlike hippotherapy, therapeutic horseback riding not only incorporates the
activity of riding but also includes the activities associated with stable management” (All et al,
1999, p. 52). The ultimate goal is to increase the quality of life of each client.
Service Animals:
Robinson (1995) defined service animals as pets “which are specifically trained to help
individuals overcome the limitations of their disabilities” (p. 64). The animals can replace
human assistance and be trained to perform tasks, which are specific to the needs/limitations of
their owner. The U.S. Department of Justice, in accordance with the Americans with Disabilities
Act o f 1990 (ADA) states service animal are trained to perform specific tasks for a person who
has a disability that limits one or more major life activities. (Robinson, 1995). Both state and
federal laws protect service dogs and their usage. (Refer to section on laws)
Service animals are primarily trained dogs, although, capuchin monkeys and small ponies are
also used. Examples of types of service include: guide animals for the visually impaired, signal
animals for the hearing impaired, medical/seizure alert animals, and assistance animals.
Allen and Blascovich (1996) state since the adoption of the American with Disabilities Act,
the development of assistive technology for individuals with disabilities has increased
significantly. Although high-tech technology does afford assistance to individuals with
disabilities, areas of unmet daily living needs may still exist, such as hygiene, dressing,
shopping, and food preparation. Another area of significant importance is the social needs of
these individuals which cannot be met through technology.
Specifically, an assistance animal can often be trained to perform nearly 100 tasks. The
animal is specifically trained for the needs of the owner. Examples of such tasks include:
28
opening doors, turning lights on and off, assist an individual from sitting to standing or getting
out of the bath, putting on a shirt, picking up objects, pulling a wheelchair, carrying items and
dragging a person to safety in case of an emergency. Camp (2001), an occupational therapist,
stated that, “Given these functions, service dogs could be considered a form of assistive
technology under the Technology Act in that they are used to increase, maintain, or improve
functional capabilities of the individual with disabilities” (p. 510). She discussed, although, how
O T’s, despite the documented benefits, typically do not recommend assistance animals to clients
as a possible alternative to the technological devices. She suggested this may be, in part, due to
the limited research performed on the use of service animals within the OT profession. (Refer to
‘benefit’s section addressing Cam p’s study for further discussion)
Service animals are typically tested for their abilities to assist, as well as their temperament
and obedience. Agencies such as Canine Companions for Independence locate and test the
animals, and then find homes to raise them for a determined period of time. The raisers work
primarily on obedience training and socialization skills until their graduation, where the animal is
handed over to the recipient with a disability. The agency then works with the service animal
and the new owner, in order to provide for specialized needs and training.
Examples and resources of specific program for service animals are as follows:
Guide Dogs fo r the Blind, Smithtown, N Y
Helping Hands: Simian Aides fo r the Disabled, Boston, MA
Canine Companions fo r Independence, Santa Rosa, CA
Paws with a Cause, Wayland, MI
(Huebscher, 2000)
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Section Four
Benefits of Using Animals as a Therapeutic Modality
Table 1
Summary Table o f Benefits from the Literature
Psychosocial Benefits
Increasing emotional satisfaction
Fulfilling the need to love and be loved
Providing acceptance
Increasing social interactions/social behaviors
Developing a sense of self-respect /Increasing self-worth
Increasing responsibility
Creating a circle of warmth/bonding
Widening areas of interest
Allowing owner to feel safe
Providing companionship
An exchange of affection and nurturance
Reducing anxiety
Assisting change in outlook
Instilling a sense of compassion and concern
Increasing self-maintenance behaviors
Increasing motivation
Decreasing maladaptive behaviors
30
Cognitive Benefits
Providing reality therapy/orientation
Increasing initiation
Being an interesting visual stimulus
Developing insight
Establishment of a daily routine
Sensory stimulation
Increasing alertness
Increasing short-term memory
Decreasing wandering
Learning new skills
Cognitive stimulation
Increasing understanding of one’s behavior
Physical Benefits
Increasing physical activity
Decreasing blood pressure
Increasing relaxation/stress reduction
Increasing/positive influence on survival rate in cardiovascular disease
A stimulus to exercise
Increasing independence
Stimulating care-giving activity
Increasing functional abilities
Increasing ambulation
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Other Benefits
Giving a second chance on life to some animals
Assisting in creating working alternatives (such as in prisons)
Decreasing boredom
Outward expressions of happiness (smiling, verbal expressions, tears)
Providing a bridge to improve client-staff and client-visitor interactions
Improving staff and client morale
Instilling a sense of control
Providing company at night/when alone or lonely
Encouraging expression of feelings
Increasing client-centered care
Increasing client, staff and family satisfaction
Changing focus from illness/fears to visiting animal
Increasing liveliness of the client/clinic atmosphere
Assisting with reminiscing
Removing barriers
Increasing hopefulness
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Table 2
Summary Table o f Conditions and Environments Involved in Animal Therapies
(The table below is not limited to possible entries)
Condition Environment
Dementia Psychiatric hospitals
Cardiovascular disease Hospice
Autism Pediatric clinics
Brain injury Correctional institutions
Cerebral palsy Acute care/intensive care units
High blood pressure Skilled Nursing Facilities
Preoperative clients Day Centers
Neurological impairment (stroke,etc) Rehabilitation hospitals
HIV/AIDS Assisted Living Centers
Chemical addiction Schools
Spinal cord injury Wellness centers
Learning disabilities
Hearing/visual impairments
Psychiatric disorders
In 1975, Corson, Corson, Gwynne, and Arnold conducted one of the first documented studies
of the benefits of using animals as a therapeutic modality. The investigation also represented the
first attempt at studying the use of dogs in psychotherapy within a hospital setting. The
researchers considered PFP ( ‘pet-facilitated psychotherapy’ a term used by Corson et al..
33
specifically in this study) to be a form of reality therapy where dogs may help fulfill basic
psychological needs of clients: the need to love, the need to be loved, and the need to feel
worthwhile. PFP’s outcome is based on clients accepting the love of a dog before they can
accept love from, and give love to, another human.
The study focused on 50 clients in which traditional therapeutic attempts were unsuccessful.
Eight of the clients were videotaped and five studied in depth. Before attempting PFP, the client
was asked whether or not they liked pets, and if so, what kind. Corson et al. (1975) stated just
the mention of a dog or cat with these clients initiated a positive response and increased verbal
interactions with the therapist. Next, the dogs were introduced to the clients in the kennels, on
the patient wards, or on the client's bed. The client was allowed to choose a dog which fit his or
her temperament or needs. Corson et al stated that insight into a client's feelings might be
obtained through learning what type of dog a client prefers, and by the reasons he or she chooses
a particular dog. PFP activities included: walking and running with the dog, grooming
activities, presence of the dog in psychotherapy, and ward visits. Of the 50 clients, PFP was
unsuccessful with three, as they did not accept their pets. According to the Corson et al. (1975),
all of the remaining 47 clients showed some improvement with PFP. The five clients studied in
depth exhibited marked improvement, as did many of the other 47 in the group. Many of these
clients were withdrawn, self-centered, non-communicative, mute, bedridden, lacked self-esteem,
and exhibited helplessness and dependence. The improvements found in the clients involved in
PFP included: Sense of self-respect, independence, responsibility, increased physical activity,
initiation, emotional satisfaction, establishment of a daily routine, self-confidence, and increased
social interaction (Corson et al., 1975).
34
Although this study found many positive improvements and is considered to be classic, some
concerns must be mentioned: One goal of the study was to quantify results, although no
quantitative data was presented. For example, the 47 subjects studied were only said to have
exhibited some improvement and the Five subjects studied in depth were said to exhibit marked
improvement (Corson et al., 1975). These five subjects studied in depth also represent a very
small sample.
In 1978, Corson and Corson, again, used PFP to study psychosocial issues of institutionalized
clients. The emphasis in this study was on the institutionalized geriatric population. The authors
stated that the elderly are more vulnerable to loneliness, depression, helplessness, boredom and
low self-esteem. The authors wrote, “The social structure of custodial institution tends to
perpetuate and exacerbate the very deficiencies which brought the residents there in the first
place. Thus a vicious cycle of debilitation and social degradation and dehumanization is
established”. Additionally, relocation to a nursing home is a major life change, which includes
leaving behind family, friends, neighbors, and even possibly, a beloved pet.
The study was begun by introducing PFP to the clients, in order to establish interests and
attitudes towards animals. Dogs were either brought to clients at the bedside or wheelchair level
when needed. In many instances, a dog would be adopted by a client who resided in a cottage on
the grounds. These clients volunteered to take the major responsibility for daily care of the
animal. Often, PFP was incorporated into a token system of a behavior modification program,
where caring for a dog was used as a reward system. In order to record the results, a 10-point
scale questionnaire was developed and put into nursing notes. The questionnaire included
physical and emotional observations, social interactions, and any changes in personal hygiene,
appearance or medication. Videotaped recordings of client-pet-staff interactions were also used
35
to quantify verbal interactions, temporal parameters, and other nonverbal communications such
as tactile interactions. Results indicated PFP served as a form of reality therapy and helped
clients to change their dependent-like behavior into more responsible and self-reliant occupations
(Corson & Corson, 1978). PFP also increased physical activity of many clients, as well as their
emotional status. According to Corson and Corson (1978), one client lost 30 pounds after a
month of involvement in PFP. Social interactions were also noted to improve. In some cases the
dogs helped to involve the clients in other activities of interest, such as one client who began to
paint pictures of dogs.
Although this study found very positive results and is considered a classic, the following
concerns are noted: The researchers stated there were 800 total clients in the nursing home
studied, they do not mention the sample size used; and it was reported that the study resulted in
statistical significance, although there were no data or statistics presented.
In 1980, Friedmann, Katcher, Lynch, and Thomas, were the first researchers to study the
relationship between pet ownership and one-year survival of clients discharged from a coronary
care unit. The researchers hypothesized that increased mortality and morbidity of clients with
coronary artery disease may be due to the emotional and behavioral effects due to the absence of
companionship, which includes depression and loneliness. Friedmann et al., (1980) found
individuals’ ability to engage in normal daily occupation, activities, and healthy behaviors may
be negatively affected by the absence of significant companions. In turn, this negative effect
may cause an illness to progress. The study also examined the relationship between pet
ownership and severity of cardiovascular disease.
The study used discriminate analysis to examine the effects of physiological severity and pet
ownership on survival. The research groups discriminated were one-year survivors and non
36
survivors and the independent variables were physiological severity, age, and pet ownership.
The population consisted of 29 white women and 67 white males with a diagnosis of myocardial
infarction or angina pectoris upon admission to the coronary care unit, medical intensive unit or
coronary care step-down unit of a large hospital between August 1975 and March 1977. The
subjects were initially given a social inventory scale which included an item for pet ownership.
After one year, all but two surviving subjects were located and contacted. Of the 92 subjects, 14
died during the year, leaving a survival rate of 84 percent, or 78 of the 92 subjects. It was
reported by Friedmann et al. (1980) that 58 percent of the subjects had one or more pets. Of the
39 subjects who did not own pets, 11 had died within the year. Three of the 53 pet owners died
within the same year. In addition, since dogs, in particular, may require the owner to perform
increased physical exertion in their care, a second comparison was made between owners of pets
other than dogs and subjects who did not own a pet. Ten subjects who were still alive within the
year owned a pet other than a dog. None of those who had died owned a pet other than a dog.
The results of this study confirm and extend previous findings o f the important health effects
of social affiliation and companionship. Specifically, Friedmann et al. (1980) found social
variables such as pet ownership added significantly to survival rates of individuals with
cardiovascular disease. Also, this study found the effect of pet ownership was not limited to
subjects who were not married or socially isolated. Therefore, pet ownership should not be
considered a substitute for human contact. The authors state an unanswered question relates to
the source of the influence of pets on survival. In other words, the effect of pets on survival rates
may not depend on pets. Instead it may result from differences in personality or social condition
between those who have pets and those who do not (Corson & Corson, 1978). In conclusion,
this research found that the presence of a pet in the client’s family was found to be associated
37
with a significantly increased one-year survival rate. In explaining this result, Corson and
Corson (1978) noted pets could serve at least seven psychological and social functions which
would be expected to increase longevity and morbidity as follows:
1. providing companionship
2. keeping individuals active
3. stimulating care-giving activity
4. making the owner feel safe
5. the exchange of affection and touch
6. being an interesting visual object
7. as stimulus to exercise
It should be mentioned this study did not use a control group. Many other potential
compounding variables were also not mentioned such as: medical issues which may include
diabetes, cognitive status, and medications; functional status; and possible changes in
occupational roles.
Friedmann, Katcher, Thomas, Lynch, and Messent (1983) studied the effect of the presence
of an animal on children's blood pressure and heart rate responses to reading aloud. It was
hypothesized an animal could make the situation or the experimenter less threatening and
decrease the physiological stressors of a testing environment (Friedmann et al., 1983). Thirty-six
children of both genders, ages 9-16, were studied in a home setting. (It was not mentioned
whether or not these children were typical readers or if the reading was based on an age level.)
Each child was introduced to the examiner, seated in a comfortable chair and fitted with a blood
pressure cuff on the arm. An initial blood pressure was taken after each subject was asked to rest
for two minutes, then the subject was asked to read aloud from a children’s book of poetry. In
38
one condition, a friendly dog was present in the room, while in the other, a dog was not present.
Blood pressures were again recorded in response to this activity. After two minutes, the dog was
either removed or moved into the room.
Data was analyzed through descriptive statistics and One-Way Analysis of Variance
(ANOVA). The findings of this study confirmed the hypothesis that the presence of a pet (not
necessarily owned by the subject) can lower blood pressure. Specifically, the presence of a pet
was associated with lowered blood pressure and heart rate both while children read, and while
they performed a mildly stressful task, reading out loud. The researchers speculated the presence
of a pet made the testing environment less threatening and friendlier. The subject’s perceptions
of the experimenter and the environment were modified leading to a decrease in resting blood
pressure and in the blood pressure response to verbalization (Friedmann et al., 1983). The
authors suggest this study provides important insight into the use of animals as a therapeutic
modality, specifically in regards to reducing anxiety while an animal is present in therapy.
According to Katcher (1984), aquarium fish are a popular companion animal and commented
on the wisdom of dentists and doctors who place aquariums in their waiting rooms. Feeding is
an important part o f their care, although they also serve as a pleasant visual stimulus. Katcher
(1984) performed a series of experiments using tropical fish as an object of contemplation. In
his initial series of studies, he established a preliminary blood pressure reading, asked normal
and hypertensive subjects to watch a tank of tropical fish for 25 minutes, and blood pressure was
re-recorded. His study demonstrated decreased blood pressure in these subjects. This study does
not mention a sample size. The researcher noted a significant fall in blood pressure after
watching the fish tank, but did not present the data or statistical analysis.
39
In a second experiment, Katcher studied subjects also watching a fish tank while receiving
elective oral surgery. He found the aquarium to be as effective as a hypnotic induction with
blood pressure also lowered in these clients. Katcher hypothesized the fish tanks ability to signal
safety may result from an innate neurophysiologic mechanism, which may also be reinforced by
symbolic conventions. This researcher also stated interacting with the animals resulted in more
relaxed facial expression and decreased blood pressure (Katcher, 1984). Again, this study did
not mention the sample size. The researcher stated a four-group analysis of variance was used in
the statistical analysis, although there was no presentation of data. Lastly, it may be questioned
how a more relaxed facial expression is measured.
Moneymaker and Strimple (1991) studied the use of animals as a therapeutic modality in
correctional institutions. The purpose of their research was to focus on a unique program at a
correctional institution which worked well for the inmates in terms of giving them a new lease on
life, but also facilitated a behavioral modification program for individuals with a history of
violence. Moneymaker and Strimple (1991) discussed how the manner in which individuals treat
animals may be linked to the way they treat fellow human beings. In addition, although it is very
difficult to prove a connection between animal abuse and violence towards humans, it is
becoming increasingly more common for individuals to exhibit violence towards humans and
animals, alike.
The research study was conducted at the Lorton Correctional facility in Lorton, Virginia in
March of 1983 using the People, Animals and Love (PAL) program. This program was founded
in 1981 to improve the quality of life for the widowed, elderly, shut-ins, individuals with
disabilities, individuals with emotional disturbances, and those institutionalized through the use
of companion animals. Each inmate involved in the study was provided with a pet animal with
40
which he or she was responsible for the following: monitoring the animal to insure it was
healthy, treating it with compassion and understanding, and if the inmate was interested,
attending classroom instruction for a related skill or vocation such as a laboratory technician for
retum-to-work.
It was found that those who completed the PAL program showed a considerable change in
their view of others, their self-worth, and their life goals (Moneymaker & Strimple, 1991). The
authors also state that upon interviewing inmates at the completion of their sentence, their
behavior was changed in terms of responsibility, altercations with others and the use of drugs.
The inmates stated in the interviews the animal instilled a sense of compassion, love, nurturance,
concern, feelings of being, and responsibility. Moneymaker and Strimple (1991) also emphasize
that the PAL program has in turn offered a second chance in life to animals who are unwanted
and/or diseased. Lastly, the Pal program has shown how pets facilitate communication and
compassion in an environment where these may be lacking, while creating a working alternative
to traditional prison programs.
A similar program was also attempted at the maximum security Purdy Center for Women in
Washington State since 1979. The purpose of the Pets as Therapists (PAT) program was to train
women prisoners in dog obedience, care, exercise, and specialized service animal training. The
end result of the inmates work was to provide an individual with a disability with a trained
service dog. The inmates where studied for the effects of their involvement in this program
through the Coopersmith Self-Esteem Inventory and the IPAT Depression Scale. Positive effects
on self-esteem and a decrease in depression were found. The inmates also had many positive
comments regarding their participation in this program such as: they were lucky to be involved,
it gave them an opportunity to use initiative, provided as sense of being worthwhile, relief from
41
boredom, and they were able to make contacts outside of the prison (Walsh & Mertin, date
unavailable). Other inmates who had not initially participated in the program, requested to be
included as they observed positive changes in those who had, such as increased calmness,
decreased aggravation and aggression, and outward expressions of happiness. The researchers
did mention that there were many uncontrollable variables within a prison system which may
have impacted upon this study, although they are not listed.
Gammonley and Yates (1991) document five cases of client responses to animal-assisted
therapy (AAT) in a nursing home. Their results were as follows:
• Mrs. A who was depressed and hard-of-hearing attempted to use alternate modes of
communication, such as writing, lip reading, and touch, during a dog visit. These
attempts to increase communication continued after the visits ended and increased her
overall functional abilities.
• Miss B was typically confused, although during dog visitations she was able to remember
her own dog who had died. She also demonstrated increased short-term memory by
recalling the name of the visiting dog and its previous visits.
• Mrs C, a former dog owner, was terminally ill, bed ridden, thereby having decreased
social and activity levels. During dog visits, she smiled, stroked the dog and expressed
verbal pleasure at the end of the visit.
• Mr D was lonely, depressed and frail, although was able to take the responsibility for care
of a wild bird feeder on the patio of his nursing home. This activity helped to increase
his ambulation and overall functional abilities involved in this activity.
42
• Miss E has a developmental delay. For one week each month her responsibility was to
caring for a resident rabbit. It was noted that this activity helped to increase her cognitive
abilities by learning new skills.
Much research involving the use of animals as a therapeutic modality involve the use of
anecdotal stories, particularly with observational studies. As the above authors did, caution must
be used, however, in drawing conclusions from these stories.
Chinner and Dalziel (1991) researched the effectiveness of an animal assisted therapy
program on personnel within a hospice. The program used a white miniature poodle named
Bobo as a resident pet. Data collection was taken by observations including videotapes, nursing
notes and interviews. The sample size consisted of 3 men and 5 women (which was
acknowledged by the researchers as a small sample size in their conclusion section). This study
found implementing an animal assisted program within a hospice improved client-staff and
client-visitor interactions and improved staff and client morale. However, with clients who were
more isolated and not affectionate toward the dog, it was assumed they were exhibiting a
distancing reaction in order to cope with dying (Chinner & Dalziel, 1991).
In 1993, Perelle and Granville studied the effectiveness of a pet visitation therapy program in
a nursing home. The program was implemented by a team of Veterinary Technology student
volunteers from a local college. The students took dogs, cats and a rabbit to the day rooms of the
nursing home for their visits. During the visits, the students also talked with the residents about
the animals, the resident’s former pets and answered questions. The Patient Social Behavior
Scale was used to evaluate client social and self-maintenance behavior. Through descriptive
analysis and ANOVA, it was found clients involved in this study showed an increase in social
behaviors and self-maintenance behaviors from pretest to midpoint and from midpoint to post
43
test. There were also anecdotal accounts of individual residents such as: a report of a male
resident who had not spoken to anyone since his admittance, spoke to one of the volunteers on
the last pet visitation day, requesting a picture of himself with one of the dogs; several residents
who were never observed smiling, did so when interacting with the animals; eleven members
required assistance with dressing prior to the start of the study, and by the post test only three
remained needing assistance (Perelle & Granville, 1993).
The researchers did not mention other potential compounding variables which may also have
positively affected social and self-maintenance behaviors. For example, subjects may have been
receiving occupational therapy for self-maintenance behaviors, or may have been involved in
other socialization/recreation programs. Anecdotal stories were used in the discussion to further
account positive results.
In terms of wellness and health promotion, Siegel (1993) studied human-animal relations in
regards to attachment and stress reduction. Over one year, the author found pet owners visited
the doctor less than nonowners and pets seem to buffer people against the impact of stressful life
events. Specifically, dog owners, in this study, spent more time with their pet than other types of
pets, felt more attached to their dog, and were more likely to state they felt security as a benefit
of dog ownership. The author mentions an important implication of this study relates to the need
for federal legislation, which would prohibit discrimination against pet ownership in public
assisted housing, and the need to inform the elderly of their rights in this situation.
An occupational therapist, (Fick, 1993) studied the effect of the presence and absence of a
dog on the frequency and types of social interactions among nursing home clients during a
socialization group. The animal-assisted activity group met each week and was led by a social
worker, while the subjects were observed. During the sessions, the presence of the dog
44
stimulated conversation about pets the clients had owned and pets, in general. These
conversations continued after the pet had left. A One-Way Analysis of Variance (ANOVA), was
used and results indicated that in the presence of a dog, verbal interactions between subjects
increased significantly. The results suggested that the presence of the dog in this group setting
provided an environment that was comfortable and conducive to the therapeutic goal of
facilitating social interactions (Fick, 1993). The author discussed the importance of these
findings in relation to the negative effects of institutionalization such as: feelings of isolation,
rejection by society, loneliness, boredom, hopelessness, low self-esteem, loss of purpose, and
absence of goal-directed activities in daily life. Most importantly, it is mentioned how animal-
assisted therapy is a valuable adjunct to therapy, verses a modality which is exclusive to client-
centered care.
Animal-Assisted Therapy was implemented and researched in an intensive care unit by two
nurses (Cole & Gawlinski, 1995). Initially the nurses faced the resistance to this type of a
program, by administration, physicians and fellow nurses. They began by implementing a fish
aquarium animal-assisted therapy (FA-AAT) program in client’s rooms who were awaiting heart
transplantation on the Coronary Care Unit. Within this study, clients classified as Status 1
awaiting orthotopic heart transplantation were assumed to be at risk of increased stress due to the
psychological effects of prolonged hospital stays. These clients were responsible for naming
their fish and feeding it on a daily basis. The outcomes of the program were measured pre and
post-test by the Multiple Affective Adjective Checklist (MAACL). The subjects were found to
express delight, a sense of relaxation, a sense of control in feeding the fish and determining the
feeding schedule, a distraction from the hospital environment. The aquariums were also said to
have provided cognitive stimulation, soothing feelings, a bridge for communication with staff,
45
and company at night. Resulting from this successful experience, the unit was given the approval
to develop a volunteer pet visitation program with handlers and their therapy dogs. Over six
months and 120 dog visitations, results from the participant’s surveys included comments such
as: the visits make them happy, calmer and less lonely. Almost one-half of the clients stated
they would be more likely to choose this hospital based on the pet visitation program. All
participants stated they would recommend a pet visitation program to a friend. When asked what
should be done differently with the program, the most frequent response was to have pet
visitations more often (Cole & Gawlinski, 1995). The successful program on this unit has
resulted in its expansion to other units of the UCLA Medical Center.
Friedman and Thomas (1995) followed 369 subjects in the Cardiac Arrhythmia Suppression
Trial (CAST) of several hospitals nationwide, for at least one year. Subjects were asked to
complete indexes on social support, social readjustment, pet ownership/attachment, anxiety, self-
rating depression, an anger scale, an activity scale and physiologic data. Using descriptive
analysis of data and Chi-square, dog ownership and social support were found to have a
significant effect on survival beyond the effects of the physiologic measures of the severity of
the cardiovascular disease. The authors stated these results support the findings of Friedman et
al (1980) regarding pet ownership in relation to survival of patients with coronary artery disease,
independent of social support (Friedmann & Thomas, 1995). It is mentioned, again, that
although owning a dog had a positive effect on health, it is not suggested as a substitute for other
sources of social support. The study also found that cat ownership, while not harmful to humans,
was not related to survival or independent of social support. It is suggested that cat owners are
more likely to be sedentary as compared to dog owners.
46
The benefits of service dogs trained for individuals with physical disabilities were studied by
Allen and Blascovich (1996). Forty-eight individuals requiring the use of a wheelchair for
assistance with mobility and a diagnoses of muscular dystrophy, multiple sclerosis, traumatic
brain injury, or spinal cord injury received trained service dogs in the experimental group. Self-
reported assessments of variables such as psychological well-being, internal locus of control,
community integration, school attendance, work status, self esteem, marital status, living
situation and number of paid and unpaid assistance hours were recorded. Analysis of Variance
(ANOVA) was performed on dependent variables comparing experimental and wait-list control
groups. The analysis revealed substantial positive changes in self-esteem, internal locus of
control, well-being, community integration, increased school and work attendance and dramatic
decreases in paid and unpaid assistance hours. (P< .001 for all comparisons) Allen and
Blascovich (1996) concluded that for individuals with a physical disability, service dogs can be a
beneficial and potentially cost-effective enhancement to independent living.
Counsell, Abram and Gilbert (1997) report implementing hospital-based animal-assisted
therapy program for individuals with spinal cord injury. Because clients with spinal cord injuries
need to make significant adjustments particularly during the acute and rehabilitation phase,
attention must be made to their self-esteem, stress levels, the expression of feelings, and sensory
stimulation (Counsell et al., 1997). Therefore, it was felt an animal assisted therapy program
would be beneficial with this clientele because it is intended to complement the more traditional
forms of therapy used with clients who have spinal cord injuries. The program was named the
Animals Heal Hearts Program, which consisted of animal assisted activities and animal assisted
therapy components. The goals of the program included: increasing client, family and staff
satisfaction; providing client-centered care; increasing client self-esteem; sensory stimulation;
47
and motivation. Since implementation of the program, both participating clients and staff have
reported positive comments and reactions which include: smiles, laughter, tears, decreased stress
through focusing on the dog versus the illness, increased morale and overall liveliness of the
unit.
Benda, Frederickson, Flanagan, Zembreski-Ruple, and McGibbon (2000) studied the effect
of hippotherapy on children with cerebral palsy. They used remote electromyography equipment
while the children were moving on the horse. The researchers achieved significant results from
this study, confirming previously obtained positive results from hippotherapy with children
diagnosed with cerebral palsy. Physical benefits include increases in: strength, postural control,
balance, coordination, range of motion and flexibility. Within this article they did not, provide
in-depth discussion of their research methodology, data collection, or analysis procedures.
MacKinnon, Noh, Lariviere, MacPhail, Allan, and Laliberte (1995) studied psychosocial
benefits of horseback riding by using the Vineland Adaptive Behavior Scale and the Harter Self-
Perception Scale. Nineteen children, ages 4-12, with mild to moderate degrees of cerebral palsy
were randomized according to their degree of disability. Ten children were designated to an
experimental group and nine to a waiting list for a one-hour weekly riding class for six months.
Following involvement in the therapeutic horseback riding program, qualitative findings were
collected from recordings of the instructor, reports of the on-site physical therapist, and reports
from parents. The findings included: increased self-perception, increased social
interaction/social skills, increased self-confidence, increased self-esteem, improved cooperation
and increased enthusiasm (MacKinnon et al., 1995). The above quantitative data, although,
showed few statistically significant changes in the children studied. The researchers commented
on the need for further studies on this topic.
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All, Loving and Crane (1999) further emphasized the general well-being benefits of
horseback riding, specifically getting out in the fresh air, away from facilities, chronic illness,
and disability. Horseback riding also allows individuals with a disability the positive
experiences of participating and succeeding in a physically demanding sport.
Katsinas (2000), studied nursing home residents participating in an animal assisted therapy
program, specifically those clients with dementia who were involved in a therapeutic day
program. The primary purpose of the study was to identify the roles/benefits that an assistance
animal may provide in this therapeutic setting. Qualitative data was collected from staff notes,
daily records and reports from the therapy visits. The observed benefits were:
■ The assistance dog sought out individuals showing signs of closing down, especially
during mid-afternoon times. The dog persuaded these clients to stay alert by barking,
blowing air out of her mouth, gently poking nudging until the client responded.
■ Unexpectedly, the participating clients became oriented to the days of the week based on
whether the dog was present that day or not. (The dog attended the program on Tuesdays
and Fridays)
■ The dog became the focal point for reminiscing and social interaction among group
members.
■ The dog was used to assist in the monitoring of clients who wandered, thereby reducing
the reliance on chemical and physical restraints.
Katsinas (2000) stated how both the animal and the client developed a bond, and the dog
quickly became a stable and contributing member of the therapeutic environment. Other
potential compounding variables were not mentioned in this study.
49
Miller and Ingram (2000) discuss how preoperative clients are under much stress. As
operating room nurses, these authors state that this stress makes their job very difficult in
terms of the client’s ability to concentrate on preoperative teaching and informed consent.
Another stressor is the focus on the possibility of death which also diverts the client’s
attention. Miller and Ingram have integrated an animal-assisted therapy program into the
coronary artery bypass graft (CABG) and intensive care pre-operative units of the hospital in
which they work. An example of an anecdotal report states:
Mrs. S visited with the unit’s therapy dogs prior to her surgery. Three days post-surgery, she
asks to see the animals again and stated how visiting with the therapy dogs the night before
surgery reminded her that she needed to get better and go home to care for her own animals
(Miller and Ingram, 2000).
In 2000, Cambell-Begg studied the use of animal-assisted therapy to promote abstinence
in clients recovering from chemical addictions. During a 2 1-day treatment, clients attended
daily individual and group therapy with the presence of a German Shepard. Clients were
given a 15-item questionnaire regarding the intervention process. This qualitative study
found the following themes: the presence of an animal removed barriers, increased
communication and, promoted a greater understanding of their own situation. Because of
this improved communication, the participants were able to increase the understanding of
their drug-seeking behaviors and transform the concept of self to a more positive perception.
In addition to the increased positive attitude, clients expressed hopefulness, decreased fear
and anxiety, and increased relaxation through the presence of a dog in therapy. The clients
expressed they were able to focus on the dog, rather than their own problems and for the first
time in their lives, were able to express feelings they never had before. From the above
results, Cambell-Begg stated this overall improved self-image allowed the clients a better
50
understanding of their recovery process, but did not specifically provide data to substantiate
this statement.
Camp (2001) applied an ethnographic approach to study the use of service dogs with
individuals with physical disabilities. She also sought to: further understand the meaning of
the experience for service dog owners; document the way service dogs promote
independence in occupational performance areas; and increase information about the use of
service dogs as an assistive technology to OT’s. Camp’s study found that: service dogs
enhanced occupation and provided a means for the participants to master and improve their
environments. Specifically, their service dogs not only provided strategies to complete tasks,
but also a means of fulfilling needs through increased social involvement, facilitating skill
development, and providing responsibilities to care for a living being. The participants also
stated the dogs made them feel less dependent, with a new sense of efficacy and
responsibility, while restoring occupational roles which were lost due to disability. These
findings are consistent with Hanebrink and Dillon’s (2000) definition of service dogs as the
ultimate assistive technology. Therefore, Camp further states the above definition and
findings assist to link the use of service dogs to occupational therapy framework. Lastly,
Camp advocates for occupational therapists to recommend service dogs as an assistive
technology for appropriate clients. The author stated OT’s are one of the primary health care
providers responsible for assessing assistive technology needs and recommending
appropriate adaptations. Therefore, they are in an ideal position to expand the use of service
animals as another potential therapeutic modality.
McKinney, Dustin and W olff (2001) wrote about a program in Key Largo, Florida, called
Dolphins Plus, which provides dolphin-assisted therapy. Dolphin-assisted therapy began in
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the 1950’s through the work of Dr. John Lilly, who studied the effects of dolphins on
individuals with disabilities. Dr. Betsy Smith of Florida International University extensively
researched this modality and has found many benefits to clients including: decreasing stress
levels/increasing relaxation, alleviating symptoms of depression, boosting production of
infection fighting T-cells, stimulation production of endorphins and hormones, enhancing the
recovery process, and reducing pain. These benefits have been found through the use of
brain wave patterns, psychological testing, blood chemistry, health of the immune system,
the state of the brain, and in cell make-up (McKinney et al., 2001). More scientific study is
needed of these changes, many theories regarding the benefits of dolphin-assisted therapy
have been presented:
■ A belief individuals experience stimulation of the immune system when interacting with
the dolphins, therefore, promoting the healing process.
■ A belief when individuals receive joy and unconditional love from the dolphins they are
more apt to recover.
■ Dolphins use sonar and echolocation (a technique dolphins use to make sounds) through
sounds such as whistles and clicks, producing changes in a person’s body tissue and cell
structure (some participants have reported a sensation of being scanned and a tingling
sensation when swimming with the dolphins).
■ Dolphins are uniquely sensitive to the needs of people with disabilities and seek to help
them through their playful expressions. This is often referred to as a secret language that
dolphins and humans with disabilities share. Dr. Smith suggests that with a variety of
movements and attention to body cues of individuals, dolphins communicate acoustically
52
and seem to understand thoughts and actions. Specifically, this phenomenon has been
observed in individuals with autism.
■ Therapeutic effects from interactions with dolphins may be due only from the happiness
they bring to people through their playful and joyous nature.
■ Playing with dolphins is reinforcing from the attention they give to humans.
The author’s report of a young boy who was paralyzed and visually impaired from birth
and participated in dolphin-assisted therapy at Dolphins Plus in Key Largo, Florida. As a
result of 22 months of dolphin-assisted therapy, it is reported the boy smiled and laughed for
the first time, and has achieved close to a full physical recovery. His mom has now started a
program called Island Dolphin Care which provides recreational, educational and
motivational programs using dolphins to enhance the health and well being of children with
disabilities and their families.
Despite their very large size and stature, dolphins are gentle, graceful, friendly, intelligent,
and communicative. Many observers believe their unique relationship with humans,
especially those with disabilities, is due to all their positive qualities and mesmerizing effects
(McKinney et al., 2001).
Most recently, Banks and Banks (2002) studied the effects of animal-assisted therapy on
loneliness in elderly residents of a long-term care facility. Forty-five subjects were randomly
assigned into three groups: a control group which did not receive AAT, a group receiving
AAT once per week and a group receiving AAT three times per week. After initial testing to
determine baseline function, the groups were retested at the end of the six-week study. The
subjects were given a Demographic and Pet History Questionnaire, as well as Version 3 of
the UCLA Loneliness Scale. Results showed subjects who had a strong life-history of
53
emotional intimacy with a pet also wished to presently have one. Through analysis of
covariance, AAT significantly reduced loneliness scores as compared to the control group
which did not receive AAT.
Potential Negative Implications and Problems in Using Animals as a Therapeutic
Modality
Table 3
Summary Table o f Negative Implications from the Literature
Cleanliness issues Allergies Potential for transmitting diseases
Risk of infection Clients may dislike animals Fear of animals
Sensory overload Legal liability Injury/accidents
Legal obstacles Unpredictable animal behaviors Shedding
Fleas Animal bites Inadequate screening of animals
Animal fatigue Injury to the animal Inadequate screening of handler
Khan and Farrag (2000) stated the most common issues with using animals as a
therapeutic modality are cleanliness, allergy, the potential for transmitting diseases, and the
risk of infection. The above authors and Howell-Newman and Goldman (1993) stated that
research to date has shown no increased rate of infection from animal contact. Alfano (1998)
discussed the issue of clients who dislike animals and the potential for sensory overload from
the inability of the client to process stimuli from the animal appropriately.
54
Legal liability is an issue for the institution in case of client injury or accident involving
the animal. Also, legal obstacles may not permit animals to be in a facility or housed with
residents (Howell-Newman & Goldman, 1993).
Potential negative problems may also arise for the animals such as injury by a client, other
animals present (Howell-Newman & Goldman 1993), and infection contracted from clients
(Khan & Farrag, 2000).
Casey (1996) lists the following potential problems:
■ Minor injuries to clients from sharp claws or scratches
■ Animal jumping unexpectedly
■ Animals shedding and carrying fleas
■ Some animals, such as rabbits may nip
■ Clients may get overexcited, over stimulated, or overwhelmed
■ Inadequate screening of animals and/or handlers
■ Animals become fatigued
■ Clients may become scared o f the animal
Strategies to avoid negative implications and problems:
■ A policy and procedure manual for all of the presented items should be written
■ Involve the infection control department of the facility in developing some of the
procedures below (Eames & Eames, 1997)
■ Requiring proper screening, training and certification of therapy animals (Khan & Farrag,
2000)
■ Requiring physical examinations of therapy animals (Khan & Farrag, 2000)
* Restriction of animals from food preparation and service areas (Khan & Farrag, 2000)
55
■ Implementing hand washing procedures after contact with animals (Khan & Farrag,
2000)
■ Adequate education of staff (Casey, 1996)
■ Supervision of all animal interactions by staff or volunteers (Khan & Farrag, 2000)
■ Knowing client limitations and tolerances (Casey, 1996)
■ Appropriate scheduling of animal therapy times (Khan & Farrag, 2000)
■ Creation of policies and procedures for protection of clients with allergies, open wounds,
splenectomy, and immunosuppression (Khan & Farrag, 2000)
■ Adequate precautions for clients on transplant units (Khan & Farrag, 2000)
■ Bathing the animal 24 hours prior to visiting (Khan & Farrag, 2000)
■ Allowing clients to wear T-shirts, smocks, or hospital gowns over regular clothing (Khan
& Farrag, 2000)
■ Respecting basic animal welfare issues such as providing a safe environment, appropriate
handling, and access to water. (Eames & Eames, 1997)
Section Five
Related Laws
When considering laws related to using animals as a therapeutic modality, the primary
category applicable is that of service animals. “Unlike therapy dogs [animals], both state and
federal law protect service dogs [animals]” (Hanebrink & Dillon, 2000, p. 16). The
Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA) are
federal laws which govern the access of rights to service dogs and their owners. Also, the
Department of Justice has regulations to define service animals as specifically trained to
perform tasks which will benefit persons with disabilities and they have published manuals to
56
clarify the regulations (Eames & Eames, 1997). Hanebrink and Dillon (2000) stated the
regulations direct employers, schools, public transportation, and others to allow access for
persons with disabilities and their service animals.
The intent of the Rehabilitation Act of 1973 and ADA (1990) was to provide broad and
extensive access to persons with disabilities and their service animal. Although, public
institutions are only required to provide reasonable accommodations in a timely manner
(ADA, 1990). For example, a grocery store may refuse to allow access to a service animal if
admission would require significant alterations to the service provided or jeopardize safety.
Although states vary in their definitions, there are two types of state laws applicable to
service animals:
1. Civil Rights Laws- Hanebrink and Dillon (2000) discuss most states have enacted civil
rights laws and state laws many times provide more protection than federal laws. “If
state laws provide less protection than the ADA, then the ADA supersedes the state laws
and provides the service dog [animal] user with greater protection (p. 16).
2. White Cane Laws- most states allow service animal users to call police or file criminal
charges against any institution denying access to the individual and the animal. The
ADA does not supersede these laws. “These criminal laws usually provide an absolute
right of access for service dogs [animal] users, with the only condition being the owner is
responsible for any damages done by the dog [animal]” (Hanebrink and Dillon, 2000, p.
16).
Eames and Eames (1997) emphasize laws pertaining to service animals should not be
confused with animal-assisted therapy programs policies. The authors recommend the
following steps when creating a policy for service animals:
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■ Check existing state and federal laws regarding the rights of individuals with
disabilities
■ Involve representatives from all departments of an institution
■ Recruit individuals with disabilities who have a service animal to join the
committee
■ Inservice all staff and departments on the policy and create a manual
■ Within the manual, include all contact information in case of problems
Other Legal Issues
Negligence- In the unfortunate event where a client became injured during AAA/AAT, the
law of negligence would apply in most situations (Bernard, 1995), According to Bernard
(1995), “negligence is the doing of something a person of ordinary prudence would not have
done under similar circumstances, or the failure to do something a person of ordinary
prudence would have done under the same or similar circumstances" (p. 65).
Negligence can be avoided by exercising ordinary care such as through: proper testing
and training animals and their handlers; training of involved staff; orienting clients and their
families to AAA/AAT; concise documentation of programs and therapy; close supervision of
animals, handlers and staff; re-evaluation and using feedback to improve program; and
adequate claims procedure.
Gross Negligence- The most serious threat to facilities and staff is gross negligence. “Gross
negligence has the want of even slight care or diligence or conscious indifference to the
welfare of others” (Bernard, 1995, p. 66). Gross negligence is also considered serious in that
insurance coverage may not be enough to cover legal costs.
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Errors and problems occur even with the best of intentions, although the law does not
provide immunity from liability. Individuals involved with AAA/AAT need to be aware of
the obligations to clients and facilities, and follow all policies and procedures specific to each
facility (Bernard, 1995)
Insurance
When creating AAA/AAT programs, facility liability policies must be reviewed in order
to determine if the programs are covered. Health professionals and student interns should
carry professional liability coverage. Some certification programs for AAA/AAT may also
provide insurance coverage for the handlers.
Section Six
Referrals and Reimbursement
When providing AAT services in a facility, various disciplines may refer clients
considered appropriate. A referral form can be created which includes basic client
information, physical and cognitive status and specific activities which may be suggested.
(Bernard, 1995)
Bernard (1995), an occupational therapist with extensive experience creating and
providing AAA/AAT services reported she has never experienced a problem with
reimbursement for animal-assisted therapy services. She stated this is because in order for
the registered occupational, physical or speech therapist to utilize the animal as a modality,
no additional physician’s orders are necessary.
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Section Seven
Related Surveys by Occupational Therapists
There are very few research studies involving the use of animals as a therapeutic
modality.
In 1994, Hughes surveyed occupational therapists specializing in developmental
disabilities or sensory integration who were using animal-assisted therapy in their practice.
Subjects were asked about their opinion of AAT, whether or not it was used in their facility,
reasons for using it or not, and their opinions as to its effectiveness specifically on children
with autism. Results indicated that 11% of those surveyed used AAT. Goals most
commonly used included improving socialization skills and improving awareness/attention.
Seventy-five percent of those using AAT stated their goals had been achieved, and 30%
stated this modality was motivating force for their clients. Problem issues included fear of
animals and unpredictable behavior of some animals.
Casey (1996) surveyed occupational therapists to identify how they used AAT and their
opinion of its worth. A questionnaire was given to 90 subjects who were asked demographic
information about the facility where they used AAT, duration of use, and the ages and
diagnosis of the clients. Also asked were the type of animal used, method and goals of
intervention, and the training background of the animal. A chi-square analysis indicated that
the responses to all questions except one were significantly different from chance.
Specifically, it was found the length of time therapists had been using AAT ranged from two
months to 19.5 years. The most frequent use was with individuals who experienced a
cerebral vascular accident (stroke). The individuals ranged in age from children to the
elderly with dogs used most often. Individual, as well as group intervention therapy was
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reported. The most prevalent related goals were to increase range of motion, to increase
socialization, and participation in therapy. Participant comments included pets being the best
catalyst in therapy, AAT being easily woven into occupational therapy goals, and occasional
dislike of dogs, as well as allergies (Casey, 1996).
Alfano (1998) also surveyed 200 occupational therapists on the use of AAT as a modality
in occupational therapy. Specifically, the study attempted to determine how many therapists
utilized AAT in their practice, how it was being used, and whether or not the therapists
viewed the modality as effective. Through descriptive statistical analysis, Alfano found a
large percentage of occupational therapists had heard of AAT but did not use it. Most
believed the modality to be effective. A large number of the therapists using AAT reported it
to be a motivational tool and helpful in assisting the client to reach set goals. The author
concluded that the lack of awareness or disbelief in the effectiveness of AAT is not
responsible for its limited use in occupational therapy (Alfano, 1998). As a result of the
above findings, Alfano then asked why occupational therapists are not using this modality in
their practice. Responses included AAT being unsuccessfully attempted in the past for
reasons such as disapproval from a supervisor, lack of proper information, resistance from
clients, and lack of cooperation on behalf of the animal (Alfano, 1998).
Subjects were asked to give opinions regarding appropriate protocols for administering
AAT. Most stated that an AAT specialist should train occupational therapists prior to using
the modality. Many also felt that occupational therapists should supervise intervention
sessions using AAT. Success with AAT could be achieved by increasing the knowledge,
skill level, and proper training of the handler as well as the therapy animal, in order to
minimize the risk of negative results. Most importantly, Alfano emphasizes the need for
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occupational therapy training programs to incorporate the use of animals as a therapeutic
modality in their curriculums (Alfano, 1998). Alfano also discusses the importance of
continuing education courses for therapists using this modality, networking with other
professionals, documentation of evidence of successful outcomes, and certification with
agencies such as the Delta Society (2000), in order to decrease resistance to using animals as
a therapeutic modality.
Section Eight
Related Theories and Occupational Science
in order to link occupational therapy practice to the use of animals as a therapeutic modality,
two occupational therapy theories are discussed, Object Relations Theory and the Model of
Human Occupation. Occupational Science, considered to be an academic discipline and
foundation for many present-day theories, is also addressed and applied to the use of animals as a
therapeutic modality within occupational therapy practice.
Object Relations Theory
Object relations theory is a psychodynamic frame of reference which provides an explanation
for how mental processes such as perceptions, thoughts, and feelings in the conscious and
unconscious awareness, influence one's selection of, participation in, and satisfaction with
occupation (Bruce & Borg, 2002). An individual creates relationships with humans and the
environment through occupation in order to satisfy needs, use skills, socially engage, and find
purpose in life. Object relations theory is a psychodynamic approach to understanding human
nature and what drives humans to engage in relationships (Klee, 2002).
Objects can be people, animals or things with which we form attachments. Freud (1937) used
the term object to describe an infant’s drive toward satisfaction. For example, children form
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relationships with stuffed animals, toys and pets. These are called transitional objects within this
theory. As an individual progresses through life, intense relationships form, which can also be
negative in nature, such as with alcohol and drugs. As the child develops, objects are
incorporated into the self, and become building blocks of the self-system (Klee, 2002). Klee
stated there are two types of drives, libidinal and aggressive. The libidinal drive, according to
Freud (1937), is an energy directed inward (to the self) or outward (to another person or thing—
objects). The aggressive drive is also energy used to plan actions which can remove obstacles in
order to provide satisfaction (Bruce and Borg, 2002). Investing energy in objects is how
individuals satisfy their needs. Modem object relations theorists believe humans have an innate
drive to form and maintain relationships, and this basic human need forms a context against
which other drives such as libidinal and aggressive drives gain meaning. Therefore, the object is
the basis of relational needs in humans. Bruce and Borg (2002) stated that although early
experiences influence the preference toward objects and ways of relating to them, objects and
occupations have no meaning in and of themselves. Individuals give them their own unique
meaning.
A blueprint of self is formed early in life with the involvement of relationships and objects.
As previously stated, an individual’s relationships and blueprints do not always follow a positive
course. Therefore, Klee (2002) explains how within this theory, psychopathology which is
acted-out in a current relationship is an expression of traumatic self-object internalizations from
childhood. It may also be said that psychological dysfunction may be described as being stuck at
a stage of development, unable to mature further. These discussions assist our understanding of
how humans form and maintain a sense of self as well as relationships with others through the
use of objects in their lives (Klee, 2002).
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Object Relations Theory can support and be applied to the use of animals as an occupational
therapy therapeutic modality. Some points of application are:
1. Objects are given meaning by the individual and are an avenue to provide meaning in the
world.
2. Each individual has an internal drive for meaning in their lives, to use their talents, and
love and be loved unconditionally.
3. Individuals need to feel physically and emotionally safe in order to be open and make
changes in their lives.
4. Bruce and Borg (2002) discuss how what is most important in an individual’s physical
and internal environment will naturally emerge and come to the forefront.
5. Occupational therapists need to respect individual preferences for need gratification and
recognize that not all approaches are equally suited for all situations.
(Bruce and Borg, 2002)
Specific references using animals as a therapeutic modality are listed below as they link to each
point of application, specifically:
1. Animals can be seen as an important object in one’s life, past or present. People attach
and form relationships with their animals. (Banks and Banks, 2002)
2. Animals can be given love and give back, unconditionally. The interactive nature of
caring for animals is deeply satisfying to many individual’s sense of self and an
unconditional source of gratification (Corson and Corson, 1978).
3. Animals can provide a sense of security through their protective nature (Adams, 2000)
Service animals have been shown to improve self-esteem, internal locus of control, and
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psychological well-being in individuals with severe ambulatory diseases (Allen et al,
1999).
4. An individual residing in a nursing home who has had an animal all their life may express
a continued need for the presence and gratification of this object (Banks and Banks,
2002 ).
5. Animals provide an opportunity to interact and receive feedback about one’s nurturing
style. Therefore, through occupational therapy, clients are encouraged to understand their
own behavior, are given opportunities to develop new styles, and change the way in
which one relates to human and non-human objects, while participating in occupation. It
is important to also note that not everyone will find meaning through interactions with
animals (Campbell-Begg, 2000).
The Model of Human Occupation
Kielhofner and Burke (1980) described the Model of Human Occupation (MOHO) as an
open or dynamic system, which influences occupational behavior in individuals. “Being
engaged in occupation means doing culturally meaningful work, play, or daily living tasks in
the stream of time and in the context of one’s physical and social world” (Kielhofner, 1995, p,
3). Occupation, according to Kielhofner and Burke (1980), is the action or doing in which
humans occupy their world. Occupational behavior occurs when one makes choices and takes
action. Humans are occupational by nature, thus needing to be active.
MOHO describes the human open system as a cycle which influences occupational
behavior. This systems theory calls information coming into the human being input. This
information is internally processes as throughput. Based on how and individual processes and
forms beliefs about this information, he or she will perform behavior or react emotionally.
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This response is called output. Lastly, information that comes back into the system from the
environment is called feedback (Kielhofner & Burke, 1980).
This model emphasizes how individuals continuously engage in this feedback loop.
Information is processed (step number two of the cycle) via three subsystems:
1. The Volition subsystem consists of three components: personal causation, valued
goals, and interests. These components influence behavior and are differentiated
out of one’s innate urge to explore and master the environment. They also
incorporate information from experience to form internal symbolic representation.
The enactment of occupational behavior and performance is guided by these
components. (Kielhofner & Burke, 1980)
2. The Habituation subsystem consists of habits and roles. Habits guide human
automatic behavior and do not always require conscious attention (Kielhofner &
Burke, 1980). According to Bruce and Borg (2002), many people find security in
their habits and may feel uncomfortable when changing them. Kielhofner, (1995)
explains how roles are images individuals keep regarding the positions held in
various social groups and of the obligations with those positions.
3. The third subsystem, Performance, is responsible for influencing occupational
behaviors via skills and the constituents of skills. Skills are further defined as
perceptual motor skills, process skills and communication/interaction skills
(Kielhofner & Burke, 1980). Bruce and Borg (2002) also state that this
subsystem is constantly interchanging information between the constituents and
the environment in the processing of information during problem solving and
actions.
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The environment significantly impacts on an individual’s behavior by providing feedback
about the output, or actions taken. The environment is believed to be comprised of components:
objects, tasks, social groups and culture (Kielhofner, 1995). Objects are used by individuals to
perform tasks. Tasks are used for performance in the environment. Social groups are natural
collections of individuals such as clubs or families. Culture refers to the values and technology
that affect an individual’s performance.
Kielhofner (1995) discussed a person’s functional status as being in order or disorder. Order,
connotes a state of health with positive feedback loops and successful performance of daily
living tasks. To explain this concept further, the term occupational function has also been used
to suggest the person is able to choose, organize, or perform occupation without difficulty (Bruce
& Borg, 2002). The person is able to meet social demands with positive feedback from the
environment. Disorder connotes the inability to perform occupational tasks, decreased or absent
role performance, and the inability to meet role responsibilities (Kielhofner, 1995). Bruce and
Borg (2002) discussed the concept further using the term occupational dysfunction to reflect
impaired occupational performance. Dysfunction occurs when an individual has difficulty
performing, organizing or choosing occupations, or when occupational behavior results in a
decreased quality of life. Occupational dysfunction can impact the cycle negatively including
one’s habits, volition, performance and the ability to negotiate in the environment.
MOHO looked at the development of occupation as a lifelong process, which includes
changes in the person as well as the environment. As developmental changes naturally occur,
the human system must learn, relearn and adapt in order to respond to, and maintain an
appropriate level of function. Occupational development is a process of transformation with
periods of stability followed by transition, and then eventually, a new order of behavior.
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MOHO can support and be applied to the use of animals as an occupational therapy
therapeutic modality. Here are some examples of this model’s application:
1. Individuals are able to engage in meaningful activity through the use of animals as
a therapeutic modality. This directly impacts one’s volitional system and
motivates a person in positive way.
2. The use of animals in therapy may inspire a behavior change such as increased
socialization or communication.
3. The positive and direct feedback encourages a person to perform this occupational
behavior (of interaction with an animal) over and over, again.
4. In the volitional subsystem, values are seen as leading to a sense of personal
obligation and appropriate behavior.
5. Within the habituation subsystem, it is evident that caring for an animal requires
the development of a daily routine, habits, and the role of caregiver.
6. The performance subsystem is positively influenced by animals as well.
Specific references using animals as a therapeutic modality from Alfano (1998) are listed
below as they link to each point of application, specifically:
1. Caring for an animal who is dependent on humans for basic needs can prove to be
a rewarding and worthwhile occupation to some individuals.
2. Increased socialization or communication is an example of positive change from
maladaptive behavior, disorder, or occupational dysfunction.
3. Alfano states how individuals are able to foster a sense of mastery over the
environment through the unconditional acceptance of animals. One’s belief
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about his or her effectiveness is reinforced by successful interaction with the
environment.
4. A simple activity such as brushing a dog may be considered a valuable activity to
an individual because he or she is performing a necessary task that is socially
acceptable. The appreciation of animals is inspirational and motivating. This
value increases a sense of self worth.
5. Many individuals have lost important personal roles in the process of becoming a
patient or client. Helping to care for an animal may help to fill significant roles
and shape one’s identity in a productive way.
6. Perceptual motor skills, such as increasing upper extremity range of motion while
brushing a dog are necessary. Process skills may be enhanced by engaging the
individual in gathering and recording information about the animal. Individuals
can engage in communication and interaction skills as the animal will offer
unconditional acceptance. Also, animals can provide a nondiscriminatory attitude
toward individuals with disabilities, thus enhancing overall occupational
performance.
Occupational Science
Occupational science is the study of occupation as it relates to the human experience. It
focuses on scholarly investigation of human and nonhuman occupational behavior, the meaning
of human occupation, and the human as an occupational being (Hinojosa and Blount, 2000).
Occupational science was founded by Elizabeth June Yerxa at the University of Southern
California in 1989 (Yerxa, Clark, Frank, Jackson, Parham, Pierce, Stein and Zemke ,1990). The
science emerged as the 20th century needs, beliefs, and values of the occupational therapy
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profession grew and changed (Neistadt and Crepeau, 1998). It is important to note that
occupational science is considered to be an academic discipline, not a theory. The authors of
occupational science hoped to further validate and offer foundational principles to occupational
therapy, as a profession, emphasizing its viability and credibility. While occupational science is
considered an academic discipline and occupational therapy is a profession, both emphasize
occupation.
Occupational science assists in the understanding of purposeful activity via a philosophical
and theoretical base. Participation in purposeful or meaningful activity is the core principle of
occupational therapy philosophy. Meaningful participation in purposeful activity helps
individuals create who they are through occupations and connects them to the outside world.
Specifically, occupational science focuses on areas such as adaptation, work, and play as they are
valued within human culture. (Hinojosa and Blount, 2000)
Yerxa et al (1990) summarized five assumptions regarding occupational science as listed below.
1. Humans are occupational beings who are driven toward culturally and personally
meaningful activities.
2. Within occupational science, humans make choices in regards to their occupations which
are influenced by their passions and convictions. While making choices, creating
themselves as occupational beings, and engaging in meaningful occupation, the human is
the author of his or her life story.
3. Humans do not just have a routine of daily occupations. Instead there is subjective
meaning and symbolic significance of their occupations. In other words, there are
reasons why individuals engage in the occupations in which they choose.
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4. Humans are capable of responding to challenges as well as creating a healthy and
meaningful life. When interacting with the environment, humans have a drive to explore
and achieve competence.
5. Occupations occur within certain environments such as physical, social, political, or
historical areas. The environment can either enable or hinder engagement in occupations.
Occupational scientists will research theories of occupation and broaden them in order to
enhance their study and application (Hinojosa and Blount, 2000). As an academic discipline, it
is hoped that many new theories will continue to be generated from the study of occupational
science.
Specific references using animals as a therapeutic modality are listed below as they link to each
of the five assumptions, specifically:
1. Roenke & Mulligan (1998) discuss how AAT parallels the basic foundations of
occupational therapy theory. It also compliments well-being through the doing and
engaging in meaningful activity. Owning and caring for a pet is a daily occupation for
many individuals and may have increased meaning for those living alone. Animal-
assisted activities may offer an opportunity for meaningful interaction for
institutionalized clients.
2. Allen et al (1998) reflects on AAT as being a highly valued occupation for some clients.
For those who value pet ownership as an occupational role, intervention incorporating the
client’s animal (as appropriate), might enable occupational performance, provide
motivation, and satisfaction. The human may author his or her own life story by
incorporating meaning into a client-centered therapeutic environment.
3. Roenke & Mulligan (1998) discussed how occupational therapists may also use animals
to accomplish cognitive, social or leisure goals specific to client needs. This approach
may be offered in a client-centered environment, considering the client’s roles, culture,
physical abilities and meaningful occupations.
4. Yerxa (1998) discussed the loss of occupational role on human health and how an
individual’s daily routines are primary sources for health. The author explains how the
human spirit strives for a healthy engagement in occupation by self-initiation and self
directed activity. Activity is productive for the person and contributes to others. The
author emphasizes that idea of health does not exclude individuals with a disability as
they also have the potential for well-beingness and good quality of life. The use of
animals as a therapeutic modality for increasing health and general wellbeing has been
researched throughout the literature and was specifically addressed in section 3 of this
chapter. Studies from Corson and Corson (1975 & 1978) laid the groundwork for future
research on the benefits of animals in therapy.
5. Reilly (1962) stated individuals have a strong need for occupation and to master, alter,
and improve their environment. Also, according to Camp (2000, p. 509), “Service dogs
assist persons with disabilities to achieve greater independence in a variety of
performance areas, including, activities of daily living, socialization, emergency alerting,
and environmental control” .
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Section Nine
Concluding Statements
It is evident the human-animal bond is a driving force toward the appeal and interest in using
animals as a therapeutic modality. Animals provide meaningful relationships and interactions,
affection, and pleasure for all individuals, regardless of their health status or disability. Benda et
al, (2000) describe animals as non-judgmental and blind to deficits and unattractive qualities.
The feedback and validation animals give an individual are direct, simple, unequivocal,
consistent, and reliable.
Pets have the ability to elicit positive emotional responses from their owners. Positive
responses are generated when a pet shows enthusiasm for seeing its owner. These responses may
initiate from tactile contact and communication which may take the place of speech, in the
human-animal relationship. The pet may then be seen as a source of comfort through the
continual matching of the pet with positive feelings. Therefore, Siegel (1993) concludes it is not
surprising when humans are experiencing stress they often turn to companion animals. Because
of these positive qualities, animals have in the past, and continue to, serve as a beneficial
adjunctive therapeutic modality in the treatment of many clients, particularly when traditional
methods have proven ineffective.
Potential problems with using animals as a therapeutic modality are minimal. For the most
part, these potential problems are controlled with sound policies and procedures, certifications,
supervision by facility staff, and involvement of infection control departments, as appropriate.
Although research is limited in occupational therapy specifically, using animals as a
therapeutic modality appears to serve as an effective adjunct tool within the practice.
Occupational therapy theory does also appear to have linkages to the use of animals as a
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therapeutic modality. The full extent of its use needs to be determined further in order to increase
its justification and promotion within our profession. Academia does need to begin the process
by teaching not only clinical application of the use of animals as a therapeutic modality, but also
the theory behind it.
The purpose of this study was to survey occupational therapy programs in order to determine
whether or not they are teaching the use of animals as a therapeutic modality, and if so, are they
linking theory to clinical practice. Lastly, based on the results of the research, this dissertation
will culminate in the creation of a curriculum model specific for occupational therapy education
and practice.
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CHAPTER 3
Design of the Study
This study developed as a result of an interest in teaching occupational therapy students about
using animals within the intervention process. Many benefits of AAA/AAT have been
documented in the literature, although most do not involve occupational therapists. Although, in
reviewing occupational therapy theory as well as the Standards of the Profession (Appendix A),
it is clear that many clients of occupational therapy may benefit from using animals as a
therapeutic modality in practice. In order for clients to properly benefit, occupational therapists
and students must be educated on this topic. Therefore, much more research is needed,
specifically, within the occupational profession.
The purpose of this study was to research accredited entry-level graduate occupational
therapy programs who are teaching the use of animals as a therapeutic modality in order to
establish a potential need to develop a curriculum model. The purpose of this chapter was to
describe the design of the study in terms of the subjects, the materials (survey and interviews),
and the data collection and analysis procedures, in order to answer the research questions and
hypotheses. The subjects included the population, invited sample, responding sample, and data-
generating sample. The research design was conducted in two parts: a quantitative and a
qualitative methodology. The quantitative design was chosen in order to first, determine general
information on the topic. Then, the qualitative design, through in-depth interviews, was intended
to further clarify the research questions, as well as understand the experiences of the subjects and
the meaning behind their experiences. The materials included a survey which was mailed to the
invited sample for the quantitative design. The qualitative technique used a field interview data
sheet which was used for phone interviews of four volunteered subjects.
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The Subjects
The research population of this study was comprised of program directors from the 103
accredited, entry-level master’s degree, occupational therapy programs (Appendix B). Entry-
level master’s degree programs were chosen because the curriculum model is specifically
intended for use at this level of occupational therapy education. The invited programs were from
colleges and universities across the United States, and were a combination of public and private
institutions.
As occupational therapy program directors were specifically requested to be involved in the
study, the following are requirements for a program director according to the Standards of the
Therapy Association, Inc. (1998), (Appendix A):
Standard A.2.2: “The program director shall be an occupational therapist, initially certified
nationally, and credentialed according to state requirements. The director shall have a minimum
of five years of professional experience in areas related to clinical practice, administration, and
teaching. At least two of these years must be a full-time academic appointment with teaching
responsibilities” (p.2).
Standard A.2.3: “The program director shall have academic qualifications comparable to other
administrators who manage similar programs within the institution; senior faculty status; and
relevant experience in higher education requisite for providing effective leadership for the
program, its faculty, and its students ” (p.3).
Standard A.2.5: ‘T h e program director and faculty must possess the necessary academic and
experiential qualifications and backgrounds, identified in documented descriptions of roles and
responsibilities, appropriate to meet program objectives” (p. 3).
In order to ensure a maximum response rate, the population of 103 programs was also chosen
as the invited sample for this study. The responding sample was comprised of 49 subjects and the
data-generating sample was also 49, as no surveys needed to be eliminated. Within the
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qualitative methodology, only four appropriate faculty names were volunteered and participated
in the interview. These individuals were all occupational therapy professors interested and
involved in AAA/AAT in the classroom and/or in their clinic practice.
Materials
The methodology of this study was in two parts: First, quantitative data was collected
through a survey sent to the program director of each of the 103 accredited, entry-level master’s
degree program in occupational therapy as listed by the American Occupational Therapy
Association website (www.aota.org). The cover letter (appendix C) and survey (appendix C)
were created by the researcher.
In the fall of 2002, the survey was initially created after reviewing the master’s thesis, A
survey o f the use o f animal-assisted therapy as a modality in the field o f occupational therapy
(Alfano, 1998). The author's survey was used as a guideline and expanded upon, in-depth, for
this study. After the initial survey design was completed, two occupational therapists/faculty
members and two university faculty, uninvolved with occupational therapy, were requested to
pilot and review the survey and interview questions for content and editorial recommendations.
The pilot was intended not only to have specific expertise from an occupational therapy
perspective, but also recommendations from experts in designing surveys, in general. The
survey was reviewed for expansion of the statistical options for data collection, proper use of
language, validity, and reliability. As a result, the survey was improved for user friendliness,
particularly, for example, with four of the fourteen questions put on a likert scale. Appendix D
contains the request letter and final review letters of the survey from the involved faculty
members.
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The survey consisted of 14 open and closed-ended questions, with four on a likert scale.
Survey questions were created to directly parallel and answer the research questions and
hypotheses. Survey questions asked whether or not programs are teaching the use of animals as
a therapeutic modality. The first question was intended as a closed-ended yes/no inquiry in order
to direct the subject in a specific track. If the subject answered yes to the question #1, he/she
was requested to continue on to #2. Questions #2 through #6 asked specific questions regarding
how, where, and when the topic is taught within the curriculum. If the subject answered no,
he/she was requested to skip to question #7. Questions #8 & #9 asked about student and faculty
involvement in using animals as a therapeutic modality. Question #10 asked about barriers to
teaching this modality. Questions #1-14, on a likert scale of strongly disagree to strongly agree,
asked about the program, faculty, and student views of teaching as well as interest regarding the
use of animals as a therapeutic modality. Lastly, the survey requested a name and contact
information of an appropriate faculty member involved in teaching this topic who might
volunteer for an interview.
The qualitative technique of this study was addressed through a case study format, and the use
of interviews. The nine interview questions (Appendix E) were not only designed to expand
upon the survey questions, but also to elicit personal and professional experiences the subject
encountered with using animals as a therapeutic modality, as well as experiences in the teaching
of this topic. Merriam (1998) stated a case study design is used to obtain an in-depth
understanding of a condition or issue. The emphasis of the study is on the process, context,
discovery, and meaning. Case studies are a unique form of qualitative research because they are
intense descriptions and analyses of a single unit or a bounded system, which could include a
person, program, group, intervention, event, or community. Lincoln and Guba (1985) discussed
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qualitative methods as related to a naturalistic paradigm in which the human is the instrument.
Meaning is emphasized within a natural setting, or context, which lends itself to the human
instrument building upon his or her own tacit knowledge. Generally, within this paradigm,
methods of inquiry such as interviews and observations are used to collect qualitative data.
As a result, the questions were designed to encourage and elicit subjects’ stories and
experiences using animals as a therapeutic modality, particularly with the involvement of
occupational therapy students. Interview questions asked about how he/she became interested in
the topic, how he/she learned about it, if there are any curriculum materials available, viewpoints
and experiences, as well as positive and negative issues surrounding the teaching of this topic.
Most importantly, each subject was asked to describe the first time he/she observed this
intervention and how it affected him/her as an occupational therapist. The interview was
designed to last a maximum of one hour in length.
Procedures
Data Collection Plan
Information regarding occupational therapy programs was located on the website of the
American Occupational Therapy Association (www.AOTA.org). Accredited, entry-level
master’s degree programs in occupational therapy, which are 103 in number, were chosen as the
invited sample (Appendix B). In the fall of 2002, a cover letter and survey was sent to the
program director of each occupational therapy department within the invited sample. The cover
letter described the purpose of the survey and gave general instructions for completion. An
introductory paragraph within the actual survey explained specific important terms to be used
and parameters of the study. The program directors were asked to either complete the survey
him/herself or, identify an appropriate faculty member to complete the survey. An appropriate
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faculty member was described as someone who had taught the use of animals as a therapeutic
modality in the occupational therapy curriculum and was potentially willing to volunteer for an
interview. Surveys were coded from 1-103 for confidentiality. Reminder post cards (Appendix
C) were also mailed to all of the above subjects ten days later. Subjects were not compensated in
any way to complete the survey.
Each survey returned was reviewed to ensure it was completed accurately in order to be used
in the data-generating sample. No surveys were eliminated. Then, each survey was placed in
numerical coding order and entered into an Excel spread sheet (Appendix F).
Qualitative data was then obtained from the four identified faculty members who volunteered
to participate in a telephone interview which was not recorded. This interview process totaled
approximately 45 minutes to one hour long, depending upon the amount of information the
subject was able to present. Before beginning the actual interview, each subject was read an
introductory paragraph (Appendix E) which explained the directions of the process and clarified
terminology to be used such as the use of animals as a therapeutic modality. The Field Interview
Data Sheet was completed for each subject during the interview by the researcher. (Appendix E)
This sheet contained the nine interview questions asked by the researcher. The questions were
created in a primarily open-ended format in order to hear subjects’ stories and experiences
surrounding the use of animals as a therapeutic modality. Specifically, the outcome was
intended to further understand the subjects’ experiences and viewpoints in regards to:
■ teaching and involving students in this modality.
■ the impact this modality has had on them as an OT/individual.
■ the impact this modality has had on past clients.
■ how they felt OT theory may apply to this modality.
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The interview also attempted to identify actual teaching tools involved with occupational
therapy courses and using animals as a therapeutic modality. In addition, the interview process
intended to further clarify applicable research questions and hypotheses.
As Seidman (1998) discusses, an in-depth interview should encompass an interest in
understanding the experience of others, and their meaning behind the experience. The author
further states the worth of hearing individual stories while interviewing.
Data Analysis Plan
After the quantitative data was collected to an Excel spread sheet, it was then coded in
preparation for analysis (Appendix F). Specifically, the data obtained through this study was
analyzed through the use of the Statistical Package for the Social Sciences (SPSS). Data from
the survey questions were analyzed using frequency distributions. Data from questions 11-14
were analyzed using cross-tabulations, in order to attempt to show a potential relationship
between two chosen sets of responses (Porter & Watkins, 2000). In addition, these statistical
tests were selected on the basis of the sample size, the coding of survey questions, information
sought, and their analytical purpose.
The qualitative data was collected from the four interviews conducted and recorded on the
Field Interview Data Sheet (Appendix E) during the interview. Following the interviews, each
subject’s data was then compiled together under the appropriate interview question (Appendix
E). The transcripts of the data were read and labeled into categories. The data was then
organized, classified, and sorted by hand in order to be analyzed for common themes and
documented (Appendix E). (Seidman, 1998)
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Research Questions and Hypothesis
Table 4
Research Questions, Hypotheses and Statistical Analysis
Research Questions Hypothesis Statistical Analysis
Research Question #1 Hypothesis #1
Are occupational therapy A limited number of Frequency distributions
programs teaching the use of occupational therapy programs

Cross-tabulations
animals as a therapeutic are teaching the use of animals
modality? How many? as a therapeutic modality
within their curriculum.

(Survey Question #1)
Research Question #2
Where in the curriculum is the No corresponding research Frequency distributions
topic being taught? hypothesis

Interview process
(Survey Questions #2,3 & 4)
Are the programs teaching the O f the occupational therapy Frequency distributions
topic focusing on clinical programs teaching the use of

Interview process
application, theory, or both? animals as a therapeutic
modality, most are not linking

(Survey Questions #5 & 6)
(table continues)
occupational therapy theory to
(Interview Question #5)
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clinical practice
What are the perceived No corresponding research Frequency distributions
outcomes of teaching about hypothesis Interview process

animals as a therapeutic
modality?
Have students expressed an Occupational therapy faculty Frequency distributions
interest in this topic? perceive students as being Cross-tabulations

interested in this topic.
(Survey Question #14) Interview process
Are occupational therapy Occupational therapy faculty Frequency distributions
programs involving students perceive students as being Interview process

in AAA/AAT? interested in this topic.
(table continues)
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Does occupational therapy No corresponding research Frequency distributions
faculty have an interest and/or hypothesis Cross-tabulations
certification in providing
AAA/AAT?
(Survey Questions #9 & 13)
Is occupational therapy faculty No corresponding research Frequency distributions
using AAA/AAT as part of their hypothesis Interview process
clinical practice?
Research Question #9 Hypothesis # 1
What are the barriers to A limited number of Frequency distributions
teaching this topic? occupational therapy programs Interview process
are teaching the use of animals
as a therapeutic modality. (table continues)
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Does occupational therapy A limited number of Frequency distributions
faculty view this topic as an occupational therapy programs Cross-tabulations
important adjunct to the are teaching the use of animals Interview process
intervention process? as a therapeutic modality.
(Survey Questions #11, 12)
Research Question # 1 1 Hypothesis #2
What is an example of a current Of the occupational therapy Interview process
curriculum or lecture series ? programs teaching the use of
animals as a therapeutic modality,
most are not linking occupational
therapy theory to clinical practice.
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Summary
This chapter presented the subject, methods, materials, and procedures of the data collection
plan and data analysis plan, hypotheses, and research questions for the present study. The
directional hypotheses and research questions of this study (below) where specifically intended
to be answered through the survey and interview process. The study’s analysis of findings is
presented in the next chapter.
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CHAPTER 4
Analysis of Findings
The purpose of this chapter was to answer the research questions, hypotheses, and present the
findings of the research study which occurred in two parts: the data obtained from the surveys
provided information for the quantitative analysis and the data obtained from the interviews
provided information for the qualitative analysis. Quantitative data was analyzed through the use
o f frequency distributions and cross-tabulations. Qualitative data was analyzed through the
categorization and sorting of common themes. Results from both designs were then synthesized
and summarized. Both quantitative and qualitative data were analyzed in order to bring further
meaning and depth to the conclusions of the dissertation. This chapter also culminated in a
curriculum model in which information was compiled from the literature review, data analysis,
and the researcher’s experience.
Quantitative Analysis
While 103 program directors were mailed surveys and requested to participate in the study,
the sample resulted in 49 respondents, or a 47.6 % response rate. Of the responding sample, no
surveys were eliminated. Therefore, the data collection sample resulted in 49 subjects or 47.6 %
of those surveyed. Within the qualitative methodology, only four appropriate faculty names
were volunteered and participated in the interview process. Survey questions were coded and
data collected in an excel spread sheet. (Appendix F) The quantitative data was analysis was
performed through the use of frequency tables and cross-tabulations. The research and survey
questions were answered as follows:
Research Question I (RQI) - Are occupational therapy programs teaching the use o f animals
as a therapeutic modality? How many?
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Survey Question I (SQI) - Within the OT program, is the use o f animals as a therapeutic
modality taught?
Of the 49 occupational therapy programs responding to the survey, only 13 programs, or
26.5%, teach the use of animals as a therapeutic modality in their curriculum. Thirty-six
programs, or 73.5%, do not teach the use of animals as a therapeutic modality. Therefore,
questions number two through four will have a maximum of 13 respondents. (Table 5)
Table 5
SQI- Within the OT program, is the use o f animals as a therapeutic modality taught?
SOI Frequencv Percent
Yes 13 26.5
No 36 73.5
N=49
RQ2-Where in the curriculum is the topic being taught?
SQ2- Is it offered in an elective course, or imbedded in a required course?
SQ3- What is the name o f the course in which it is taught ?
SQ4- In what year o f the curriculum is the use o f animals as a therapeutic modality
taught?
O f the 13 programs teaching this modality, 12 subjects, or 92.3%, have imbedded the topic
into a required course. Only one program offers an elective course on using animals as a
therapeutic modality. (Table 6)
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O f the 13 programs teaching this modality, 3 programs, or 23.1% offer the topic in
assessment, intervention, introduction, and OT seminar courses. Two programs offer the topic in
an introduction/OT seminar course, while another two programs offer it in a
rehabilitation/healthcare course. The remaining six schools offer the topic individually in the
following courses: assessment/intervention, occupation-based, OT theory, special issues, and an
introduction/seminar course. (Since the topic is imbedded into required curriculum, there were
not specific names of courses offered within the survey responses. Instead, subjects named the
type of course, such as an intervention course. Therefore, the data analysis coded the responses
as such.) (Table 7)
O f the 12 subjects, 5 programs, or 41.7%, stated the modality is primarily taught in the first
year of the OT program. Two programs teach the modality in the first and second years of the
program. Four programs teach the modality individually in the second, third, and fourth years of
the program. One program teaches throughout the first to the fifth year of the OT program. One
subject did not respond to this question. (Table 8)
Table 6
SQ2- Is it offered in an elective course. or imbedded in a required course?
S02 Frequency Percent
Elective course 1 7.7
Imbedded in
a required course 12 92.3

N=13
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Table 7
SQ3- What is the name o f the course in which it is taught?
S 03 Freauencv Percent
Assessment & intervention 1 7.7
Occupation-based 1 7.7
OT theory-based 1 7.7
Introduction/OT seminar 2 15.4
Rehabil itation/healthcare 2 15.4
Special issues I 7.7
Throughout curriculum 1 7.7
Assessment/intervention/intro
& OT seminar 3 23.1
Occupation-based/intro
& OT seminar 1 7.7

N= 13
90
Table 8
SQ4- In what year o f the curriculum is the use o f animals as a therapeutic modality taught?
SO Frequency Percent
1st year 5 41.7
2nd year 1 8.3
3rd year 1 8.3
4th year 1 8.3
5th year 1 8.3
1st & 2nd years 2 16.7
1st through 5th years 1 8.3

N=12
RQ3- Are the programs teaching this topic focusing on clinical application, theory, or both?
Which theories/theorists are linked to the topic?
SQ5- Is the subject taught with a theoretical approach, clinical approach, both, or within
fieldwork?
SQ6a- I f a theoretical approach is taught, which theories are incorporated?
SQ6b- Which clinical experts are referred to?
O f the 12 subjects, 8 subjects, or 66.7%, teach this topic with a clinical application only.
One subject stated the topic is taught with a theoretical approach, only. One subject stated the
topic is taught with both theory and clinical application, while another subject stated it is taught
with a clinical application at the fieldwork site. One subject did not respond to the question.
(Table 9)
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Table 9
SQ5- Is the subject taught with a theoretical approach, clinical approach, both, or within
fieldw ork?
S05 Frequency Percent
With a theoretical approach only 1 8.3
Clinical application only 8 66.7
Both theory and clinical application 1 8.3
At fieldwork site 1 8.3
Clinical application and at fieldwork site 1 8.3
N=12
Of the 13 subjects, only four responded to survey question 6a. None of the four subjects
listed a specific theory taught related to the use of animals as a therapeutic modality. O f only
two subjects, neither referred to a clinical expert, although they involve guest speakers, such a
service animal organizations when teaching the use of animals as a therapeutic modality. One
subject referred to general psychology theories and another stated it depends on the course this
modality is taught in. (Table 10 & 11)
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Table 10
Q6a- I f a theoretical approach is taught, which theories are incorporated?
SQ6a________________________________ Frequency Percent
depend upon the course 1 2
psychology theories I 25
no specific theory 2 50
N=4
*No response= 11
Table 11
SQ6b- Which clinical experts are referred to ?
SQ6b__________________________________ Frequency Percent
Guest speaker, no specific theorist 1 50
Organizations, no specific theorists______________1________ 50___________________________

N=2
No response= 11
RQ3- What are the perceived outcomes o f teaching about animals as a therapeutic modality?
SQ7- What are your curricular goals fo r teaching this course?
O f the 12 subjects, 4 subjects, or 33.3% stated their curricular goals for teaching this modality
are to understand the therapeutic use of animals and how it applies to daily life and occupational
roles. Three subjects stated their goals are to introduce emerging practice areas and alternative
medicine. One respondent’s goal is to identify resources available to clients in order to increase
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independence and quality of life. One subject uses this modality to introduce intervention
techniques. One subject teaches the modality to help students understand the use of animals in
therapy, and another respondent added to this comment by stating it is important for students to
understand how animals fit into an individual's daily life and roles. One subject stated there are
too many goals to list. One subject did not respond to this question. (Table 12)
Table 12
SQ7- What are your curricular goals fo r teaching this course?
S07 Freauencv Percent
Identify resources, learning, & practice 1 8.3
Introduce intervention techniques 1 8.3
Introduce emerging practice areas
& alternative medicine 3 25
Too many to list I 8.3
Understand animals, daily life, roles
& therapeutic use of animals 4 33.3
Understand therapeutic use of animals
& introduce interventions 1 8.3
Understand animals, daily life, roles,
& introduce interventions 1 8.3

N=12
No response= 1
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RQ5- Have students expressed an interest in this topic?
S Q M - O ur students have expressed interest in learning about this topic
Three of 49 subjects, or 6.1%, strongly agreed and twenty, or 40.8%, agreed that their
occupational therapy students are interested in learning about the use of animals as a therapeutic
modality. Seventeen subjects, or 34.7%, neither agreed nor disagreed with this statement.
Seven, or 14.3% disagreed and 2, or 4 .1 strongly disagreed that their occupational therapy
students are interested in learning about the use of animals as a therapeutic modality. (Table 13)
Table 13
SQ14- Our students have expressed interest in learning about this topic
S 014 Frequency Percent
Strongly disagree 2 4.1
Disagree 7 14.3
Neither agree/disagree 17 34.7
Agree 20 40.8
Strongly agree 3 6.1

N=49
RQ6- Are occupational therapy programs involving students in AAA/AAT?
SQ8a- Have students been involved in programs outside o f the classroom using animals as
a therapeutic modality ?
SQ8b- I f yes, how?
95
Forty of 49 subjects, or 8 1.6% reported that students were involved in AAA/AAT outside of
the classroom (multiple responses allowed): in Fieldwork- 32.3%, volunteering on their own-
35.5%, through service learning- 15.8%, with clinicians- 10.52%. Only 1.3% have been
involved outside of the classroom with faculty who teach the modality. Nine subjects, or 18.4%,
reported that students have not been involved outside of the classroom using animals as a
therapeutic modality. (Table 14 & 15)
Table 14
SQ8a- Have students been involved in programs outside o f the classroom using animals as a
therapeutic modality ?
S08a Freauencv Percent
Yes 40 81.6
No 9 18.4
N=49
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Table 15
SQ8b- If yes, how?
S08b Freauencv Percent
With faculty who teach the course 1 1.32
With clinicians 8 10.52
In fieldwork 25 32.89
Through service learning 23 15.79
Volunteering on their own 27 35.53
Other 3 3.95
♦Multiple responses allowed
RQ7- Do occupational therapy faculty have an interest and/or certification in providing
AAA/AA 77
SQ9a- Are faculty members involved in programs outside o f the classroom using animals as
a therapeutic modality?
SQ9b- I f yes, does faculty hold a certification ?
O f 49 subjects, 42, or 85.7% stated that faculty members are not involved in programs outside
of the classroom using animals as a therapeutic modality. Seven subjects, or 14.3%, stated that
faculty are involved outside of the classroom. Only one subject of 49 is certified in AAA/AAT.
(Table 16 & 17)
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Table 16
SQ9a- Are faculty members involved in programs outside o f the classroom using animals as a
S 09a Frequencv Percent
Yes 7 14.3
No 42 85.7
N=49
Table 17
SQ9b- If yes, does faculty hold a certification?
S09b Frequencv Percent
Yes 1 2
No 48 98
N=49
RQ8- Are occupational therapy faculty using AAA/AAT as part o f their clinical practice?
(Question answered in interview component of qualitative analysis)
RQ9- What are the barriers to teaching this topic?
SQ10- What do you perceive as barriers to implementing programs using animals as a
therapeutic modality within your curriculum?
O f the 43 subjects to answer this question, 29.2% stated that the largest barrier to teaching this
modality is the fact that it is not a curricular priority. Barriers also included: lack of research on
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the topic, 15.6%, lack of experienced faculty, 14.6% and lack of room in the curriculum, 13.5%,
lack of physical space, 11.46%, lack of resources, 10.42% and lack o f interest in this topic,
5.21%. (multiple responses allowed) (Table 18)
Table 18
SQ10- What do you perceive as barriers to implementing programs using animals as a
therapeutic modality within your curriculum ?
SOlO Frequencv Percent
Lack of research on the modality 15 15.63
Lack of physical space 11 11.4
Lack of experienced faculty 14 14.58
Lack of room within the curriculum 13 13.54
Not a curricular priority 28 29.17
Lack of resources (animals) 10 10.42.
Lack of interest 5 5.21
♦Multiple responses allowed
RQ10- Do occupational therapy faculty view this topic as an important adjunct to the
intervention process?
SQ I 1- Our program views the use o f animals as a therapeutic modality as a valued
component o f the O T profession.SQI2- Our program views the use o f animals as a
therapeutic modality as a valued component o f the OT curriculum
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SQ I 3- Our faculty is interested in teaching about this topic
Of 48 subjects, two, or 4.2% strongly agreed that the use of animals as a therapeutic
modality is a valued component of the OT profession. Nineteen subjects, or 38.8% agreed
with this statement, while 20, or 40.8% neither agreed nor disagreed. Six subjects, or 12.2%
disagreed, and 1 strongly disagreed, that the use of animals as a therapeutic modality is a
valued component of the OT profession. Although, when asked if faculty viewed the
modality as a valued component of OT curricula, of 48 subjects, 21, or 43.8% neither agreed
nor disagreed with this statement. More specifically, two, or 4.1% strongly disagreed, and
17, or 34.7%, disagreed with the statement. Seven subjects, or 14.3% agreed, and one
strongly agreed, that faculty viewed the modality as a valued component of OT curricula. In
terms of faculty interest in teaching about this topic, of 48 subjects, 20, or 41.7% neither
agreed nor disagreed that faculty is interested. More specifically, four or 8.2% strongly
disagreed, and 15, or 30.6% disagreed with this statement. Eight subjects, or 16.3% agreed,
and one strongly agreed that faculty is interested in teaching about this topic. (Table 19, 20,
& 21)
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Table 19
SQ I I- Our program views the use o f animals as a therapeutic modality as a value component o f
the OT profession
SO U Frequencv Percent
Disagree 6 12.5
Agree 19 39.6
N=48
No response= 1
Table 20
SQ I 2- Our program views the use o f animals as a therapeutic modality as a valued component
o f the O T curriculum
S 012 Freauencv Percent
Disagree 17 35.4
Neither agree/disagree 21 43.8 (table continues)
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SO 12________ Frequencv Percent
Agree 7 14.6

N=48
No response=l
Table 21
SQ I 3- Our faculty is interested in teaching about this topic
SO 13 Frequencv Percent
Disagree 15 31.3
Agree 8 16.7

N=48
No response= 1
11. What is an example(s) o f a current curriculum or lecture series?
(Question answered in interview component of qualitative analysis)
Cross*tabulations:
SQ8a- Have students been involved in programs using animals as a therapeutic modality?, and
SQ8a- Have students been involved in programs using animals as a therapeutic modality?
Of 49 subjects, 3 strongly agreed and 19 agreed that students, who have expressed interest in
learning about the use of animals as a therapeutic modality, have also been involved in programs
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providing animal therapies. Fourteen subjects neither agreed nor disagreed with this statement,
19 agreed, and 3 strongly agreed. (Table 22)
Table 22
Cross-tabulation of SQSa & SQM
SQ8a & SQ14 SQ8a- Have students been involved
in programs using animals as a
SQM- Our students have expressed interest in Yes No
learning about this topic
strongly disagree 2
disagree 4 3
neither agree/disagree 14 3
agree 19 1
strongly agree 3
Total 40 9
N=49
103
SQ I I- Our program views the use o f animals as a therapeutic modality as a valued component
o f the O T profession, and SQI- Within the OT program, is the use o f animals as a therapeutic
modality taught?
O f 13 subjects who teach the use of animals as a therapeutic modality, 61.5% also agreed that
it is viewed as a valued component of the OT profession. None of the subjects strongly agreed,
15.4% neither agreed nor disagreed, 23.1% disagreed, and none strongly disagreed. Of the 36
who do not teach it, 5.7% strongly agreed, 31.4% agreed, 51.4% neither agree nor disagree, 8.6%
disagreed, and 2.9% strongly disagreed that the use of animals as a therapeutic modality is a
valued component of the OT profession. (Table 23)
Table 23
Cross-tabulation o f SQI I & S Q I
SQI 1 & SQI SQ I I- Our program views the use o f
animals as a therapeutic modality as a valued
component o f the OT profession
SQI- Within the OT program Strongly Disagree Neither Agree Strongly
Disagree agree/ agree

is the use o f animals as a
disagree
therapeutic modality taught ?
Yes 23.1% 15.4% 61.5%
No 2.9% 8.6% 51.4% 31.4% 5.7%
N=49
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SQI 2- Our program views the use o f animals as a therapeutic modality as a valued component
o f the O T curriculum, and SQI- Within the OT program, is the use o f animals as a therapeutic
modality taught?
O f the 13 programs who teach the use of animals as a therapeutic modality, 38.5% agreed that
it is a valued component of the OT curriculum. None strongly agreed. In addition, 38.5% neither
agreed nor disagreed, 23% disagreed, none strongly disagreed with this statement. Of the 36
programs who do not teach the use of animals as a therapeutic modality, 2.9% strongly agreed,
5.7% agreed, 38.5% neither agreed nor disagreed, 45.7% disagreed, 40% disagreed, and 5.7
strongly disagreed that it is a valued component of the OT curriculum. (Table 24)
Table 24
Cross-tabulation o f SQI2 & SQI
S Q I 2- Our program views the use o f
animals as a therapeutic modality as a valued
component o f the OT curriculum
Strongly Disagree Neither Agree Strongly
disagree
SQI- Within the O T program,
therapeutic modality taught?
Yes 23.0% 38.5% 38.5%
No 5.7% 40.0% 45.7% 5.7% 2.9%
N=49
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SQ I 3- Our faculty is interested in teaching about this topic, and SQ I- Within the OT program, is
the use o f animals as a therapeutic modality taught?
Of the 13 programs teaching the use of animals as a therapeutic modality, 46.2% of the
programs have faculty interested in the topic (7.7% strongly agreed and 38.5% agreed). In
addition 46.2% neither agreed, nor disagreed, 7.6% disagreed and none strongly disagreed with
this statement. O f the 36 programs not teaching this topic, 11.4% strongly disagreed and 40%
disagreed that faculty is interested. In addition, 40% neither agree nor disagreed, 8.6% agreed,
and none strongly agreed with this statement. (Table 25)
Table 25
Cross-tabulation o f SQ13& SQI
SQI 3- Our faculty is interested in teaching about
this topic
disagree
SQ I- Within the O T program,
therapeutic modality taught ?
Yes 7.6% 46.2% 38.5% 7.7%
No 11.4% 40.0% 40.0% 8.6%
N=49
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SQ M - Our students have expressed interest in learning about this topic, and SQ I- Within the OT
program, is the use o f animals as a therapeutic modality taught?
O f the 13 subjects teaching the use of animals as a therapeutic modality, 7.7% strongly agreed
and 53.8% agreed that students are interested in learning about this topic. 15.4% neither agreed
nor disagreed, 15.4% disagreed and 7.7% strongly disagreed with this statement. Of those not
teaching it, 5.6% strongly agreed and 36.1%, also agreed that students are interested, while
41.7% neither agreed nor disagreed. 13.9% disagreed and 2.7% strongly disagreed with this
statement. (Table 26)
Table 26
Cross-tabulation o f SQ M & SQI
SQ M - Our students have expressed interest in
learning about this topic
disagree
SQ I- Within the OT program,
therapeutic modality taught?
Yes 7.7% 15.4% 15.4% 53.8% 7.7%
No 2.7% 13.9% 41.7% 36.1% 5.6%
N=49
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Qualitative Analysis
In addition to the quantitative data, research questions were further addressed in depth and
detail through an interview process. Four telephone interviews were conducted after contact
names were collected on a volunteer basis. The subjects were faculty members who teach
occupational therapy students regarding the use of animals as a therapeutic modality. Three out
of four of the faculty members also used this modality as part of their clinical practice. Two of
the four involve students, as well. It is also important to note, information obtained from the
interviews, as well as surveys, found only one faculty member certified in AAA/AAT.
The following questions were documented using the Field Interview Data Sheet, (refer to
Appendix E for each subject’s Field Interview Data Sheet which contains detailed individual
data)
1. Tell me how you became interested in teaching about using animals as a therapeutic
modality. Did your program mandate this, or did your interest drive the topic to be
included into the curriculum?
2. How did you learn about this topic? Was it part of an OT curriculum? Are you certified
in AAT?
3. Please explain the details of the curriculum, including: type of course, syllabi, and
student assignments.
a. Please explain what categories of using animals as a therapeutic modality are covered
in your curriculum.
b. What animals are introduced and are they brought into the classroom and/or at a
clinical site?
c. Would you be willing to share some of your materials as part of this research study?
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4. How do you involve your clinical practice in the teaching of this topic? Are students
actively involved in this?
5. From your viewpoint and experience, are there any OT theories which link to using
animals as a therapeutic modality in OT? Do you teach them with this modality?
6. Can you describe the first time you saw this intervention and how it affected you as an
OT?
7. What are some positive and negative issues regarding teaching this topic?
8. What do you feel is the future of teaching about this topic and involving students?
9. Is there anything else you would like to contribute to this survey or discuss ?
As a result of the interview process, the data was sorted by reviewing and categorizing (by
hand) individual field interview data sheets. The following eleven themes developed and
qualitative data analyzed:
Theme #1
Faculty member's interest in using animals as a therapeutic modality evolved in a similar
manner
1. The faculty involvement in the use of animals as a therapeutic modality began initially as
a personal interest and then evolved into a professional experience, specifically, within
their programs occupational therapy curriculum. For example:
a. Those interviewed grew up with animals being an important part of their lives.
b. Prior to working in academia, interest in using animals as a therapeutic modality
began through exposure to AAT, AAA and service animals within their clinical
experiences.
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c. Faculty members have seen the positive results of using animals as a therapeutic
modality in their private and professional experiences: one faculty member
observed the effects with her own hospitalized child, as well as when her father
was in hospice. Another faculty member has meshed her OT skills with the use of
service animals. Faculty members have been exposed to the important role
animals have had in the lives of their clients.
2. In addition, student interest has fueled the faculty member’s desire to present the
modality in the occupational therapy curriculum.
a. Faculty members have observed students’ successful involvement in hippotherapy
sessions.
Theme #2
Faculty members were not exposed to this topic within their own experiences as an occupational
therapy student
1. The faculty members learned about the topic from personal interest and experiences, as
well as continuing education courses.
2. Faculty members always wanted to do something with animals and people, through the
occupational therapy profession.
3. As a result of the positive changes observed in their clients from observing the use of
animals as a therapeutic modality, faculty members described their reactions as being
“inspired” and “sold” on the modality.
4. Service animals were used as a resource for their clients within the faculty members’
clinical practices.
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Theme #3
Primarily, the use o f animals as a therapeutic modality is taught as an ‘exposure ’ within
occupational therapy curriculum
1. Faculty statements have also included: “it is mentioned”, “encouraged students”, and
“introduced”.
2. The topic is frequently used as an optional assignment, research project, or Field trip that
is based on student interest. Topics have ranged from field trips to hippotherapy sessions,
presentations on AAT and service animals, and observations in clinics.
Theme #4
Specific categories o f using animals as a therapeutic modality amongst interviewed faculty
included:
1. Service animals, AAA, AAT, and hippotherapy.
2. Animals primarily included dogs, cats and horses.
3. Service animals were typically presented in the classroom by an agency who trains them,
students have attended sites which provide hippotherapy, as well as facilities which
provide AAA and AAT. These facilities included skilled nursing facilities, hospice,
pediatric clinics, adult day centers, and hospitals.
4. Generally, exposure is seen in the geriatric and pediatric clientele.
Theme #5
None o f the faculty interviewed had specific curriculum materials to share on this topic. Faculty
stated that since this is only an exposure or an optional assignment, no teaching materials are
used.
I ll
Theme #6
Interviewed faculty perceive very few occupational therapists to be using animals as a
therapeutic modality within clinical practices and involve students.
1. Of the minimal clinical occupational therapists who are using the modality, it is perceived
that very few are involving students.
2. If students are present, they are primarily observing the intervention.
Theme #7
Primarily, the faculty interviewed teach this modality from a clinical practice perspective versus
linking a theoretical approach.
1. Occupational therapy theory is mentioned informally through the use of terminology
which is within the theories such as: adaptation, compensation, changing the
environment, increasing skills and function, increasing range of motion, meaningful
occupation, sensory modulation, everyday life, roles, occupational performance and
responsibilities.
2. When thinking of occupational therapy theory the following issues also emerged: clients
need to be a responsible and contributing member of society, caring for a pet as an
occupational role, manipulating and adapting the environment, the animal as an attribute
of the person, and animals increasing the quality of life.
3. When asked what occupational therapy theories might apply to the use of animals as a
therapeutic modality, the following were commonly mentioned: The Person-
Environment Occupational Performance Model (Christiansen and Baum, 1997) and the
Model o f Human Occupation (Kielhofner and Burke, 1980)
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Theme #8
In describing their first time observing the use o f animats as a therapeutic modality, all
experiences were positive
1. The positive response from the clients’ interactions with the animal was most frequently
mentioned.
2. Commonly it was also mentioned how well occupational therapy meshes with the use of
animals as a therapeutic modality. For example:
a. With clients who are physically challenged, the occupational therapist used
barretts, decorated hair clips, a leash, and dog treats in a ja r to increase motor
planning, range of motion, strength, and gross/fine motor control.
b. An occupational therapist worked with service animal agencies and their clients to
adapt equipment and the environment. For example: adapting the dogs’ uniforms
in order for clients to donn them independently, created back packs for the
animals, adapted the dogs head halters with a buckle system for power steering,
adapted houses with a door knob strap for the dog to open the door and loops on
the phone.
3. Other comments included: increased social interactions, increased motivation, increased
verbalization, increased animation, they felt good, positive reaction, increased awareness
of the environment, students can relate from personal experiences.
4. Stories included:
a. A child was learning how to drive her power chair and when the occupational
therapists tried to help her, she would hit the joystick, take off, and laugh. When
given a dog to walk, she looked around for an individual and drove right to them.
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Using the animal as a facilitator, she was able to learn the correct way to drive her
chair and was able to demonstrate that she knew how to safely move around in
her environment. The dog actually brought out more than what she thought she
knew and could do.
b. After exposure to AAT, a child with autism increased his verbalizations, asked
more questions, initiated eye contact, and smiled. The child spoke about touching
the dog’s whiskers.
c. During AAA sessions, the occupational therapist observed clients with depression
and low-motivation who became close to the animals show increased animation
and increased motivation.
d. An occupational therapist’s nephew who was severely mentally impaired and did
not bond with human beings well. Through the use of hippotherapy, he has
become much more aware of his environment, relates to the animal well, and is
better able to relate to humans.
Theme #9
Positive aspects o f using animals as a therapeutic modality
1. Using animals in occupational therapy brings a whole new aspect to intervention and
relating to our clients.
2. Occupational therapists are able to use their skills to enhance occupation and quality of
life through the use of an animal in therapy. Examples mentioned above.
3. Students are very interested in this topic.
4. Many positive outcomes occur, as mentioned above.
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5. Using animals as a therapeutic modality increases the possibility for adaptation
possibilities
6. Some states are prescribing service dogs for clients.
7. An emerging practice area in terms of creativity, a new learning experience, more options
for adaptation and compensation and increasing quality of life.
Theme #10
Negative aspects o f using animals as a therapeutic modality
1. Clients may not be comfortable around pets, some are fearful.
2. Clients may have allergy to pet dander.
3. Faculty/OT may have allergies or an aversion to pets, as well.
4. There may be logistical roadblocks to initiating a program in facilities.
5. Not many fieldwork sites are using the modality.
6. It is only an adjunct modality that does not work for everyone.
7. Others do not always realize the actual benefits, particularly if they are not fond of
animals.
8. Occupational therapists do not know much about this modality, even if they are interested
in it.
9. Billing and funding.
Theme #11
Future o f teaching this topic and involving students
1. Imbedding the topic into many areas of the curriculum is seen as the most common way
of addressing this modality into the future as it is still seen as an exposure within the
curriculum. It was suggested as being potentially addressed successfully at the
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advanced master’s level as there may be more room in the curriculum. Also, teaching
this modality as a specialty topic, elective course, or independent study was also
mentioned. The modality can also be seen as an emerging practice area for the future.
2. Because this is a specialty area, there are not many therapists using it. Therefore, we
need to further inquire about the level of interest, educate those interested, and most
importantly create a network for those occupational therapists using this modality.
When this becomes a more typical practice, it will be easier to teach our students, send
them on fieldtrips, and incorporate the modality into fieldwork.
3. It is important to continually foster education and awareness on this topic.
4. Billing, reimbursement, and cost-benefit analysis remain issues within provision of
services.
All four subjects interviewed offered similar responses as summarized in the table of common
themes below. (Table 27)
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Table 27
Summary Table of Common Themes
Faculty member’s interest in using animals as a therapeutic modality evolved in a similar
manner.
Faculty members were not exposed to this topic within their own experiences as an occupational
therapy student.
Primarily, the use of animals as a therapeutic modality is taught as an ‘exposure’ within
occupational therapy curriculum.
Specific categories of using animals as a therapeutic modality where found amongst interviewed
faculty.
None of the faculty interviewed had specific curriculum materials to share on this topic. Faculty
stated that since this is only an exposure or an optional assignment, no teaching materials are
used.
Interviewed faculty perceives very few occupational therapists to be using animals as a
therapeutic modality within clinical practices and involvement of students.
Primarily, the interviewed faculty teaches this modality from a clinical practice perspective
versus linking a theoretical approach.
In describing their first time observing the use of animals as a therapeutic modality, all
experiences were positive.
Many common positive aspects of using animals as a therapeutic modality were presented.
Common negative aspects of using animals as a therapeutic modality were presented.
All interviewed stated there is a future in teaching this topic and involving students in practice.
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Synthesis o f Quantitative and Qualitative findings
General Information
O f the faculty researched, dogs appear to be the most popular animal to use in therapy. It
appears, although, that hippotherapy is becoming increasingly popular, particularly in locations
which have many horse farms. Service animal agencies have been reported to participate as
guest speakers in OT courses and are frequently used as resources for student learning.
According to the faculty, the most popular environments in which AAA/AAT occur have
been reported to include skilled nursing facilities, hospitals, day centers, and pediatric clinics.
Older adults and pediatric clientele appear to be the individuals most exposed to the use of
animals as a therapeutic modality with OT’s and students.
Specifics
It is clear that the majority of OT programs involved in this study are not teaching the use of
animals as a therapeutic modality. O f those who are, none have a formal curriculum on the
topic. In addition, there are no specific theories or theorists who are mentioned, although related
OT terminology is included.
OT faculty interest in the use of animals as a therapeutic modality appears to be an important
factor as to whether or not the topic is taught within the curriculum. The faculty interviewed
stated that their interest in the topic began while working as a clinician, before their involvement
in academia. This personal interest was further reflected during the interviews, as the subjects
had grown up with animals, and had made a special connection with them. The interviewed
faculty had much more positive aspects, than negative, of using animals as a therapeutic
modality. Many anecdotal stories attested to their emotional connection with animals and the
benefits of including animals in OT. The interviews have further reflected on the fact that this
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connection, or bond, with animals is also a driving force as to whether or not an OT may involve
animals in their clinical practice or facility. For example, it was mentioned how it is much more
difficult to market an AAT program in a facility in which the administrator does not care for
animals, than if he/she does have that connection.
Student interest not only appears to be higher than faculty interest, but also appears to be
channeled into assignments/activities which involve choice, such as service learning,
volunteering, research projects, and theses. This does also reflect how students may explore
their interests even if a program does not teach a particular modality, such as the use of animals
in OT. Faculty mentioned, also, how students relate very well to this modality and make a
connection to the animal, as well as the client.
Faculty mentioned how most OT’s are not educated in the use of animals as a therapeutic
modality. In addition, faculty stated that the use of animals as a therapeutic modality is an
adjunct to OT, is considered to be a specialty area, and is best imbedded into the curriculum. It
was, although, emphasized how well the use of animals “meshes* into OT, particularly by
increasing the quality of life and enhancing one’s occupation.
Hypotheses
The quantitative and qualitative data addressed the hypotheses as follows:
1. A limited number o f occupational therapy programs are teaching the use o f animals
as a therapeutic modality within their curriculum. It is clear through the invited
sample of this study that this hypothesis is supported as only 13 of the 49 subjects, or
26.5%, are actually teaching this topic.
2. O f the occupational therapy programs teaching the use o f animals as a therapeutic
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This hypothesis is supported as 66.7% of the subjects who teach this topic are using a
clinical approach, only. In addition, none of the subjects refer to a specific theory or
theorist, although they do use specific OT terminology and clinical experts in the field
such as service animal agencies, within the classroom.
This hypothesis is marginally supported as 46.9% of faculty surveyed agreed that
students are interested in the use of animals as a therapeutic modality. In addition
they are involved in programs outside of the classroom which include volunteer
experiences, service learning, and fieldwork.
Description of Curriculum Model
As a culminating component of this research, a curriculum model (Appendix G) was created
for use by occupational therapists in order to include this topic into present curriculum, or, create
an elective, stand-alone course on the use of animals as a therapeutic modality, within
occupational therapy programs. The results of the qualitative and quantitative analysis found,
primarily, that this topic is infused into present courses. The interview process, although, found
faculty member interest in a stand-alone, elective course on this topic. In addition, this
researcher has planned to offer this course as an elective within the OT curriculum at Quinnipiac
University. Based on results of the research data and analysis, the following two options for
curriculum models are presented:
1. Elective/specialty topics course
2. Optional assignments and activities to imbed in courses such as intervention, research,
and administration.
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The curriculum model will refer, as applicable, to specific sections of chapter 2 of this
dissertation, specifically as noted below:
Section 1-History of the Human-Animal Bond
Section 2-History of Using Animals as a Therapeutic Modality
Section 3-Description of Specific Uses of Animals as a Therapeutic Modality
Section 4-Benefits, Negative Implications of Using Animals as a Therapeutic Modality
Section 5-Related Laws and Other Legal Issues
Section 6-Referrals and Reimbursement
Section 7-Related Surveys by Occupational Therapists
Section 8-Related Theories
Summary
This chapter addressed the analysis of the quantitative data through the use of frequency tables
and cross-tabulations. The case study approach, through an interview process, was used to
analyze the qualitative data. Both approaches were synthesized, research questions answered,
and hypotheses supported. The chapter culminated in the creation of a curriculum model
(Appendix G).
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CHAPTER 5
Summary, Conclusions and Recommendations, and Other Considerations
This chapter presents a summary, conclusions and recommendations for future research of
this dissertation which researched the use of animals as a therapeutic modality within accredited
occupational therapy, entry-level master’s degree programs, in order to establish a need for, and
develop, a curriculum model.
Summary
Review of the literature found support for the teaching of this topic in occupational therapy
through the history of the human-animal bond, the benefits of using animals as a therapeutic
modality, as well as the link between the topic and occupational therapy theory. The literature
reviewed regarding the benefits of using animals as a therapeutic modality discussed not only
quantitative research methods, but also qualitative methodology and anecdotal stories. Within
the literature, very few studies were found involving occupational therapists, students, and the
use of animals as a therapeutic modality, although two master’s theses researched the topic. For
example, Alfano (1998) found, similarly to this study, that most occupational therapists surveyed
do believe that AAT can be an effective intervention technique. The researcher also found,
although, that barriers do exist such as lack of administrative support and lack of
training/education on the modality. Alfano concluded, and this study agreed, that occupational
therapists need training in AAT in order to minimize risk of negative results and increase skill
level. Lastly, the researcher strongly suggested that occupational therapy programs incorporate
the teaching of this modality within their programs, as did the present study.
Specifically, this study sought to answer the following research questions and hypotheses:
Research questions
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1. Are occupational therapy programs teaching the use of animals as a therapeutic
modality? How many?
2. Where in the curriculum is the topic being taught?
3. Are the programs teaching this topic focusing on clinical application,theory, or both?
Which theories/theorists are linked to the topic?
5. What are the perceived outcomes of teaching about animals as a therapeutic
modality?
6. Have students expressed an interest in this topic?
7. Are occupational therapy programs involving students in AAA/AAT?
8. Does occupational therapy faculty have an interest and/or certification in providing
AAA/AAT?
9. Is occupational therapy faculty using AAA/AAT as part of their clinicalpractice ?
10. What are the barriers to teaching this topic?
11. Does occupational therapy faculty view this topic as an important adjunct to the
intervention process ?
12. What is an example(s) of a current curriculum or lecture series?
Hypotheses
1. A limited number of occupational therapy programs are teaching the use of animals as a
therapeutic modality within their curriculum.
2. Of the occupational therapy programs teaching the use of animals as a therapeutic
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The population and invited sample of this study consisted of a total of 103
occupational therapy entry-level master’s degree programs who were mailed surveys
requesting their participation. 49 respondents, or 47.6% of those surveyed, participated in the
quantitative component of the study. Participants were requested to volunteer names and
contact information of faculty who are teaching this topic within the occupational therapy
curriculum for the interview process. Only four faculty members were volunteered and
participated in the qualitative, case study format, of the study through an interview process.
Data was gathered in two formats: First, the survey was developed by the researcher and
consisted of 14 open-ended questions, four of which were on a likert scale. Then, nine
interview questions were presented to the four volunteered subjects during the qualitative
methodology. The data analysis plan was organized according to the information found in the
surveys for the quantitative analysis, and from the interviews within the qualitative analysis.
Specifically, SPSS and Microsoft Office 2000, Excel were used for the analysis of findings
through frequency distributions and cross-tabulations, within quantitative component of the
study. The qualitative component was organized through the use of themes developed
resulting from the interview process. Research questions and hypotheses were addressed
through the analysis of data and answered as follows:
1. Are occupational therapy programs teaching the use o f animals as a therapeutic
modality? How many? Only 13, of the 49 programs surveyed, are teaching this topic
2. Where in the curriculum is the topic being taught? The curriculum is primarily imbedded
in existing OT courses such as those that address introduction to OT, OT seminar, and
assessment/intervention. The subject is primarily taught in the first year of the program
within a classroom setting.
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3. Are the programs teaching this topic focusing on clinical application, theory, or both?
Which theories/theorists are linked to the topic? Most programs are teaching a clinical
approach only. None of the programs are linking a specific theory or theorist, although
they do use formal OT terminology and invite in guest speakers who are clinical experts.
4. What are the perceived outcomes o f teaching about animals as a therapeutic modality ?
The understanding of the use of animals as a therapeutic modality and how it applies to
daily life and occupation is the primary goal of teaching this topic.
5. Have students expressed an interest in this topic? It is clear that OT faculty perceive
students as being interested in learning about this topic as well as being involved outside
of the classroom.
6. Are occupational therapy programs involving students in AAA/AAT? OT programs are
involving students, although with few faculty members. Primarily, students are involved
through service learning, volunteer experiences, and through fieldwork. In addition,
students are choosing assignments, fieldtrips, research projects, and presentations on this
topic.
7. Does occupational therapy faculty have an interest and/or certification in providing
AAA/AAT? Few OT faculty appear to have an interest in this topic, and only one
surveyed is certified in AAA/AAT.
8. Is occupational therapy faculty using AAA/AAT as part o f their clinical practice? Very
few OT faculty are using AAA/AAT as part of their clinical practice.
9. What are the barriers to teaching this topic? Primary barriers included lack of room in
the curriculum, the topic is not a curricular priority, lack of research on the topic, and
lack of experienced faculty.
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10. Does occupational therapy faculty view this topic as an important adjunct to the
intervention process? OT faculty appears to view the topic as more important to the OT
profession, in general, than as an important part of the curriculum. This may be
explained as the use of animals as a therapeutic modality is primarily taught within
existing curriculum, not standing alone. Students, although, are being encouraged to
choose a topic of interest for an assignment or project. Therefore, they are exposed to
this modality more prevalently through their own interest such as when choosing topics
for theses, service learning and volunteering, for example.
11. What is an example(s) o f a current curriculum or lecture series ? None of the programs
surveyed, or subjects interviewed had any formal material on the use of animals as a
therapeutic modality, to contribute to this study. Two interviewed faculty members did
offer information on service animal agencies as resources, although.
Hypotheses
1. A limited number o f occupational therapy programs are teaching the use o f animals
as a therapeutic modality within their curriculum. As stated above, this hypothesis
is supported through the findings of research question #1, as above.
2. O f the occupational therapy programs teaching the use o f animals as a therapeutic
This hypothesis is supported through the findings of research question #3, as above.
This hypothesis is marginally supported though the findings of research question #5,
as above.
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This study culminated in the development of a curriculum model (Appendix G) based on the
literature review, analysis of findings, and experience of the researcher. The research supported
the need for a curriculum model based on lack of curriculum materials on the topic, its perceived
value to the occupational therapy profession, perceived student interest and involvement in the
modality outside of the classroom, and the data gathered from the interview process.
Conclusions
The findings of this study conclude that OT programs are teaching the use of animals as a
therapeutic modality, although on a limited basis. First of all, there are very few programs
surveyed who are teaching the topic. O f those that are, all are teaching a clinical approach verses
teaching a link to OT theory. For the most part, the topic is mentioned within the introductory,
first year, of OT programs. Very few faculty are interested, educated, and experienced in this
area o f specialty. Only one faculty member is certified in AAA/AAT. The above comments
may be due to the reported barriers to teaching this topic, which include: lack of room in the OT
curriculum, the topic not being a curricular priority, lack of research on the topic, and lack of
experienced faculty. An additional reason may be faculty reported that the topic is important to
the OT profession, in general, but not an important component of the OT curriculum. Of those
teaching the topic, the importance of animals in daily life and occupation, was commonly
reported.
The faculty members interviewed have reported their interest in this topic first began by
having dogs in their personal lives, at an early age. Also, they became proponents of using
animals as a therapeutic modality after having seen it as a successful intervention with clients
and/or family members. The above comments may be important indicators of whether or not a
faculty member develops an interest in the topic, or not.
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Many faculty surveyed do agree that students are interested in learning about this topic and
are choosing assignments in which they may learn and report on it. In addition, faculty reports
that students are involved in programs using animals as a therapeutic modality, outside of the
classroom. Very few OT faculty, however, are involved in these programs with the students.
Therefore, students are primarily learning about the use of animals as a therapeutic modality
outside of the classroom and possibly without the supervision of an occupational therapist.
Recommendations for Future Research
In consideration of the findings of this study, the following are recommendations for future
research:
1. Comparable studies should be conducted involving advanced master’s level occupational
therapy programs and faculty, and possibly certified occupational therapy assistant
(COTA) programs.
2. Additional research should be conducted directly involving occupational therapy students
and their interest level in this topic.
3. Additional research should be conducted directly involving occupational therapy
clinicians who are either providing, and/or are interested in providing, interventions
involving the use of animals as a therapeutic modality.
4. Additional research should be conducted directly involving other healthcare faculty,
and/or clinicians, who are either providing, and/or are interested in providing,
interventions involving the use of animals as a therapeutic modality.
5. Additional research should involve certified individuals outside of the healthcare
profession who are providing AAA in the community.
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6. Additional investigation may ask if the type of facility/environment (such as a hospital
versus a long-term care facility) has an impact on the use, or lack of use, of AAA/AAT.
7. Further research should be conducted linking occupational therapy theory to the use of
animals as a therapeutic modality.
8. More occupational therapists conducting this type of research should publish their work
in juried publications.
9. The curriculum model (Appendix G) should be piloted for its effectiveness, evaluated,
and updated/edited by occupational therapy faculty who may be interested in using it
within their own curriculum.
Other Findings and Considerations
Several other concluding issues and comments have surfaced as a result of this study and will
be discussed below.
1. When considering teaching the use of animals as a therapeutic modality within
occupational therapy curriculum, it must be determined how the topic will be taught.
For example, the course may be taught as a stand-alone, elective/special topics course, or
the topic may be imbedded in current courses. There are many strategies to achieve this
task such as using components of chapter two of this dissertation within applicable
courses and topics. Examples of courses include those that address occupational therapy
theory and intervention. (Refer to the curriculum model (Appendix G) for many more
examples)
2. When considering teaching this topic, the level of education must also be considered.
For example, one of the subjects interviewed considered this topic better taught, and fit
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into, an advanced master’s degree program. Specifically, at an advanced level, the topic
may be used as an independent study or thesis material.
3. When considering teaching this topic, an additional significant consideration was the
lack of room within the occupational therapy curriculum for an additional course or
subject. Again, therefore, the curriculum model in chapter four addresses many
alternatives for using this topic within occupational therapy curriculum.
4. Benefits versus the risks of using animals as a therapeutic modality- the literature clearly
supports the benefits out-weighing the risks. It is pertinent, although, that the risks are
addressed when planning and creating programs and interventions as those who are not
sold on this modality, particularly if they are administrators, will be concerned. This
obstacle, as the literature states, can be easily overcome through prevention of infection,
cleanliness, and sound policies and procedures when dealing with animals, in particular.
5. Other logistical issues do present when attempting to create a program using animals as a
therapeutic modality. Again, sound policies and procedures are vital to the success of
this type of program. It is also important for decision-makers to see the positive results
of these programs.
6. Research and publications- much more work is needed in this area in order to further
justify the use of animals as a therapeutic modality in occupational therapy, as well as
other healthcare professions. This work is also needed in order to further educate the
general public regarding the many positive aspects of the use of animals as a therapeutic
modality.
7. OT as a profession- As seen in chapter two of this dissertation, the profession of
occupational therapy, with it’s emphasis on occupation and the whole person, makes a
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viable fit with the use of animals as a therapeutic modality. This link is grounded
through occupational therapy theories, as well as occupational science.
8. Involving students- it is clear that students have an interest in this topic and are being
exposed to it at some level in the field. This brings up the typical question of who drives
the profession, academia or the clinic? Because of the many issues brought forth in this
dissertation, it is clear that academia must begin the education of this topic, particularly
because of the theory links as well as potential safety issues.
9. This issue of billing for the occupational therapy service when using animals as a
therapeutic modality has surfaced in both the survey and interview components of this
study. Again, as stated in chapter 2, it must be emphasized that the use of animals in OT
is considered an adjunct tool to the delivery of occupational therapy services, and
therefore, the specific O T service, is billed for. For example, if an occupational therapist
is attempting to teach a child use an electric wheelchair, the billing is for functional
mobility education, not for animal-assisted therapy. AAT was the tool used to achieve
the goal, not the actual category of service.
10. Because AAA is primarily voluntary in nature, the availability of certified Pet Partner
Teams may be a barrier.
11. Get certified- It is important to inform our students and clinicians that when considering
using animals as a therapeutic modality, at any level, it is important not only to choose
an appropriate animal, but also for the handler and the animal to be formally educated,
leading to a certification.
12. The future of this topic was of concern to at least two of the subjects interviewed. This
concern has grown out of the fact that very few occupational therapists and few
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occupational therapy faculty (as seen in this study) are using/teaching this modality.
Also, as noted, in addition to this researcher, only one other faculty member surveyed is
nationally certified to offer AAT services. One of the interviewed faculty suggested a
networking group for occupational therapists using animals as a therapeutic modality.
This special interest group or network may provide education, support, currency on the
topic and educational materials, particularly for those individuals interested in starting
programs, services, and/or certification. The network may work together through emails,
newsletters, mailings, and meeting as a special interest group at national conference.
Finally, it is the ultimate vision/hope of the researcher that this dissertation will spark further
interest of OT faculty members, clinicians, and students to increase education on the topic,
involvement, and certification in the use if animals as a therapeutic modality.
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References
Abdill, M., & Juppe, D. (Eds.). (1997). Pets in therapy. Ravensdale, WA: Idyll Arbor, Inc.
Therapy Association, Inc. (1998). Standards fo r an accredited educational program fo r
occupational therapists. Author.
Adams, M. B. (2000). Emily Bronte and dogs: Transformation within the human-dog
bond. Society and Animals, 8(2), 167-181.
Alfano, T. (1998). A survey o f the use o f animal assisted therapy as a modality in the field o f
occupational therapy. Unpublished master’s thesis, D’Youville College, Buffalo, NY.
All, A. C., Crane, L. L., & Loving, G. L. (1999). Animals, horseback riding, and implications for
rehabilitation therapy. Journal o f Rehabilitation, July/August/September, 49-57.
Allen, K., & Blascovich, J. (1996). The value of service dogs for people with severe ambulatory
disabilities. Journal o f the American Medical Association, 275( 13), 1001-1006.
Allen, J. M., Kellegrew, D. H., & Jaffe, D. (2000). The experience of pet ownership as a
meaningful occupation. Canadian Journal o f Occupational Therapy, 67(4), 271-278.
Americans with Disabilities Act of 1990. Pub. L. 101-336,42 U.S.C. 12101.
Arkow, P. (1998). Pet therapy: A study and resource guide fo r the use o f companion animals
in selected therapies (8lh ed.). Stratford, NJ: Author.
Banks, M. R., & Banks, W. A. (2002). The effects of animal-assisted therapy on loneliness in an
elderly population in long-term care facilities. Journal o f Gerontology, 57A(1), M428-
M432.
Bardill, N., & Hutchinson, S. (1997). Animal-assisted therapy with hospitalized adolescents.
Journal o f Child and Adolescent Psychiatric Nursing, 10(1), 17-25.
133
Barker, S. B. (1999). Therapeutic aspects of the human-companion animal interaction.
Psychiatric Times, 16(2), 1-6.
Beck, A., & Meyers, M. (1996). Health enhancement and companion animal ownership.
Annual Review o f Public Health, 17, 247-257.
Benda, W., Frederickson, M., Flanagan, S., Zembreski-Ruple, J., & McGibbon, N. H. (2000).
Animal-assisted therapy: A highly versatile modality. Complementary Medicine fo r the
Physician, 5(6), 44-48.
Bernard, S. (1995). Animal assisted therapy: A guide fo r health care professionals and
volunteers. Whitehouse, TX: Therapet L.L.C.
Brodie, S. J., & Biley, F. C. (1999). An exploration of the potential benefits of pet-facilitated
therapy. Journal o f Clinical Nursing, 8(4), 329-337.
Bruce, M. A. G., & Borg, B. A., (2002) Psychosocial fram es o f reference. (3rd ed.) Thorofare,
NJ: Slack, Inc.
Bruck, L. (1999). Bringing life to the facility. Long Term Care Management, 48(10), 57-58.
Camp, M. M. (2001). The use of service dogs as an adaptive strategy: A qualitative study. The
American Journal o f Occupational Therapy, 55(5), 509-517.
Campbell-Begg, T. (2000). A case study using animal-assisted therapy to promote abstinence in
a group of individuals who are recovering from chemical addictions. Journal o f
Addictions Nursing, 12( 1), 31 -35.
Casey, H. M. (1996). A survey of occupational therapists using pet-facilitated therapy. Home
Health Care Management and Practice, 8(4), 10-17.
Chinner, T. L., & Dalziel, F. R. (1991). An exploratory study on the viability and efficacy of a
pet-facilitated therapy project within a hospice. Journal o f Palliative Care, 7(4), 13-20.
134
Christiansen, C., & Baum, C. (1997). Occupational therapy: Enabling function and well-being
(2nd ed.). Thorofare, NJ: Slack, Inc.
Clark, F„ Parham, D., Carlson, M., Frank, G., Jackson, J., Pierce, D., Stein, C., & Zemke, R.
(1990). Occupational Science: Academic innovation in the service of occupational
therapy’s future. American Journal o f Occupational Therapy, 45, 300.
Cole, K. M., & Gawlinski, A. (1995). Animal-assisted therapy in the intensive care unit: A staff
nurse’s dream comes true. Nursing Clinics o f North America, 30(3), 529-536.
Cole, K. M., & Gawlinski, A. (2000). Animal-assisted therapy: The human-animal bond. AACN
Clinical Issues, 11(1), 139-149.
Connell, A. L., (1995). Bridging the generation gap with animal assistance._Unpublished
master’s thesis, Prescott College, Prescott, AZ.
Connor, K., & Miller, J. (2000a). Help from our animal friends. Nursing Management, 31(1), 42-
46.
Connor, K., & Miller, J. (2000b). Animal-assisted therapy: An in-depth look. Dimensions o f
Critical Care Nursing, 19 (3), 20-26.
Corson, S. A., Corson, E. O., & Gwynne, P. (1975). Pet-facilitated psychotherapy in a hospital
setting. Current Psychiatric Therapies, 15, 277-286.
Corson, S. A., & Corson, E. O. (1978). Pets as mediators of therapy. Current Psychiatric
Therapies, 18, 195-205.
Counsell, C.M., Abram, J., & Gilbert, M. (1997). Animal-assisted therapy and the individual
with spinal cord injury. SCI Nursing, 14(2), 52-55.
Delta Society. (2000). The Pet Partner’s TEAM training course (4,h ed.). Renton, WA: Author.
135
Denzin, N. K., & Lincoln, Y. S. (2000). Handbook o f qualitative research. (2nd ed.). Thousand
Oaks, CA: Sage Publications.
Dew, B. L. (2000). Co-therapy with Moses. Family Journal, 8(2), 199-202.
Eames, E., & Eames, T. (1997). Interpreting legal mandates: Assistance dogs in medical
facilties. Nursing Management, 25(6), 49-51.
Fick, K. M. (1993). The influence of an animal on social interactions of nursing home residents
in a group setting. The American Journal o f Occupational Therapy, 47(6), 530-533.
Fine, A. (Ed.). (2000). Handbook on animal-assisted therapy: Theoretical foundations and
guidelines fo r practice. San Diego, CA: Academic Press.
Freud, S. (1937). The ego and mechanisms o f defense. London: Hogarth Press.
Friedmann, E., Katcher, A. H., Lynch, J. J., & Thomas, S.A. (1980). Animal companions and
one-year survival of patients after discharge from a coronary care unit. Public Health
Reports, 95(4), 307-312.
Friedmann, E., Katcher, A. H., Thomas, S. A., & Messant, P. R. (1983). Social interactions and
blood pressure influences of animal companions. Journal o f Nervous and Mental
Disease, 171, 8,461-465.
Friedmann, E., & Thomas, S. A. (1995). Pet ownership, social support, and one-year survival
after acute myocardial infarction in the cardiac arrhythmia suppression trial (CAST).
American Journal o f Cardiology, 76, 1213-1217.
Gammonley, J., & Yates, J. (1991). Pet projects: Animal-assisted therapy in nursing homes.
Journal o f Gerontological Nursing, 17(1), 12-15.
136
Golin, M. (1994). Heal emotions with fur, feathers and love. Prevention, December, 81-84.
Hanebrink, S., & Dillon, D. (2000). Service dogs: The ultimate assistive technology. OT
Practice, 5(14), 16-19.
Hasenauer, H. (2000). Pets helping patients. Soldiers, 55(8), 28-30.
Hasselkus, B. R. (2000). The meaning o f everyday occupation. Thorofare, NJ: Slack, Inc.
Hinojosa, J., & Blount, M. (2000) The texture o f life. Bethesda, MD: American Occupational
Therapy Association.
Holliday, A. (2002). Doing and writing qualitative research. Thousand Oaks, CA: Sage
Publications.
Howell-Newmann, K., & Goldman, R. (1993). Marketing animal-assisted therapy. Health
Marketing Quarterly, 11(1/2), 77-98.
Huebscher, R. (2000). Pets and animal-assisted therapy. Natural/Altemative/Complementary
Health Practices, 1-3.
Hughes, M. H. (1994). The use of animal-assisted therapy within the occupational therapy
profession. Unpublished master’s thesis, D’Youville College, Buffalo, NY.
Jacobson, G., Sato, A., and Gilmore, B. (2000). Fish aquarium animal-assisted therapy and its
influence on clients with multiple sclerosis. Research fo r Nursing Practice, 2-9.
Janssen, M. (1998). Therapeutic interventions: Animal-assisted therapy programs. Palaestra,
14(A), 40-42.
Jorgenson, J. (1997). Therapeutic use of companion animals in health care. Journal o f Nursing
Scholarship, 29(3), 249-255.
Katcher, A. H. (1982). Are companion animals good for your health? Aging, 2-8.
137
Katcher, A. H. (1984). Emotional and cognitive responses to interactions with companion
animals. The Journal o f the Delta Society, I, 34-36.
Katcher, A. H. (1985). Physiologic and behavioral responses to companion animals. Veterinary
Clinics o f North America: Small Animal Practice, 15(2), 403-410.
Katsinas, R. P. (2000). The use and implications of a canine companion in a therapeutic day
program for nursing home residents with dementia. Activities, Adaptation and Aging,
25(1), 13-30.
Katz, S., & Westbrook, G. J. (1985). Pet-facilitated therapy: Therapeutic application of
companion animals in physical therapy. Clinical Management, 5( 1), 32-34.
Keil, C. I. P. (1990). Conceptual fram ework o f human-animal relationships: An empirical
examination. (Doctoral dissertation, University of Kansas) Ann Arbor, MI: UMI.
Kielhofner, G. (1992). Conceptual foundations o f occupational therapy. Philadelpha, PA: F.A.
Davis Co.
Kielhofner, G. (1995). A model o f human occupation: Theory and application (2nd ed.).
Baltimore, MD: Williams and Wilkins.
Kielhofner, G., & Burke, J. P. (1980). A Model of Human Occupation, Part 1. Conceptual
Framework and Content. American Journal o f Occupational Therapy, 34(9), 572-581.
Khan, M. A., & Farrag, N. (2000). Animal-assisted activity and infection control implications in
a healthcare setting. Journal o f Hospital Infection, 46, 4-11.
Kief, C. A., & Scheerer, C. R. (2001). Clinical competencies in occupational therapy. Upper
Saddle River, N.J.: Prentice Hall.
Klee, T. (2002). http://www.objectrelations.org.
138
Kogan, L. R., and Wayne, V. (1998). Reported strength of human-animal bonding and method of
acquiring a dog. Psychological Reports, 82, 647-650.
Kogan, L. R. (2000). Effective animal-intervention for long term care residents. Activities,
Adaptation and Aging, 25( 1), 31-45.
Lincoln, Y. S., & Guba, E. G. (1885). Naturalistic inquiry. Beverly Hills, CA: Sage
Publications.
MacKinnon, J. R., Noh, S., Lariviere, J., MacPhail, A., Allan, D. E., & Laliberte, D. (1995). A
study of the therapeutic effects of horseback riding for children with cerebral palsy.
Physical and Occupational Therapy in Pediatrics, /5( 1), 17-34.
Mangione, T. W. (1995). Mail surveys: Improving the quality. Thousand Oaks, CA: Sage
Publications.
McKinney, A., Dustin, D., & Wolff, R. (2001). The promise of dolphin-assisted therapy. Parks
and Recreation, 36(5), 46-50.
Merriam, S. B. (1988). Qualitative research and case study applications in education. San
Francisco, CA: Jossey Bass Publications.
Miller, J., & Ingram, L. (2000). Perioperative nursing and animal-assisted therapy. AORN
Journal, 72(3), 477-586.
Miller, J. (2000). Going to the dogs....for help. Nursing, 30 ( \ 1), 65-67.
Modlin, S. J. (2000). Service dogs as interventions: State of the science. Rehabilitation Nursing,
25(6), 212-219.
Moneymaker, J. M., & Strimple, E. O. (1991). Animals and inmates: A sharing companionship
behind bars. Journal o f Offender Rehabilitation, 16(3/4), 133-152.
139
Neistadt, M. E., & Crepeau, E. B. (1998). Willard and Spackman's occupational therapy. (9th
ed.) Philadelphia, PA: Lippincott.
Ockleford, E., & Berryman, J. (2001). Do companion animals have a therapeutic value ?
European Journal o f Palliative Care, 8(2), 75-78.
Odendaal, J. S. J. (2000). Animal-assisted therapy: Magic or medicine? Journal o f
Psychosomatic Research, 49(4), 275-280.
Parlin, C. (1992). Human-animal interaction: Basis for pet therapy. Nevada RN Information, 22.
Pedretti, L. W., & Zoltan, B. (1990). Occupational therapy practice fo r physical dysfunction.
(3rd ed.) St. Louis, MO: The C.V. Mosby Co.
Perelle, I. B., & Granville, D. A. (1993). Assessment of the effectiveness of a pet-facilitated
therapy program in a nursing home setting. Society and Animals, / ( I), 91-100.
Podberscek, A. L., Paul, E. S., & Serpell, J. A. (Eds.). (2000). Companion animals and us:
Exploring the relationships between pets and people. Cambridge, U.K.: Cambridge
University Press.
Portney, L. G., & Watkins, M. P. (2000). Foundations o f clinical research: Applications to
practice. Upper Saddle River, N.J.: Prentice Hall Health.
Proulx, D. (1998). Animal-assisted therapy. Critical Care Nurse, 18(2), 80-84.
Reed, K. L. (1986). Tools of practice: Heritage or baggage. American Journal o f Occupational
Therapy, 40, 597.
Reed, M. (1996). Animal assisted therapy: Positive documentable outcomes. Workshop and
manual presented by Advanced Rehabilitation Services, Inc., Boston, Mass.
Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century medicine,
1961 Eleanor Clark Slagle lecture. American Journal o f Occupational Therapy, 16, 1-9.
140
Rehabilitation Act of 1973. Pub. L. 93-112, 29 U.S.C. 701 et seq.
Ring, E. (1993). Assistance dogs in special service. Brookfield, CT: The Millbrook Press.
Robinson, I. (Ed.). (1995). The Waltham book o f human-animal interaction: Benefits and
responsibilities o f pet ownership. Great Britain: Pergamon Veterinary Handbook Series.
Roenke, L., & Mulligan, S. (1998). The therapeutic value of the human-animal connection.
Occupational Therapy in Health Care, 11(2), 27-43.
Sawicki, S. (1998). Four-legged medicine: With help, HIV sufferers enjoy the miracle of the
human-animal bond. Animals, 131,(2), 10-14.
Schwartzberg, S. (2002). Interactive reasoning in the practice o f occupational therapy. Upper
Saddle River, N.J.: Prentice Hall.
Seidman, I. (1998). Interviewing as qualitative research. (2nd ed.). New York, N.Y.: Teachers
College Press.
Serpell, J. (1996). In the company o f animals: A study o f human-animal relationships.
Cambridge, U.K.: Cambridge University Press.
Siegel, J. (1993). Companion animals: In sickness and in health. Journal o f Social Issues, 49( 1),
157-168.
Teeter, L. M. (1997). Pet therapy program: Proposal for the U.S. Department of Health and
Human Services, 1996 Secretary’s Award. Journal o f the American Veterinary Medicine
Association, 210(10), 1435-1438.
Walsh, P. G., & Mertin, P. G. ( ). The training of pets as therapy dogs in a women’s prison: A
pilot study. Anthrozoos, 7(2), 124-128.
141
Waltner-Toews, D., & Ellis, A. (1994). Good fo r your animals, good fo r you: How to live and
work with animals in activity and therapy programs and stay healthy. Ontario, Canada:
The University of Guelph.
Willis, D. A. (1997). Animal therapy. Rehabilitation Nursing, 22(2), 78-81.
Winkle, M. (2003). Dogs in practice: Beyond pet therapy. OT Practice, 4(4), 12-17.
Winkle, M., & Williams, C. C. (2002, May). Benefits o f Developing a Canine-Assisted Therapy
Program. Short Course presented at the American Occupational Therapy Conference,
Miami, FL.
Yerxa, E. J., Clark, F., Frank, G., Jackson, J., Parham, D., Pierce, D., Stein, C., & Zemke, R.
(1990). Occupational therapy in the twentieth century: A great idea whose time has
come. Occupational Therapy in Health Care, 6( 1), 7.
Yerxa, E. J. (1998). Health and the human spirit for occupation. American Journal o f
Occupational Therapy, 52412-418.
Zemke, R., & Clark, F. (1996) Occupational science: The evolving discipline. Philadelphia,
PA: F.A. Davis.
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Appendix A
Standards for an Accredited Educational Program for the Occupational Therapist
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STANDARDS FOR AN ACCREDITED EDUCATIONAL PROGRAM
FOR THE OCCUPATIONAL THERAPIST
Adopted December 1998 by the
ACCREDITATION COUNCIL FOR OCCUPATIONAL THERAPY EDUCATION
of
THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION, INC.
The Accreditation Council for Occupational Therapy Education (ACOTE) of the American
Occupational Therapy Association (AOTA) accredits educational programs for the occupational
therapist. These Standards comply with the United States Department of Education (USDE)
criteria for recognition of accrediting agencies.
These Standards are the requirements used in accrediting educational programs that prepare
individuals to enter the occupational therapy profession. The extent to which a program complies
with these Standards determines its accreditation status.
Sections A and C contain general standards, while Section B delineates standards specific to
curriculum. The specific standards in Section B are stated as outcome-based criteria.
PREAMBLE
The rapidly changing and dynamic nature of contemporary health and human service delivery systems
requires the entry-level occupational therapist to possess basic skills as a direct care provider,
consultant, educator, manager of personnel and resources, researcher, and advocate for the profession
and the consumer.
A contemporary entry-level occupational therapist must:
• have acquired, as a foundation for professional study, a breadth and depth of knowledge in the
liberal arts and sciences and an understanding of issues related to globalism and diversity;
• be educated as a generalist, with a broad exposure to the delivery models and systems utilized
in settings where occupational therapy is currently practiced and where it is emerging as a
service;
• have achieved entry-level competence through a combination of academic and fieldwork

education;
• be prepared to articulate and apply professional principles, intervention approaches and

rationales, and expected outcomes as related to occupation;
• be prepared to supervise and work in cooperation with the occupational therapy assistant;
• be prepared to be a lifelong learner and keep current with best professional practice;
• uphold the ethical standards, values, and attitudes of the occupational therapy profession;
• be prepared to be an effective consumer of the latest research and knowledge bases that
undergird practice and contribute to the growth and dissemination of research and knowledge.
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SECTION A: GENERAL REQUIREMENTS FOR ACCREDITATION
A.1.0 SPONSORSHIP
A.1.1 The sponsoring institution(s) and affiliates, if any, must be accredited by

recognized national, regional, or state agencies with accrediting authority. For
programs in countries other than the United States, ACOTE will determine an
alternative and equivalent external review process.
A.1.2 Sponsoring institutions must be authorized under applicable law or other

acceptable authority to provide a program of postsecondary education and must
have degree granting authority.
A.1.3 For programs in which the academic and fieldwork components of the curriculum
are provided by two or more institutions, responsibilities of each sponsoring
institution and fieldwork site must be clearly documented in a memorandum of
understanding.
A.1.4 Documentation must be provided that each memorandum of understanding

between institutions and fieldwork sites is reviewed at least every five years by
both parties.
A.1.5 Accredited occupational therapy educational programs may only be established

in senior colleges, universities, or medical schools.
A.1.6 The sponsoring institution shall assume primary responsibility for appointment of
faculty, admission of students, curriculum planning, including selection of course
content, and granting the certificate or degree documenting satisfactory
completion of the educational program. The sponsoring institution shall also be
responsible for the coordination of classroom teaching and supervised fieldwork
practice and for providing assurance that the practice activities assigned to
students in a fieldwork setting are appropriate to the program.
A.2.0 ACADEMIC RESOURCES
A.2.1 The program must have a director who is assigned to the occupational therapy
program on a full-time basis.
A.2.2 The program director shall be an occupational therapist, initially certified

nationally, and credentialed according to state requirements. The director shall
have a minimum of five years of professional experience in areas related to
clinical practice, administration, and teaching. At least two of these years must
be a full-time academic appointment with teaching responsibilities.
A.2.3
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effective leadership for the program, its faculty, and its students.
A.2.4 The program director shall be responsible for the management and
administration of the program, including planning, evaluation, budgeting,
selection of faculty and staff, maintenance of accreditation, and commitment to
strategies for professional development.
A.2.5 The program director and faculty must possess the necessary academic and
experiential qualifications and backgrounds, identified in documented
descriptions of roles and responsibilities, appropriate to meet program
objectives.
A.2.6 The occupational therapy faculty will assume responsibility for development,
implementation, and evaluation of fieldwork education. There will be an
individual specifically identified with fieldwork coordination responsibilities.
A.2.7 The faculty shall include occupational therapy practitioners who have been
initially certified nationally and who have documented expertise in their area(s)
of teaching responsibility.
A.2.8 The occupational therapy faculty must be sufficient in number and must possess
the expertise necessary to ensure appropriate curriculum design, content
delivery, and program evaluation.
A.2.9 Faculty responsibilities shall be consistent with the mission of the institution.
A.2.10 Each full-time faculty member shall have a written continuing professional
growth and development plan to ensure effectiveness and currency as an
academic educator consistent with the structure of the program's strategic plan.
A.2.11 The program shall develop a strategic plan congruent with the mission of the
institution and the curriculum design. This plan shall incorporate professional
development plans of the faculty and the program objectives.
A.2.12 The faculty/student ratio shall permit the achievement of the purpose and stated
objectives of the program, be compatible with accepted practices of the
institution for similar programs, promote quality education in laboratory and
fieldwork experiences, and ensure student and/or consumer safety.
A.2.13 Clerical and support staff shall be provided to the program, consistent with
institutional practice, to meet programmatic and administrative requirements.
A.2.14 The program shall be allocated a budget of regular institutional funds, not
including grants, gifts, and other restricted sources, sufficient to implement and
maintain the objectives of the program and to fulfill the program's obligation to
matriculated and entering students.
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A.2.15 Classrooms and laboratories shall be provided consistent with the program's
educational objectives, teaching methods, number of students, and safety/health
standards of the institution, and shall allow for efficient operation of the program.
A.2.16 Laboratory space shall be assigned to the occupational therapy program on a

priority basis.
A.2.17 Space shall be provided to store and secure equipment and supplies.
A.2.18 The program director and faculty shall have office space consistent with
institutional practice.
A.2.19 Space shall be provided for the private advising of students.
A.2.20 Appropriate and sufficient equipment and supplies shall be provided for student
use and for the didactic and supervised fieldwork components of the curriculum.
A.2.21 Students shall be given access to the evaluative and treatment technologies that
reflect current practice.
A.2.22 Students shall have ready access to a supply of current books, journals,
periodicals, computers, software, and other reference materials needed to meet
the requirements of the curriculum. This may include, but is not limited to,
libraries, on-line services, interlibrary loan, and resource centers.
A.2.23 Instructional aids and technology shall be available in sufficient quantity and
quality to be consistent with the program objectives and teaching methods.
A.3.0 STUDENTS
A.3.1 Admission of students to the occupational therapy program shall be made in

accordance with the practices of the institution. There shall be stated admission
criteria that are clearly defined and published, and reflective of the demands of
the program.
A.3.2 Policies pertaining to standards for admission, advanced placement, transfer of

credit, credit for experiential learning (if applicable), and prerequisite educational
or work experience requirements shall be readily accessible to prospective
students and the public.
A.3.3 Criteria for successful completion of each segment of the educational program
and for graduation shall be given in advance to each student.
A.3.4 Evaluation content and methods shall be consistent with the objectives and
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competencies of the didactic and fieldwork components of the program.
A.3.5 Evaluation shall be employed on a regular basis to provide students and

program officials with timely indications of the students’ progress and academic
standing.
A.3.6 Students must be informed of and have access to the health services provided
to other students in the institution.
A.3.7 Advising related to professional coursework and fieldwork education shall be the
responsibility of the occupational therapy faculty.
A.3.8 A mechanism shall be in place to ensure collaboration between the fieldwork

educator and representatives of the academic program during fieldwork
experiences.
A.3.9 The program faculty shall have access to institutional and community resources
and make them available to students in situations that could interfere with
student progress through the program.
A.4.0 OPERATIONAL POLICIES
A.4.1 All program publications and advertising (including academic calendars,

announcements, catalogs, handbooks, and internet descriptions) must
accurately reflect the program offered.
A.4.2 The program's accreditation status and the name, address, and telephone
number of ACOTE shall be published in the catalog, program brochures for
prospective students, and, if available, internet sites.
A.4.3 Faculty recruitment and employment practices as well as student recruitment

and admission procedures shall be non-discriminatory.
A.4.4 Graduation requirements, tuition, and fees shall be accurately stated, published,
and made known to all applicants.
A.4.5 The program or sponsoring institution shall have a defined and published policy
and procedure for processing student and faculty grievances.
A.4.6 Policies and processes for student withdrawal and for refunds of tuition and fees
shall be published and made known to all applicants.
A.4.7 Policies and procedures for student probation, suspension, and dismissal shall
be published and made known.
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A.4.8 Policies and procedures shall be published and made known for human subject
research protocol; appropriate use of equipment and supplies; and for all
educational activities that have implications for the health and safety of clients,
students, and faculty (including infection control and evacuation procedures).
A.4.9 A program admitting students on the basis of ability to benefit must publicize its
objectives, assessment measures, and means of evaluating ability to benefit.
A.4.10 Documentation of all progression and retention, graduation and credentialing

requirements, including certification/licensure, shall be published and made
known to applicants.
A.4.11 The program shall have a documented and published policy to ensure students
complete all graduation and fieldwork requirements in a timely manner.
A.4.12 Records regarding student admission, enrollment, and achievement shall be

maintained and kept in a secure setting. Grades and credits for courses shall be
recorded on students' transcripts and permanently maintained by the sponsoring
institution.
A.5.0 CURRICULUM FRAMEWORK
This is a description of the program that includes the mission, philosophy, and
curriculum design.
A.5.1 The statement of the mission of the occupational therapy program shall be
consistent with that of the sponsoring institution.
A.5.2 The statement of philosophy of the occupational therapy program shall reflect
the current published philosophy of the profession and shall include a statement
of the program’s fundamental beliefs about human beings and how they learn.
A.5.3 The curriculum design shall reflect the mission and philosophy of both the
occupational therapy program and the institution and shall provide the basis for
program planning, implementation, and evaluation. The design shall identify
educational goals and describe the selection of the content, scope and
sequencing of coursework.
A.5.4 Didactic instruction and supervised practice shall follow a plan documenting
learning experiences appropriate for the development of the competencies
required for graduation; the plan shall also delineate the instructional methods
(e.g., presentations, demonstrations, discussions) and materials that shall be
used to develop these competencies.
A.5.5 Instruction must follow a plan that documents clearly written course syllabi that
are consistent with the curriculum design and describe learning objectives and
competencies to be achieved for both didactic and fieldwork education
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components.
A.5.6 Instruction must follow a plan that documents evaluation of students on a regular
basis to assess their acquisition of knowledge, skills, and attitudes, and their
ability to apply them to occupational therapy practice.
A.6.0 PROGRAM EVALUATION
The program must have a continuing system for reviewing the effectiveness of the
educational program, especially as measured by student achievement, faculty
performance, and the ability to meet program goals. Timely self-study reports must be
prepared to aid the faculty and staff, the sponsoring institution, and the accrediting
agencies in assessing program qualities and needs.
A.6.1 Programs shall routinely secure and systematically analyze sufficient qualitative
and quantitative information about the extent to which the program is meeting its
stated goals and objectives. This must include, but need not be limited to:
faculty effectiveness in their assigned teaching responsibilities;

students' progression through the program;
graduates' performance on the National Board for Certification in
Occupational Therapy (NBCOT) exam; and
graduate job placement and performance based on employer satisfaction.
The manner in which programs seek to comply with this criterion may vary;
however, timely efforts should be made to document the data and analysis
provided. These sources of data may include, but should not be limited to,
surveys covering type and scope of practice, salary, job satisfaction, and
adequacy of the educational program in addressing education and skills, and
interviews or surveys with program graduates and employers of graduates.
A.6.2 The results of ongoing evaluation must be appropriately reflected in the

program's strategic plan, curriculum design, and other dimensions of the
program.
Program evaluation should be a continuing systematic process with internal and

external curriculum validation in consultation with employers, faculty, preceptors,
fieldwork educators, students, and graduates, with follow-up studies of their
employment and national examination performance. Other dimensions of the
program merit consideration as well, such as the mission and philosophy of the
program, admission criteria and process, and the purpose and productivity of all
advisory bodies.
SECTION B: SPECIFIC REQUIREMENTS FOR ACCREDITATION
B.1.0 FOUNDATIONAL CONTENT REQUIREMENTS
150
Program content shall be based on a broad foundation in the liberal arts and sciences.
A strong foundation in the biological, physical, social and behavioral sciences
supports an understanding of occupation across the life span. Coursework in these
areas may be prerequisite to or concurrent with professional education and shall
facilitate development of the performance criteria listed below. The student will:
B.1.1 Demonstrate oral and written communication skills.
B.1.2 Employ logical thinking, critical analysis, problem-solving, and creativity.
B.1.3 Demonstrate competence in basic computer use.
B.1.4 Demonstrate knowledge and understanding of the structure and function of the
human body to include the biological and physical sciences.
B.1.5 Demonstrate knowledge and understanding of human development throughout

the life span.
B.1.6 Demonstrate knowledge and understanding of the concepts of human behavior

to include the behavioral and social sciences.
B.1.7 Demonstrate knowledge and appreciation of the role of sociocultural,

socioeconomic, diversity factors, and lifestyle choices in contemporary society.
B.1.8 Appreciate the influence of social conditions and the ethical context in which
humans choose and engage in occupations.
B.1.9 Demonstrate the ability to use statistics, tests, and measurements.
B.2.0 BASIC TENETS OF OCCUPATIONAL THERAPY
These shall facilitate development of the performance criteria listed below. The
student will:
B.2.1 Acknowledge and understand the importance of the history and philosophical
base of the profession of occupational therapy.
B.2.2 Be able to differentiate among occupation, activity, and purposeful activity.
B.2.3 Understand the meaning and dynamics of occupation and purposeful activity
including the interaction of performance areas, performance components, and
performance contexts.
B.2.4 Be able to articulate to the consumer, potential employers, and the general
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public both the unique nature of occupation as viewed by the profession of

occupational therapy and the value of occupation for the client.
B.2.5 Acknowledge and understand the importance of the balance of performance

areas to the achievement of health and wellness.
B.2.6 Understand and appreciate the role of occupation in the promotion of health and
the prevention of disease and disability for the individual, family, and society.
B.2.7 Understand the effects of health, disability, disease processes, and traumatic
injury to the individual within the context of family and society.
B.2.8 Exhibit the ability to analyze tasks relative to performance areas, performance
components, and performance contexts.
B.2.9 Demonstrate appreciation for the individual's perception of quality of life, well
being, and occupation to promote health and prevention of injury and disease.
B.2.10 Understand the need for and use of compensatory strategies when desired life
tasks cannot be performed.
B.3.0 OCCUPATIONAL THERAPY THEORETICAL PERSPECTIVES
The theoretical basis for the practice of occupational therapy shall facilitate
development of the performance criteria listed below. The student will:
B.3.1 Understand the theories that underlie the practice of occupational therapy.
B.3.2 Understand the models of practice and frames of reference that are used in
occupational therapy.
B.3.3 Understand how theories, models of practice, and frames of reference are used
in occupational therapy evaluation and intervention.
B.3.4 Understand how history, theory, and sociopolitical climate influence practice.
B.3.5 Be able to apply theoretical constructs to evaluation and intervention with clients
to analyze and effect meaningful occupation.
B.3.6 Develop a basic understanding of theory development and its importance to

occupational therapy.
B.4.0 SCREENING AND EVALUATION
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The process of screening and evaluation shall be based on theoretical perspectives,

models of practice, and frames of reference that facilitate development of the
performance criteria listed below. The student will:
B.4.1 Use standardized and non-standardized screening tools to determine the need
for occupational therapy intervention. These include, but are not limited to,
specified screening assessments, skilled observation, checklists, histories,
interviews with the client/family/significant others, and consultations with other
professionals.
B.4.2 Select appropriate assessment tools based on client need, contextual factors,
and psychometric properties of tests.
B.4.3 Use appropriate procedures and protocols, including standardized formats,

when administering assessments.
B.4.4 Understand and appreciate the importance of cooperation with the occupational
therapy assistant as a data gatherer and contributor to the screening and
evaluation process.
B.4.5 Exhibit the ability to interpret criterion referenced and norm referenced
standardized tests scores based on an understanding of sampling, normative
data, standard and criterion scores, reliability, and validity.
B.4.6 Consider factors that might bias assessment results, such as culture, disability
status, and situational variables related to the individual and context.
B.4.7 Interpret the evaluation data in relation to uniform terminology of the profession
and relevant theoretical frameworks.
B.4.8 Demonstrate the ability to use safety precautions with clients during the
screening and evaluation process, such as standards for infection control that
include, but are not limited to, universal precautions.
B.4.9 Identify when it is appropriate for referral to specialists, internal and external to
the profession, for additional evaluation.
B.4.10 Document occupational therapy services to ensure accountability of service

provision and to meet standards for reimbursement of services. Documentation
shall effectively communicate the need and rationale for occupational therapy
services.
B.5.0 INTERVENTION PLAN: FORMULATION AND IMPLEMENTATION
The process of formulation and implementation of the therapeutic intervention plan

shall be based on theoretical perspectives, models of practice, and frames of
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reference and shall facilitate development of the performance criteria listed below. The
student will:
B.5.1 Interpret evaluation findings based on appropriate theoretical approaches,

models of practice, and frames of reference.
B.5.2 Develop occupationally based intervention plans and strategies, including goals
and methods to achieve them, based on the stated needs of the client as well as
data gathered during the evaluation process.
B.5.3 Provide evidence-based effective therapeutic intervention related to

performance areas, performance components, and performance contexts
directly and in collaboration with the client and others.
B.5.4 Employ relevant occupations and purposeful activities that support the
intervention goals and are meaningful to the client.
B.5.5 Use individual and group interaction and therapeutic use of self as a means of
achieving therapeutic goals.
B.5.6 Develop and promote the use of appropriate home and community programming
to support performance in the client's natural environment.
B.5.7 Demonstrate the ability to educate and train client/family/significant others to

facilitate skills in performance areas as well as prevention, health maintenance,
and safety.
B.5.8 Exhibit the ability to use the teaching-learning process with

client/family/significant others, colleagues, other health providers, and the public.
This includes assisting learners to identify their needs and objectives and using
educational methods that will support these needs and objectives.
B.5.9 Demonstrate the ability to interact through written, oral, and nonverbal
communication with client/family/significant others, colleagues, other health
providers, and the public.
B.5.10 Use therapeutic adaptation with occupations pertinent to the need of the client.
This shall include, but not be limited to, family/careprovider training, behavioral
modifications, orthotics, prosthetics, assistive devices, equipment, and other
technologies.
B.5.11 Demonstrate the ability to grade and adapt tasks related to performance areas
and performance components for therapeutic intervention.
B.5.12 Demonstrate the ability to teach compensatory strategies such as use of

technology, adaptations to the environment, and involvement of humans and
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nonhumans in the completion of tasks.
B.5.13 Demonstrate the ability to use safety precautions with the client during
therapeutic intervention, such as contraindications and use of infection control
standards that include, but are not limited to, universal precautions.
B.5.14 Develop skills in supervising and collaborating with occupational therapy

assistants on therapeutic interventions.
B.5.15 Demonstrate the ability to refer to specialists both internal and external to the
profession for consultation and intervention.
B.5.16 Monitor and reassess, in collaboration with the client, the effect of occupational
therapy intervention and the need for continued and/or modified intervention.
B.5.17 Plan for discharge, in collaboration with the client, by reviewing the needs of
ciient/family/significant others, resources, and discharge environment. This
includes, but is not limited to, the identification of community, human, and fiscal
resources, recommendations for environmental adaptations, and home
programming.
B.5.18 Organize, collect, and analyze data in a systematic manner for evaluation of
practice outcomes.
B.5.19 Terminate occupational therapy services when stated outcomes have been
achieved or determined that they cannot be achieved. This includes a summary
of occupational therapy outcomes, appropriate recommendations and referrals,
and discussion with the client of post-discharge needs.
B.5.20 Document occupational therapy services to ensure accountability of service

provision and to meet standards for reimbursement of services. Documentation
shall effectively communicate the need and rationale for occupational therapy
services and must be appropriate to the system in which the service is delivered.
B.6.0 CONTEXT OF SERVICE DELIVERY
The knowledge and understanding of the various contexts in which occupational

therapy services are provided shall facilitate development of the performance criteria
listed below. The student will:
B.6.1 Understand the models of health care, education, community, and social
systems as they relate to the practice of occupational therapy.
B.6.2 Understand the current policy issues in the above mentioned systems that
influence the practice of occupational therapy.
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B.6.3 Understand the current social, economic, political, geographic, and demographic
factors that promote policy development and the provision of occupational
therapy services.
B.6.4 Understand the role and responsibility of the practitioner to address changes in
service delivery policies and to effect changes in the system.
B.6.5 Understand the trends in models of service delivery and their effect on the
practice of occupational therapy, including, but not limited to, medical,
educational, community, and social models.
B.6.6 Appreciate the influence of international occupational therapy contributions to

education, research, and practice.
B.7.0 MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES
Application of principles of management and systems in the provision of occupational

therapy services to individuals and organizations shall facilitate development of the
B.7.1 Understand a variety of systems and service models, including, but not limited
to, health care, education, community, and social models, and how these
models may effect service provision.
B.7.2 Demonstrate knowledge of the social, economic, political, and demographic

factors that influence the delivery of health care in the United States.
B.7.3 Understand the implications and effects of federal and state regulatory and
legislative bodies on practice.
B.7.4 Understand governmental and policy issues, including knowledge and

implications of current statutes and regulations that affect the provision of
occupational therapy services.
B.7.5 Demonstrate knowledge of applicable national and state requirements for

credentialing.
B.7.6 Demonstrate knowledge of and ability to comply with the various reimbursement
mechanisms that affect the practice of occupational therapy, including, but not
limited to, federal and state reimbursement practices and third party and private
payers.
B.7.7 Advocate for the profession and the consumer and demonstrate an
understanding of the due process and appeals systems when reimbursement is
not approved for occupational therapy services.
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B.7.8 Demonstrate an understanding of the resources a practitioner can use to

respond to changes in the marketplace.
B.7.9 Use principles of time management, including being able to schedule and
prioritize workloads.
B.7.10 Maintain and organize treatment areas, equipment, and supply inventory.
B.7.11 Maintain records as required in practice setting, third party payers, and
regulatory agencies.
B.7.12 Demonstrate the ability to design program improvement measures and ongoing
service delivery assessment using predetermined criteria.
B.7.13 Plan, develop, and organize the delivery of services to include the determination
of programmatic needs such as staffing and service delivery options.
B.7.14 Understand the supervisory process of occupational therapy and non-

occupational therapy personnel.
B.7.15 Develop strategies for effective use of professional and non-professional staff.
B.7.16 Understand the ongoing professional responsibility for providing fieldwork

education and supervision.
B.7.17 Develop skills to formulate and manage teams for effective service provision.
B.7.18 Understand the use of outcome studies analysis to direct administrative

changes.
B.7.19 Develop fundamental marketing skills to advance the profession.
B.8.0 USE OF RESEARCH
The ability to read and understand current research that affects practice and the
provision of occupational therapy services shall facilitate development of the
B.8.1 Articulate the importance of research for practice and the continued
development of the profession.
B.8.2 Be able to use professional literature to make informed practice decisions.
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B.8.3 Know when and how to find and use national and international informational
resources, including appropriate literature within and outside of occupational
therapy.
B.8.4 Understand and interpret basic descriptive, correlational, and inferential

statistics.
B.8.5 Understand and critique research studies, including various methodologies using
both quantitative and qualitative designs.
B.8.6 Understand the importance of scholarly activities that will contribute to the
development of a body of knowledge relevant to the profession of occupational
therapy.
B.8.7 Design and implement beginning-level research studies.
B.8.8 Develop basic skills necessary for the publication and presentation of research
projects.
B.8.9 Develop a basic understanding of the process of securing grants.
B.9.0 PROFESSIONAL ETHICS, VALUES, AND RESPONSIBILITIES
An understanding and appreciation of ethics and values of the profession of

occupational therapy shall facilitate development of the performance criteria listed
below. The student will:
B.9.1 Demonstrate a knowledge and understanding of the AOTA Code of Ethics, Core
Values and Attitudes of Occupational Therapy, and AOTA Standards of Practice
as a guide for professional interactions and in client treatment and employment
settings.
B.9.2 Understand the functions and influence of national, state, and local occupational
therapy associations and other related professional associations.
B.9.3 Promote occupational therapy by educating other professionals, consumers,

third-party payers, and the public.
B.9.4 Acknowledge the personal responsibility for planning ongoing professional

development to ensure a level of practice consistent with current and accepted
standards.
B.9.5 Demonstrate an understanding of professional responsibilities related to liability

concerns under current models of service provision.
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B.9.6 Develop an understanding of personal and professional abilities and

competencies as they relate to job responsibilities.
B.9.7 Understand and appreciate the varied roles of the occupational therapist as a
practitioner, educator, researcher, and entrepreneur.
B.9.8 Articulate the importance of professional relationships between the occupational

therapist and the occupational therapy assistant.
B.9.9 Understand professional responsibilities when service provision is on a

contractual basis in the current system.
B.9.10 Demonstrate an understanding of approaches to use in resolving personal and

organizational ethical conflicts.
B.9.11 Demonstrate an understanding of the variety of informal and formal ethical

dispute resolution systems that have jurisdiction over occupational therapy
practice.
B.9.12 Be able to assist the consumer in gaining access to occupational therapy

services.
B.9.13 Demonstrate knowledge of advocacy for the benefit of the consumer and the
profession.
B.10.0 FIELDWORK EDUCATION
Fieldwork education is a crucial part of professional preparation and is best integrated

as a component of the curriculum design. Fieldwork experiences should be
implemented and evaluated for their effectiveness by the educational institution. The
experience should provide the student with the opportunity to carry out professional
responsibilities under supervision and for professional role modeling. The program
will:
B.10.1 Document a plan to assure collaboration between academic and fieldwork

representatives. The plan shall include agreed upon fieldwork objectives that are
documented and made known to the student.
B.10.2 Ensure that the ratio of fieldwork educators to student(s) enables proper
supervision and frequent assessment of the progress in achieving stated
fieldwork objectives.
B.10.3 Ensure that fieldwork agreements shall be sufficient in scope and number to
allow completion of graduation requirements in a timely manner in accordance
with the policy adopted by the program.
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B.10.4 Conduct fieldwork in settings equipped to provide application of principles

learned in the academic program and appropriate to the learning needs of the
student.
B.10.5 Require that all aspects of the fieldwork program be consistent with the
curriculum design of the program.
The goal of Level I Fieldwork is to introduce students to the fieldwork experience, and
develop a basic comfort level with and understanding of the needs of clients. Level I
fieldwork shall be integral to the program's curriculum design and include experiences
designed to enrich didactic coursework through directed observation and
participation in selected aspects of the occupational therapy process. The focus of
these experiences is not intended to be independent performance. Qualified personnel
for supervised Level I fieldwork include, but are not limited to, occupational therapy
practitioners initially certified nationally, psychologists, physician assistants,
teachers, social workers, nurses, and physical therapists. The program will:
B.10.6 Ensure that Level I fieldwork shall not be substituted for any part of Level II
fieldwork.
B.10.7 Document all Level I fieldwork experiences that are provided to students.
B.10.8 Document mechanisms for formal evaluation of student performance on Level

I fieldwork.
The goal of Level II fieldwork is to develop competent, entry-level, generalist

occupational therapists. Level II fieldwork shall be integral to the program's
curriculum design and shall include an in-depth experience in delivering occupational
therapy services to clients, focusing on the application of purposeful and meaningful
occupation and/or research, administration and management of occupational therapy
services. It is recommended that the student be exposed to a variety of clients across
the life span and to a variety of settings. The fieldwork experience shall be designed to
promote clinical reasoning and reflective practice; to transmit the values and beliefs
that enable ethical practice; and to develop professionalism and competence as
career responsibilities. The program will:
B.10.9 Recognize that Level II fieldwork can take place in a variety of traditional settings
and emerging areas of practice. The student can complete Level II fieldwork in a
minimum of one setting and maximum of four different settings.
B.10.10 Require a minimum of the equivalent of 24 weeks full-time Level II fieldwork.

This may be completed on a full-time or part-time basis, but may not be less
than half-time as defined by the fieldwork site.
B.10.11 Ensure that the student shall be supervised by an occupational therapist who
meets state regulations and has a minimum of one year of practice experience,
subsequent to the requisite initial certification. The supervising therapist may be
engaged by the fieldwork site or by the educational program.
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B.10.12 Ensure that supervision provides protection of consumers and opportunities for
appropriate role modeling of occupational therapy practice. Initially, supervision
should be direct, then decrease to less direct supervision as is appropriate for
the setting, the severity of client’s condition, and the ability of the student.
B.10.13 In a setting where there is no occupational therapist on site, the program must
document that there is a plan for the provision of occupational therapy services.
On-site supervision must be provided in accordance with the plan and state
credentialing requirements. The student must receive a minimum of six hours of
occupational therapy supervision per week, including direct observation of client
interaction. Additionally, the occupational therapy supervisor must be readily
available for communication and consultation during work hours. Such fieldwork
shall not exceed 12 weeks.
B.10.14 For programs wishing to pursue fieldwork outside of the United States. Ensure
that the student completing Level II fieldwork outside the United States is
supervised by an occupational therapist who has graduated from a program
approved by the World Federation of Occupational Therapists (WFOT) and have
one year of experience in practice. Such fieldwork shall not exceed 12 weeks.
SECTION C: MAINTAINING AND ADMINISTERING ACCREDITATION
C.1.0 PROGRAM AND SPONSORING INSTITUTION RESPONSIBILITIES
C.1.1 The accreditation review process conducted by ACOTE can be initiated only at
the written request of the chief executive officer or an officially designated
representative of the sponsoring institution and the occupational therapy
program director or dean overseeing the proposed program.
C.1.2 This process is initiated by submitting a letter of intent to seek accreditation to

the:
Accreditation Department
American Occupational Therapy Association, Inc.
4720 Montgomery Lane
P.O. Box 31220
Bethesda, MD 20824-1220
C.1.3 At any time before the final accreditation action is made by ACOTE, a program
or sponsoring institution may withdraw its request for initial or continuing
accreditation.
C.1.4 To maintain accreditation, the following actions are required: The program must
submit a Report of Self-Study and other required reports within a period of time
determined by ACOTE. The program must agree to a site visit date before the
end of the period for which accreditation was previously awarded. In accordance
with stated policy, the program must inform ACOTE within 90 days of a change
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in program director. The sponsoring institution must inform ACOTE of the

transfer of program sponsorship.
C.1.5 The program and the sponsoring institution must pay accreditation fees within a
time period specified in the ACOTE Accreditation Manual.
Failure to meet these administrative requirements for maintaining accreditation may lead to
being placed on Administrative Probation and ultimately to having accreditation withdrawn.
C.2.0 ACOTE RESPONSIBILITIES
C.2.1 All policies and procedures relating to the accreditation process are found in the
AOTA Accreditation Council for Occupational Therapy Education (ACOTE)
Accreditation Manual.
C.2.2 ACOTE will follow fair practice procedures when complaints are received by
ACOTE indicating that accredited programs or programs seeking accreditation
may not be in substantial compliance with the Standards for an Accredited
Educational Program for the Occupational Therapist or may not be following
established accreditation policies. A record of complaints is maintained by the
AOTA Accreditation Department. The policy and procedure for complaints are
found in the AOTA Accreditation Council for Occupational Therapy Education
(ACOTE) Accreditation Manual.
GLOSSARY:
Standards for an Accredited Educational Program for the
Occupational Therapist and Occupational Therapy Assistant
Definitions given below are for the purposes of this document.
ABILITY TO BENEFIT: a phrase that refers to a student who does not have a high school diploma
or its recognized equivalent, but is eligible to receive funds under the Title IV Higher Education
Act (HEA) programs after taking an independently administered examination and achieving a
score specified by the Secretary of Education that the student has the ability to benefit from the
education being offered. (United States Department of Education)
ACADEMIC CALENDAR: the official institutional document which lists registration dates,
semester/quarter stop and start dates, holidays, graduation dates and other pertinent events.
ACTIVITY: a natural or normal task.
AFFILIATE: an entity which formally cooperates with the sponsoring institution in implementing
the occupational therapy educational program.
ASSIST: to aid, help, or hold an auxiliary position.
CLIENT: a person, group, program or organization for whom the occupational therapy
practitioner is providing services and receives remuneration.
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systems, models and contexts in making decisions that focus on the client’s needs and that
engage the client as a participant.
COLLABORATE: to work together with a mutual sharing of thoughts and ideas.
COMMUNITIES OF INTEREST: various stakeholders directly affected by the occupational therapy

accreditation and education process, i.e., clinicians, faculty, students, parents, consumers,
college administrators, clients, etc.
COMPETENT: to have the requisite ability/qualities and capacity to function in a professional

environment.
COMPUTER COMPETENCE: the ability to use basic software applications, e.g., word processing,
spreadsheets, e-mail, and to use the Internet and intranets for research to accomplish the
requirements of the occupational therapy/occupational therapy assistant program.
CONSUMER: the direct and/or indirect recipient of educational and/or practitioner services
offered.
COOPERATE: to work together toward a common end or purpose where there is an implied
hierarchy among the participants; in this case, the occupational therapist and occupational
therapy assistant.
CURRICULUM DESIGN: an overarching set of assumptions that explain how the curriculum is
planned, implemented, and evaluated. Typically, a curriculum design includes educational goals
and provides a clear rationale for the selection of content, the determination of scope of content,
and the sequence of the content. A curriculum design is expected to be consistent with the
mission and philosophy of the sponsoring institution and the program.
ENTRY-LEVEL OCCUPATIONAL THERAPIST: the outcome of the occupational therapy

educational and certification process; the individual prepared to begin generalist practice as an
occupational therapist with less than one year of experience.
ENTRY-LEVEL OCCUPATIONAL THERAPY ASSISTANT: the outcome of the occupational therapy

educational and certification process; the individual prepared to begin generalist practice as an
occupational therapy assistant with less than one year of experience.
FACULTY, COLLECTIVE: the aggregate of individuals charged with the design, implementation
and evaluation of the occupational therapy curriculum.
FACULTY, INDIVIDUAL/FULL-TIME: a qualified paid employee of an institution to teach specific

content in the occupational therapy curriculum, who holds an appointment that is considered by
that institution to constitute full time service.
FACULTY, PART-TIME: a qualified paid employee of an institution to teach specific content in the
occupational therapy curriculum, who holds an appointment that is considered by that institution
to constitute less than full time service.
FIELDWORK COORDINATOR: the person identified to schedule all activities related to fieldwork.
This person may or may not be responsible for the development, implementation and evaluation
of fieldwork education.
FRAME OF REFERENCE: set of interrelated internally consistent concepts, definitions,

postulates, and principles that provide a systematic description of a practitioner’s interaction
with clients. It is intended to link theory to practice.
INITIALLY CERTIFIED NATIONALLY: the process by which a non-governmental agency or
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specified by that agency or association. [As evidenced by the Representative Assembly action
(97 M121) in April 1997 and 1998 N88 in April 1998, AOTA understood the term to refer to entry-
level certification.]
MISSION: the statement which explains the unique nature of the program and how it helps fulfill
or advances the mission of the sponsoring institution.
MODEL OF PRACTICE: set of theories and philosophies that define the views, beliefs,
assumptions, values, and domain of concern of a particular profession or discipline. Models of
practice delimit the boundaries of the profession.
OCCUPATION: the uniquely human task behavior that is characterized by the qualities of
personal meaning and purpose used in the context of occupational therapy. Occupation is the
means through which a patient/client (consumer) achieves therapeutic goals for maximum
independence and life satisfaction. Successful engagement in occupation is the desired end
product for intervention.
OCCUPATIONAL THERAPY: the art and science of applying occupation as a means to effect
positive, measurable change in the health status and functional outcomes of the client by a
qualified occupational therapist and/or occupational therapy assistant (as appropriate).
OCCUPATIONAL THERAPY PRACTITIONER: an individual who is credentialed as an

occupational therapist or an occupational therapy assistant.
PERFORMANCE AREAS: broad categories of human activity that are typically part of daily life.
They are activities of daily living, work and productive activities, and play or leisure activities.
PERFORMANCE COMPONENTS: elements of performance required for successful engagement

in performance areas, including sensorimotor, cognitive, psychosocial and psychological
aspects.
PERFORMANCE CONTEXTS: situations or factors that influence an individual’s engagement in

desired and/or required performance areas. Performance contexts consist of temporal aspects
(chronological, developmental, life cycle, disability status) and environmental aspects (physical,
social, political, cultural).
PHILOSOPHY: the undergirding belief and value structure for the program that is consistent with
the sponsoring institution and which permeates the curriculum and the teaching learning
process.
PROGRAM DIRECTOR: the program director (as outlined in the Standards) is an occupational
therapist, initially certified nationally, with sufficient knowledge, experience, academic
qualifications, and senior level status within the educational institution for providing effective
guidance and leadership to the program, faculty and students.
PROGRAM EVALUATION: a continuing system for reviewing and assessing the effectiveness of
an educational program, especially as measured by student achievement.
PURPOSEFUL ACTIVITY: refers to goal-directed behaviors or tasks which may be a means to an

end and may or may not have personally imbued meaning. Purposeful activity may be subsumed
under the larger context of occupation and may be internally or externally driven.
RECOGNIZED AGENCIES: specialized and regional accrediting agencies recognized by the

United States Department of Education (USDE) and/or the Council for Higher Education
Accreditation (CHEA) to accredit post-secondary educational programs/institutions. The purpose
of recognition is to assure that these accrediting agencies are reliable authorities for evaluating
quality education or training programs in the institutions they accredit.
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SKILL: the ability to use one’s knowledge effectively and readily in execution or performance.
SPONSORING INSTITUTION: the identified legal entity which assumes total responsibility for
meeting the minimal standards for ACOTE accreditation.
STRATEGIC PLAN: a comprehensive plan that sets forth the broad program goals, specific
measurable objectives, and strategies for objective attainment. Typically, a strategic plan
provides the basis for continuous program evaluation.
SUPERVISE: to direct and inspect the performance of (workers or work).
SUPERVISOR: one who ensures that tasks assigned to others are performed correctly and
efficiently.
SYSTEM: an organized entity of interdependent components or principles that provides a

structure by which to function.
THEORY: set of interrelated concepts used to describe, explain or predict phenomena.
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Appendix B
Accredited Entry-Level Master’s Degree Programs
(Invited Sample)
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University o f Central Arkansas

University o f Alabama at Birmingham Program Director
Program Director Occupational Therapy Department
Occupational Therapy Department
201 Donaghey Avenue, HSC Suite 300
1530 3rd Ave, South, BB 102 Box 5001
Birmingham AL 35294-2030 Conway AR 72035-0001
Arizona School of Health Sciences Midwestern University-Glendale Campus

Program Director Program Director
Occupational Therapy Department Occupational Therapy Department
5850 E. Still Circle 19555 North 59th Avenue
Mesa AZ 85206 Glendale AZ 85308
Loraa Linda University Samuel Merritt College

Occupational Therapy Department Occupational 'therapy Department
SAHP - Nichol Hall, Room A902 370 Hawthorne Avenue
Loma Linda CA 92350-0001 Oakland CA 94609-3108
San Jose State University University of Sourthem California

One Washington Square 1540 Alcazar, CHP-133
San Jose CA 95192-0059 Los Angeles CA 90089-9003
Colorado State University Sacred Heart University

228 Occupational Therapy Building 5151 Park Avenue
Fort Collins CO 80523 Fairfield CT 06432-1000
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Quinnipiac University Barry University

275 Mount Carmel Avenue 11300 Northeast Second Avenue
Hamden CT 06518-0569 Miami Shores FL 33161-6695
Nova SoutheasteCUniversity University of Florida

3200 S. University Drive P.O. Bo* 100164, HSC
Fort Lauderdale FL 33328 Gainesville FA 32610-0164
University of St. Augustine for Health Sciences St. Ambrose University

I University Boulevard 518 West Locust
St. Augustine FL 32086 Davenport 1A 52803-2898
Idaho State University Governors State University

Campus BOx 8045 College o f Health Professions
Pocatello ID 83209-8045 University Park IL 60466-0975
Midwestern University Rush University

555 31st Street 600 South Paulina, Suite 1009B
Downers Grove IL 60515 Chicago IL 60612-3833
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University of Illinois at Chicago University of Indianapolis

1919 West Taylor Street, M/C 811 1400 East Hanna Avenue
Chicago IL 60612 Indianapolis IN 46227-3697
University o f Kansas Medical Center Spalding University

3033 Robinson. 3901 Rainbow Blvd 851 South Fourth Street
Kansas City KS 66160-7602 Louisville KY 40203-2188
Louisiana State University Health Sciences Ctr.

Louisiana State University Health Sciences Ctr
Program Director
Program Director
1501 Kings Highway
1900 Gravier Street
P.O. Box 33932
New Orleans LA 70112-2223
Shreveport LA 71130-3932
American International College Boston University

1000 State Street Box 46 635 Commonwealth Avenue
Springfield MA 0 1109-3189 Boston MA 02215
Springfield College l ufts University-Boston School of O.T.

263 Alden Street 26 Winthrop Street
Springfield MA 01109-3797 Medford MA 0215S-7084
Worcester State College Towson University
486 Chandler Street 8000 York Road
I Worcester MA 01602-2597 Towson MD 21252-0001
Lewiston-Auburn College University of New England

5 1 Westminister Street College of Arts & Sciences
Lewiston ME 04240-3534 Biddeford ME 04005-3534
Grand Valley State University

Eastern Michigan University
Program Director
Program Director
322 Henry Hall
322 Everett Marshall Hall
1 Campus Drive
Ypsilanti MI 48197-2239
Allendale Ml 49401-9403
Western Michigan University

East Carolina University
Program Director
Program Director
1903 W. Michigan Avenue
School of Allied Health Sciences
EWB Building Greenville NC 27858-4353
Kalamazoo MI 49008-5051
University of North Carolina at Chapel Hill

University of Mary
Program Director
Program Director
Division o f Occupational Sciences
7500 University Drive
Medical School, Wing E, CB0712O
Bismarck ND 58504-9652
Chapel Hill NC 27599-7120
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Kean University
University of New Hampshire Program Director
Occupational Therapy Department School o f Natural, Applied & Health Sciences
Hewitt Hall, 4 Library Way Townsend T209, PO Box 411
Durham NH 03824-3563 Union NJ 07083-9982
Richard Stockton College of N.J. Western Michigan University

P.O. Box 195 EWB Building
Jim Leeds Road 1903 W. Michigan Avenue
Pomona NJ 08240-0195 Kalamazoo MI 49008-5051
College of St. Catherine College of St. Scholastica

2004 Randolph Avenue 1200 Kenwood Avenue
Mail # 4092 Duluth MN 55811
St. Paul MN 55105-1794
University o f Minnesota Maryville University

420 Delaware Street, SF. 13550 Conway Road
Minneapolis MN 55455-0392 St. Louis MO 63141
Rockhurst University Saint Louis University

Occupational Therapy Department Occupational Therapy Dept
1100 Rockhurst Road 3437 Caroline Street
Kansas City MO 64110-2561 St. Louis MO 63104
171
University of New Mexico Columbia University

Health Science & Services Bldg 710 West 168th Street
Room 215 Neurological Institute, 8th Floor
Albuquerque NM 87131 -5641 New York NY 10032
Dominican College D'Youvillc College

470 Western Highway 320 Porter Avenue
Orangeburg NY 10962-1299 Buffalo NY 14201-1084
Ithaca College Keuka College

200 Smiddy Hall Keuka Park NY 14478-0098
Ithaca NY 14850
Long Island University Mercy College

One Univereity Plaza 555 Broadway
Brooklyn Campus Dobbs Ferry NY 10522-1189
Brooklyn NY 11201
New York Institute o f Technology New York University

P.O. Box 8000 35 West 4th Street
School of Education 11th Floor
Old Westbury NY 11S68-8000 New York NY 10012-1172
Stony Brook University
Sage Colleges Program Director
Occupational Therapy Department School of Health Tech. & Mgmt,L2-031
45 Ferry Street Division o f Rehabilitation Sciences
Troy NY 12180-4115 Stony Brook NY 11794-8201
State University of NY Downstate Medical Ctr. Touro College

450 Clarkson Avenue, Box 81 1700 Union Blvd
Brooklyn NY 11203-2098 Bay Shore NY 11706
Cleveland State University

Touro College-Manhattan Program Director
Occupational Therapy Department 1983 E. 24th Street
27-33 West 23rd Street Health Sciences 103
New York NY 10010-4202 Cleveland OH 44115-2440
Medical College of Ohio at Toledo Ohio State University

3015 Arlington Avenue 1583 Perry St, 406 SAMP
Toledo OH 43614-5803 Columbus OH 43210-1234
Universityof Oklahoma Health Sciences Ctr.

University o f Findlay Program Director
Occupational Therapy Department 801 N.E. 13th Street
1000 North Main Street College of Allied Health
Findlay OH 45840-3695 Oklahoma City OK 73190-1090
Univ. of Oklahoma at Schusterman Health
Pacific University
Program Director
Program Director
4502 E 41st Street 2043 College Way
Science Center Forest Grove OR 97116-1797
Tulsa OK 74135
Alvemia College Chatham College

Occupational Theapy Department Occupational Therapy Department
400 St. Bemardine Street Woodland Road
Reading PA 19607-1799 Pittsburgh PA 15233
College Misencordia Duqucsne University

301 Lake Street John G. Rangos, Sr.
Division o f Health Sciences School of Health Sciences, Rm 234
Dallas PA 18612-1098 Pittsburgh PA 15282-0020
Elizabethtown College Gannon University

One Alpha Drive 109 University Square
Elizabethtown PA 17022-2298 Erie PA 16541-0001
Philadelphia University St. Francis University

School House Lane & Henry Ave. PO Box 600
Philadelphia PA 19144-5497 Loretto PA 15940-0600
174
Temple University Thomas Jefferson University

3307 N. Broad Street 130 South 9th Street
College of Allied Health Professions Philadelphia PA 19107-5233
Philadelphia PA 19140
University of Pittsburgh University o f Sciences in Philadelphia

5012 Forbes Tower 600 South 43rd St, Box 24
Pittsburgh PA 15260 Philadelphia PA 19104-4495
Medical University of South Carolina

University o f Scranton Program Director
Occupational Therapy Department 171 Ashley Avenue
Scranton PA 18510-4501 College of Health Professions
Charleston SC 29425-2701
University o f South Dakota Belmont University

414 East Clark Street 1900 Belmont Blvd.
Vermillion SD 57069-2390 Nashville TN 37212-3757
Texas Tech Univ. Health Sciences Ctr.

Milligan College Program Director
3601 4th Street
P.O.Box 130 STOP 6220, Rm 2C212
Milligan College TN 37682 Lubbock TX 79430
175
Texas Tech University Texas Tech University

800 West 4th Street 1300 Wallace Blvd
Health Sciences Center Health Science Center
Odessa TX 79763 Amarillo TX 79106
Texas Woman's University

Texas Woman's University
Program Director
Occupational Therapy Department Program Director
Box 423648. TWU Station
Dallas TX
Denton TX 76204-5648
Texas Woman's University University o f Texas

Houston TX Laredo TX Health Science Ctr at Laredo
University of Texas
The University of Utah
Program Director
Program Director
7703 Floyd Curl Dr
520 Wakara Way
Health Science Ctr at San Antonio
Salt Lake City UT 84108-1290
San Antonio TX 78229-3900
Shenandoah Universyity Virginia Commonwealth Univ.

333 West Cork St, 5th FI. PO Box 980008
Winchester VA 22601 Richmond VA 23298-0008
University o f Washington
University o f Puget Sound
Program Director
Program Director
Box 356490
1500 N. Warner
Dept o f Rehabilitation Medicine
Tacoma W A 98416-0510
Seattle WA 98195
Concordia Univ. W isconsin Mount Mary College

12800 N. Lake Shore Drive 2900 N Mcnomponee River Pkwy
Mequon WI 53092-2402 Milwaukee W I 53222-4597
University o f Wisconsin-Milwaukee
West Virginia University
Program Director
Program Director
P.O. Box 413
P.O. Box 9 1 3 9 - HSN
School o f Allied H ealth Professions
Morgantown WV 26506-9139
M ilwaukee WI 26506-9139
W ashington University School o f Medicine

East Carolina University
Program Director
Program Director
4444 Forest Park Avenue
School o f Allied Health Sciences
Campus Box 8505
Greenville NC 27858-4353
St. Louis MO 63108
University o f North Carolina at Chapel Hill University o f M ary

Medical School, W ing E, CB# 7120 7500 University Drive
Chapel Hill NC 27599-7120 Bismarck ND 58504-9652
University of New Hampshire Kean University
School of Health and Human Services School of Natural. Applied and Health Sciences
Hewitt Hall. 4 Library Way Townsend T 209, PO Box 4 11
Durham NH 03824-3563 Union NJ 077083-9982
Richard Stockton College of New Jersey Seton Hall University

PO Box 195 McQuaid Hall
Jim Leeds Road 400 South Orange Avenue
Pomona NJ 08240-0195 South Orange NJ 07079-2689
178
Appendix C
Cover Letter
Survey
Reminder Post Cards
179
October 18, 2002
Dear Program Director,
1 am presently conducting my doctoral research toward an Ed.D. degree at the University of

Bridgeport in Connecticut. My dissertation is entitled “Animals as a Therapeutic Modality: A
Curriculum Model for Occupational Therapy”. This study is conducted under the supervision of
Dr. Robert Kirschmann, Professor of Education, at the University of Bridgeport.
This study is to determine if the use of animals as a therapeutic modality is being taught within
occupational therapy curricula. The study will survey entry-level master degree occupational
therapy programs. The end result of this dissertation will be a curriculum model on the topic.
This letter is to request your participation by either completing the survey yourself, or identifying
and forwarding this survey to a faculty member who may be interested or involved in teaching
this topic.
I fully understand that you are most likely flooded with surveys on a regular basis. Although, in
order to advance the occupational therapy profession, we all know how important involvement in
this type of research is.
The survey has been piloted and found to take about ten minutes to complete. At your earliest
convenience, please return it in the enclosed self-addressed, stamped envelope. Each survey is
numbered to ensure confidentiality and as a reminder, in approximately ten days, a follow-up
postcard will be mailed to all initially contacted.
Thank you for your time and consideration,
Sincerely,
Donna Latella, MA, OTR/L

Asst. Professor/Asst. Clinical Coordinator
Department of Occupational Therapy
Quinnipiac University
Mt. Carmel Ave.
Hamden, Ct. 06518
donna.latella@quinnipiac.edu
(203) 582-5364
180
Survey #_________
SURVEY ON THE USE OF ANIMALS AS A THERAPEUTIC MODALITY
For the purpose o f this study, “the use o f animals as a therapeutic modality" refers to OT’s,
clients, and OT students working with: animal-assisted activities, animal-assisted therapy,
companion animals, facility-trained animals, hippotherapy/therapeutic horseback riding, and
service animals. It is also important to note that although the term “pet therapy" is often used,
it is no longer recognized as an accepted term by the Delta Society, a nationally recognized
organization which certifies pets and their handlers.
1. Within the OT program, is the use of animals as a therapeutic modality taught?

Yes
No (please skip to question # 7)
2. Is it offered
as an elective course
as a required course
imbedded in a required course
3. What is the name of the course in which it is taught?
4. Specifically, in what year of your curriculum is the use of animals as a therapeutic modality
taught?
First year
Second year
Third year
Fourth year
Fifth year
3. Is the subject taught

with a theoretical approach only
as a clinical application only
with both theory and clinical application
at the fieldwork site
6. If a theoretical approach is taught, which theories are incorporated? Which clinical experts
are referred to?
181
7. What are your curricular goals for teaching this course?
8. Have students been involved in programs outside of the classroom using animals as a
therapeutic modality?
Yes
No
If yes, how?
With faculty who teach the course
With clinicians
In fieldwork
Through service learning
Volunteering on their own
Other (please explain)_______________________________________________
9. Are faculty members involved in programs outside of the classroom using animals as a
therapeutic modality?
Yes
No
If yes, do faculty hold a certification ?

Yes
No
10. What do you perceive as barriers to implementing programs using animals as a therapeutic
modality within your curriculum?
lack of research on the modality

lack of enough physical space
lack of experienced faculty
lack of room within the curriculum
not a curricular priority
resources (animals)
lack of interest
other (please explain)___________________________________________________
182
Please indicate the degree to which you agree or disagree with the following questions:
(please circle)
11. Our program views the use of animals Strongly Disagree Neither agree Agree Strongly NA
as a therapeutic modality as a valued disagree or disagree agree
component in the OT profession.
12. Our program views the use of animals Strongly Disagree Neither agree Agree Strongly NA
as a therapeutic modality as a valued disagree or disagree agree
component of an OT curricula.
13. Our faculty is interested in teaching Strongly Disagree Neither agree Agree Strongly NA
about this topic. disagree or disagree agree NA
14. Our students have expressed interest in Strongly Disagree Neither agree Agree Strongly NA
learning about this topic. disagree or disagree agree
If you, or a faculty member, are currently teaching this topic, would you be willing to be
contacted for an interview?
If yes, please provide:
Name and title:___________________________________________________________

School:__________________________________________________________________
Address:________________________________________________________________
Phone:___________________________________________________________________
Email address:___________________________________________________________
Thank you for your participation
Donna LaMta
S MwlfMK't Way
Bm rtbrt.CT 0S406
- 4 .
PR06RAH DIRECTOR
OCCUPATIONAL THERAPY BEPARTRENT
4UINNIPIAC UNIVERSITY
STS nOUNT CARnEL AVENUE
HAnBENiCTOkSia-OSk1!
V Please call us if any questions: (203) 481-1727 or (203) 582-6364
Just a Reminder
Your participation in
The Survey on the Use of Animal* as a
Therapeutic Modality
it greatly appreciated.
Thank you fbr your-time and consideration.

Question*: (203) 481-1727 or (203) 882-8384
184
Appendix D
Survey Review Request Letter
Survey Review Letters
185
Dear
As previously discussed, I have enclosed a copy of the survey and interview questions to be used
for my doctoral dissertation entitled: Animals as a Therapeutic Modality: A Curriculum Model
for Occupational Therapy. In addition, I have included chapter one of the dissertation, in order
to provide any additional information you may need for this request.
As an experienced professional in research design, I would greatly appreciate your feedback

regarding the quality of this survey. Please give any appropriate feedback in terms of bias,
proper use of language, as well as basic reliability and validity.
It would be very helpful if this feedback could be given in letter form as I will need to include
this feedback in the appendix of my dissertation.
Thank you very much for your time and expertise.
Sincerely,
186
Original Message—
From: Livingston, Kathy Prof.
Sent: Monday, January 27, 2003 7:09 PM
To: Latella, Donna Prof.
Subject: letter-
To Whom it May Concern:
I am an Associate Professor in the Department of Sociology and

Criminal Justice at Quinnipiac University. My area of
specialization within the field is research methods, and I teach a
course in evaluation research for my department.
During the Fall of 2002, I met with Donna Latella to talk about her
Ed.D. dissertation, particularly the methods section and the
questionnaire she proposed to use to collect the data for her study.
I found the questionnaire to be expertly designed and it was
remarkable in that the questions directly represented the hypotheses
that she proposed to test. I offered several ideas for how to
"tweak" the wording of several questions in order to expand the
statistical options after data collection. We discussed options such
as cross-tab tables and chi square. I saw the final draft of the
questionnaire and it maximizes validity and reliability of the data,
while keeping bias to a minimum.
Donna's thesis is a fascinating topic as well as a timely one. What

I find particularly engaging about her study is that her thesis
speaks to a wide range of disciplinary perspectives. Within the
Criminal Justice field, for example, some prisons/corrections
programs have begun to incorporate the use of dogs as part of the
rehabilitation process for prisoners. I am certain that the
implications of Donna's study will be far-reaching.
If I can provide additional information, please do not hesitate to

call on me.
Sincerely,
Kathy Livingston, Ph.D.

Associate Professor of Sociology
QUINNIPIAC UNIVERSITY
275 Mount Carmel Avenue - CL-AC1, Rm. 338
Hamden, C T 06518
kathy. livingston @quinnipiac. edu
phone: 203/582-8298
fax: 203/582-8709
187
B a y Pa t h C ollege
K 'I'M '1 * ■» I * • ! '
h i.L i Vr ; N •. 1 ' '* M U R Rt *V > L »• «\ £ > h R.-V
January 24. 2003
To: Dissertation Review Committee for Donna Latella
From: Karen Sladyk. PhD. OTR. FAOTA
Re: Review o f survey
The survey designed by Donna Latella was reviewed for bias, proper use o f language, reliably,
and validity. The following are my comments.
Bigs: No bias is present that would interfere in data collection. Clearly, (he topic is o f interest
to the author and the survey reflects this however, this will not effect data collection.
t i«a»<-»ru»npimgr- The survey is clear.
Reliability: Test-rctest or equivalent form methods are not used or appropriate to a survey.
The survey does appear to be consistent internally.
Validity: Content or face validity is present. Criterion or construct related evidence was not
used.
If 1 can be of further help, please let me know.
L o m c m e m k n f S n u r r • L o n i^ m e a d o w , M a s s a c jh l s e t t s o t : o 6 • T e l e p h o n e t + i t ) 5 6 5 -1 0 0 0 F a x .w <6 5 - 115}
188
February 17, 2003
To whom it may concern:
I am an assistant professor of occupational therapy at Quinnipiac University. My teaching and

practice areas include physical management, research, and administration. I had the pleasure of
working with Donna throughout the Fall, 2002 to develop survey items, particularly the
qualitative interview.
I found that the items in Ms. Latella’s survey directly relates to her research questions and
hypotheses. The survey addresses not only the clinical components of an animal assisted therapy
(AAT) curriculum but also the theoretical components. Very often ignored in unique practice
areas, the theoretical components are truly vital to expanding occupational therapy knowledge.
The survey further identifies the practical barriers to teaching animal assisted therapy, which will
enable Ms. Latella to provide practical recommendations for educators who wish to include this
important practice area in their programs.
Ms. Latella's use of qualitative interviews strengthens her research so that more depth on the
curricular issues in animal assisted therapy can be gained from the point of view of those actively
teaching AAT.
Overall, Ms. Latella’s survey demonstrates excellent face validity and is presented in a
nonbiased manner so as to gain the most objective data possible. Her research will be an
important asset to occupational therapy educators.
Respectfully submitted,
Martha J. Sanders MA OTR

Assistant Professor
Occupational Therapy
Quinnipiac University
189
Appendix E
Interview Introduction Statement
Compiled Interview Data
Individual Interview Data
190
Interview Introduction Statement
The purpose of this interview is to obtain qualitative data regarding your experiences with using
animals as a therapeutic modality. For the purpose of this interview, this term encompasses
AAA, AAT, companion animals, facility-trained animals, hippotherapy, and service animals.
Pet therapy term will not be used because it is considered out-dated and misleading by the Delta
Society. Specifically, I will be inquiring about your clinical and teaching practices, especially
involving students.
191
1. Tell me how you became interested in teaching about using animals as a therapeutic modality.
Did your program mandate this, or did your interest drive the topic to be infused into the
curriculum?
2. How did you learn about this topic? Was it part of an OT curriculum? Are You certified in
AAT?
3. Please explain the details of the curriculum, including: type of course, syllabi, student
assignments,
in your curriculum.
clinical site?
4. How do you involve your clinical practice in the teaching of this topic? Are students actively
involved in this?
5. From your viewpoint and experience, are there any OT theories which link to using animals
as a therapeutic modality in OT? Do you teach them with this modality ?
6. Can you describe the first time you saw this intervention and how it affected you as an OT?
7. What are some positive and negative issues regarding teaching this topic ?
9. Is there anything else you would like to contribute to this survey or discuss?
192
Themes:
modality. Did your program mandate this, or did your interest drive the topic to be infused into
the curriculum?
NM
❖ teaching O T fo r 23 years.—first a COTA, then became an OT
❖ saw experiences students had on their FW—pets being used at local hospital
❖ thought students should be exposed and knowledgeable in order to use this modality
❖ PERSONAL EXPERIENCE with own child in hospital and dad in hospice and had AAT
❖ Feels students should at least have exposure
DTM
> began as adjunct and gave presentations on service dogs. When became fu ll time she
made sure it was part o f 'occupational adaptation ’ course.
> Became interested in working with animals and people 13 years ago with preschoolers—
started by going to a dog show and saw a vendor with service animals. Became involved
with the agencies in order to further adapt the service dog's equipment and the
environment. For example: adapted the d o g ’s uniforms so the client could donn it.
Created back packs fo r the animals, adapted the dogs head halters with buckle systems
fo r power steering. Adapts houses fo r service dogs such as door opener strap, lever
adapter, loops on phone.
> Then became a puppy raiser and very involved in obedience training and drill teams with
the service dog and her own pet dogs. From here started visiting SN F ’s and became TDI
certified—the service dog did, too. Her dog also was a demonstration service dog. She
visits with teams and on her own. Teaches others to do this too.
> Therapy dogs and service dogs— she helps to train them. Trained many o f both. Uses
her demo service dog fo r public relations and demonstrations— also TDI certified. Uses
“helping paws "agency.
> Class is exposed to service dog training
> OT students invited to be involved in both. Takes her service and TDI dogs to work as
well
> **In physical management course: a-pet owner with a disability visits the class. She
also teaches clients how to do basic dog obedience and exposes students to this strategy
in the class
DM
□ his interest and other faculty drove the topic, it was not a mandate
□ became interested in a couple o f different ways: as a modality and occupational
behavior. Uses it in the maturity class and pediatric: -children's practice class which is
an intro class to SI and modulation issues. Teaches how a big dog in home environment
can give deep modulation to a child.
□ fie ld trip to hippotherapy with physically disabled kids. This is introduced in classroom,
too and students learn from practitioners in field
□ animals part o f lifestyle, families, rewards, caring, nurturance
□ Elderly- social networks imp, nurturance, companionship, loss o f friends and relatives.
193
□ Worked with kids with sensory modulation problems in his clinical practice
□ Interest through hippotherapy group through Easter Seals
□ ECF next to their university which has facility cats
□ A service animal brought into classroom by a client
CH
S Practiced in a mental health clinic which had AAA with dogs
V Started in Mental Health Theory and Practice Course gave a general assignment fo r
students to pick an intervention, research and present it. Options given and one was ‘pet
therapy'. Every year a student picks this. Last year, a student looked at it very broadly:
AAA, AAT, hippotherapy and service animals.
V Saw it first in clinic and interest drove the idea
V Hippotherapy is very popular now in Maine
program did not mandate X4
2. How did you learn about this topic? Was it part of an OT curriculum ? Are you certified
in AAT?
❖ Program did not have this topic x4
❖ Only one person certified
❖ Learned about the topic from own personal experiences and what students brought from
clinic
❖ Had clinic o f own and PAWS with a Cause, service dogs were presented to clients as a
resource
❖ Use the organizations to learn
Capuchin monkeys— use videos/brochures
❖ National spinal cord association as learning tool
> NO, not part o f curriculum. First learned because she knew about hippotherapy and was
considering working as a therapist in this program as they were looking fo r an OT, not
much $$. She always wanted to do something with animals and people. Went to a dog
show saw a vendor and became inspired.
> Informally, went to a dog show, saw the service dog vendor. And became inspired. Her
dog became Canine Good Citizen (CGC) certified
'r Saw changes in clients. “The clients talked to the dogs".
> Had an opportunity to volunteer at school on day o ff to work with those not getting to
with people interaction. Visiting became much more fun than the obedience training
(drill team). Picked her dog fo r therapy potential after this.
□ Not in his curriculum, not certified
□ Began by having his own cats and dogs. Saw programs in many environments such as a
rehab institute, hospital, through the humane society and therapeutic recreation. (AAA)
a ‘everybody lit up ’ 'a little Chihuahua sat on someone’s lap
a SI courses-deep pressure and mod. Problems: A big dog can help, families can
incorporate into a home program.
□ Adapt with Aging course
□ Took continuing education courses which talked about this therapy
V Not certified.
194
■S Learned about topic as above through mental health clinical practice as above.
S Went to a hippotherapy conference
S Has a hearing impaired Springer spaniel and is interested in cert.
V Remembers vaguely some mentioning o f service animals in her graduate work in OT
assignments,
❖ Just a part o f a course—fits into OT orientation course— want new, innovative, exciting
things introduced such a PAWS presentation on service dogs. JU ST EXPOSURE
> No student assignments
> Encourage assignment as an option
> Former students return to sit in on this class****
> Refers to OT articles in Practice (Hanebrink and Dillon, etc) and Shari Bernard's info
> Lecture consists o f AA T and Service dog information —refers to diagnosis such as autism
> AAT and SD demos in class. Uses the videos o f her on TV and receiving a volunteer
award from a TV station in the area on therapy and service animals
□ Field trip to hippotherapy mentioned in syllabi
□ Mentioned in evaluationl/intervention with SI course, conditions course and occupations
topics
□ Aging course: topic mentioned in outlines o f this and above courses
□ Emerging Practice Area? Tried through a Level IIF W sw im m ing with the dolphins in the
Florida keys—yes i f in addition to the normal curriculum—didn 7 work out fo r logistics
reasons— they have an OT
V MH theory and practice course as above—only presented as an optional assignment
•S Another faculty member does a similar assignment in the PD course fo r an alternative
intervention...some pick hippotherapy
a. Please explain what categories of using animals as a therapeutic modality are covered in
your curriculum.
❖ Just service dogs
> Service dogs and AAT
a Hippotherapy
□ Service animals
□ Dolphin-assisted therapy—as above, exposure
□ Facility animal— the ECF cat
□ AAA/AATmentioned in above courses
V any general option is available through the assignment
b. What animals are introduced and are they brought into the classroom and/or at a clinical
site?
❖ Classroom through PA WS presentation
♦> Clinic site—adult day center, hospice, hospitals, level I and II— were they have visiting
animals—dogs, monkeys (not in classroom— referred to)
> Both sites, dogs
□ Clinical site only-cats, dogs, horses
195
S Hippotherapy at a center only, a student did bring in her certified dog as part o f her
presentation and another student has a service animal guest speaker as part o f her
presentation
S Not mentioned by students as being part o f FW
involved in this?
❖ Previously, when had clinical practice, involved students
❖ Students mostly observe on F W ’s
'r Not a requirement
> Thesis advisor in related topics, students did project on program evaluation on
> the helping paws program
□ In peds practice, through Easter Seals, therapeutic recreation provides AAA and animals
visit fo r the day in SI clinic.
□ Clients are referred fo r hippotherapy, as appropriate
□ Occasionally, students actively involved, mostly observation. No animals brought to
classroom
S No animals in her per diem practice, but has an idea on how to involve them in a
potential new practice with adolescents in a psychosocial setting using a pony
as a therapeutic modality in OT? Do you teach them with this modality?
❖ Because this addressed in an orientation level course, theory is not addressed, although,
occupational adaptation is touched upon.
> Theories—non definite, refers to: adaptation, compensation— service dog, change
environment. Person, Environment, Occupational Performance model??
Improvement o f skills— increased ROM— (Biomechanical) ....Meaningful
occupation, activities behavioral/social/aquisitional with autistic kids
□ SI
□ Everyday life-occupation— part o f our lives
□ Just hint at the theories
□ Responsible as a contributing member o f our community, ca n ’t hold down a jo b — can
care fo r an animal as an occupation, reciprocity, role/occupation
□ Thought o f these as he was talking??!!
S Does not form ally teach it...just thoughts
S Ecology o f Human performance— the interventions outlined to manipulate/adapt
environment- can introduce animals as part
S PEO model- dog as an attribute o f the person; part o f occupation and environment
■S MOHO- relationship with the animal in sense o f self-motivation, habits, routines.
S EPA- Yes, in Maine a lot o f interest in hippotherapy and therapeutic riding. OT in
rehab—SCI/MS—options fo r adapting ways o f doing things.
■S Animals should be thought o f as part adaptations—add to quality o f life
196
❖ At first, like anybody, unsure if animals were appropriate, especially in all places, but as
soon as see the response from clients, see it is such a natural thing in their lives—
observation— SOLD
> Felt OT and animals in therapy 'meshed'. Inspired to try much. Memorable.
> Worked with a child to drive her power chair and when people tried to help her she
would hit the jo y stick, take o ff and laugh. When given a dog to walk, looked around
fo r an individual and went right to them, did it right and could do it, knew how to get
around. The dog brought out more than what they thought she knew and could do.
> Spoke about dog whiskers (the patient did)
> Autism— increased verbalizations, asked questions, initiation o f eye contact.
Emotional— smiling in the hospital
> Uses barrettes, hair clips decorated to manipulate, motor plan. Clip a leash, dog treats,
open the jar, lower functioning—figure things out.
□ Having visited a facility and watched the interactions at Detroit Medical Center
□ Saw depressed, low motivated, stroke pats have increased animation, get closer to the
animal and increase motivation.
□ Need to care fo r an animal. A Role or meaningful responsibility
□ Had animals all his life. Has meaning to you in your own life.
S Heard about it. At psychiatric facility was running the OT dept and had a person
interested in visiting with their dog. Had logistical problems in setting it up. Once that
was over, set up regular visits with many teams. Used cats and rabbits, too. Became a
consistent part o f the volunteer services.
S Exciting, raved about it, satisfied, felt good, positive
❖ P- Brings a whole new aspect o f what can use. IE: her nephew uses hippotherapy—
severely mentally impaired and does not connect or bond. Now an increased awareness
o f his environment.
❖ N- some people are not animal comfortable. For example: inner city person who sees
mean dogs wandering the streets, how can it be brought into a facility and with kids ?
(pack dogs) Some people are more accepting.
> N- not a payed position. People do not realize the true benefits.
> N- Where is a FW site that is doing this? Students ask, not formalized, or enough hours.
> N- therapists do not know much about it (might be interested)
> N - right fo r everyone— not a miracle cure, a limit.
> P-interest is high
> P-important to be aware o f
> P- a lot o f positive things can happen
> P the more awareness opens possibilities o f increased thinking o f things to do
> P- in some states, O T ’s are prescribing service dogs — increased interest
□ P- most students can relate personally when expose this in the classroom, (has adult
weekend program)
a N- adverse reactions/allergies to animals
□ N-supplementary modality only
S N- logistics o f setting up program
197
V N-students need to see this as not 'fluff' but as a real appreciation as an intervention
tool. Students need to articulate the value versus a diversion, as appropriate. "An
occupationally-based’ intervention. ”
V P- gives students a chance to explore EPA. Use only as an option in class now
V P- A good practice model to investigate, stay current, creativity, take risks, research.
V P-a great learning exp
■S P-mimick professional lifelong learning exp
❖ still see it as an exposure in the curriculum— more with advanced masters??
❖ see many students on campus using service dogs. Students should see why a better fit
sometimes fo r clients than a person or equipment, "no people skills ”
□ A different wav o f looking at things. " How would WOULD LIKE TO INCLUDE IN
ADVANCED M ASTER’S PROGRAM—SEES ROOM FOR IT HERE— uses in intro now.
but could see it as an elective or special topics course in OT
□ This is one part o f many things covered
you let a monkey touch your food?"
o So many other things to use to make a connection with client with animals
> She wonders what would happen i f she did not do it?
> Concerned about others level o f interest because it is a specialty area
> More networking needed on our own (SIS???)
> Nationally a lot o f interest
> Emerging Practice Area ?-yes, funding is difficult
> Hope? More people wanting it through the grapevine? appropriately? Billing?
> Education and awareness are important.
V EMERGING PRACTICE AREA ? Yes, see comments to above question
V Would help as more O T ’s are involved and network. When it is part o f typical practice it
will be easier to teach and have people to present and places to go, (who drives—
academia or clinic question??) Bring more to forefront
V Level IIplacem ents involved—can students bring their own animals??
•S VERY interested in looking at a curriculum such as a comprehensive manual that talked
more about both theory and practice, why it is an occupation-based intervention and
helps occupational performance. Why cost/benefit analysis...service dog issue
❖ this is a great topic...glad bringing it to light!
> This intervention is a great match fo r her
> great i f it was reimbursed, some people are more business minded to figure out
how to get this paid fo r within OT practice. She is more healthcare oriented
198
Faculty Interviewed- NM
modality. Did your program mandate this, or did your interest drive the topic to be infused
into the curriculum?
❖ teaching OT fo r 23 years.—first a COTA, then became an OT

❖ saw experiences students had on their FW—pets being used at local hospital
❖ thought students should be exposed and knowledgeable in order to use this modality
❖ PERSONAL EXPERIENCE with own child in hospital and dad in hospice and had AAT
❖ Feels students should at least have exposure
2. How did you leam about this topic? Was it part of an OT curriculum? Are you certified in
AAT?
❖ Program did not have this topic

❖ Only one person certified
❖ Learned about the topic from own personal experiences and what students brought from
clinic
❖ Had clinic o f own and PA WS with a Cause, service dogs were presented to clients as a
resource
*> Use the organizations to leam
❖ Capuchin monkeys— use videos/brochures
♦> National spinal cord association as learning tool
assignments.
❖ Just a part o f a course—fits into OT orientation course— want new, innovative, exciting
things introduced such a PAWS presentation on service dogs. JUST EXPOSURE
your curriculum.
❖ Just service dogs
site?
199
❖ Classroom through PA WS presentation

❖ Clinic site—adult day center, hospice, hospitals, level I and II— were they have visiting
animals—dogs, monkeys (not in classroom— referred to)
(no form al materials used)
involved in this?
❖ Previously, when had clinical practice, involved students

❖ Students mostly observe on F W ’s
Because this addressed in an orientation level course, theory is not addressed, although,
occupational adaptation is touched upon.
❖ A t first, like anybody, unsure if animals were appropriate, especially in all places, but as
soon as see the response from clients, see it is such a natural thing in their lives—
observation—SOLD
❖ P- Brings a whole new aspect o f what can use. IE: her nephew uses hippotherapy—
severely mentally impaired and does not connect or bond. Now an increased awareness
o f his environment.
❖ N- some people are not animal comfortable. For example: inner city person who sees
mean dogs wandering the streets, how can it be brought into a facility and with kids?
(pack dogs) Some people are more accepting.
❖ still see it as an exposure in the curriculum— more with advanced masters??

❖ see many students on campus using service dogs. Students should see why a better fit
sometimes fo r clients than a person or equipment, “no people skills”
A different way o f looking at things. “ How would you let a monkey touch your fo o d ? ”
o So many other things to use to make a connection with client with animals
9. Is there anything else you would like to contribute to this survey or discuss ?
❖ this is a great topic...glad bringing it to light!
200
Faculty Interviewed- DTM

curriculum?
> began as adjunct and gave presentations on service dogs. When became fu ll time she
made sure it was part o f ‘occupational adaptation' course.
> Became interested in working with animals and people 13 years ago with preschoolers—
started by going to a dog show and saw a vendor with service animals. Became involved
with the agencies in order to further adapt the service dog ’s equipment and the
environment. For example: adapted the dogs uniforms so the client could donn it.
Created back packs fo r the animals, adapted the dogs head halters with buckle systems
fo r power steering. Adapts houses fo r service dogs such as door opener strap, lever
adapter, loops on phone.
> Then became a puppy raiser and very involved in obedience training and drill teams with
the service dog and her own pet dogs. From here started visiting SNF's and became TDI
certified—the service dog did, too. Her dog also was a demonstration service dog. She
visits with teams and on her own. Teaches others to do this too.
> Therapy dogs and service dogs— she helps to train them. Trained many o f both. Uses
her demo service dog fo r public relations and demonstrations—also TDI certified. Uses
“helping paws ”agency.
> Class is exposed to service dog training
> OT students invited to be involved in both.Takes her service and TDI dogs to work as
well
> **In physical management course: a-pet owner with a disability visits the class. She
also teaches clients how to do basic dog obedience and exposes students to this strategy
in the class
AAT?
> NO, not part o f curriculum. First learned because she knew about hippotherapy and was
considering working as a therapist in this program as they were looking fo r an OT, not
much $$. She always wanted to do something with animals and people. Went to a dog
show saw a vendor and became inspired.
> Informally, went to a dog show, saw the service dog vendor. And became inspired. Her
dog became Canine Good Citizen (CGC) certified
> Saw changes in clients. “The clients talked to the dogs”.
> Had an opportunity to volunteer at school on day o ff to work with those not getting to
with people interaction. Visiting became much more fun than the obedience training
(drill team). Picked her dog fo r therapy potential after this.
201
assignments.
> No student assignments

> Encourage assignment as an option
> Former students return to sit in on this class****
> Refers to O T articles in Practice (Hanebrink and Dillon, etc) and Shari Bernard’s info
> Lecture consists o f AAT and Service dog information —refers to diagnosis such as autism
> A AT and SD demos in class. Uses the videos o f her on TV and receiving a volunteer
award from a TV station in the area on therapy and service animals
your curriculum.
> Service dogs and AAT
site?
> Both sites, dogs
(no form al material used)
involved in this?
> Not a requirement

> Thesis advisor in related topics, students did project on program evaluation on
the helping paws program
> Theories— non definite, refers to: adaptation, compensation— service dog, change
environment. Person, Environment, Occupational Performance model?? Improvement
o f skills— increased ROM— (Biomechanical) ....Meaningful occupation,
activities Behavioral/social/aquisitional with autistic kids
> Felt O T and animals in th era p y‘meshed’. Inspired to try much. Memorable.
> Worked with a child to drive her power chair and when people tried to help her she
would hit the jo y stick, take o ff and laugh. When given a dog to walk, looked around fo r
202
an individual and went right to them, did it right and could do it, knew how to get
around. The dog brought out more than what they thought she knew and could do.
> Spoke about dog whiskers (the patient did)
> Autism— increased verbalizations, asked questions, initiation o f eye contact.
> Emotional—smiling in the hospital
> Uses barrettes, hair clips decorated to manipulate, motor plan. Clip a leash, dog treats,
open the jar, lower functioning—figure things out.
'r N- not a payed position. People do not realize the true benefits.
> N- Where is a FW site that is doing this? Students ask, not formalized, or enough hours,
r N- therapists do not know much about it (might be interested)
> N - right fo r everyone— not a miracle cure, a limit,
r P-interest is high
> P-important to be aware o f
> P- a lot o f positive things can happen
> P the more awareness opens possibilities o f increased thinking o f things to do
> P- in some states, O T ’s are prescribing service dogs — increased interest
8. What do you feel is the future of teaching about this topicand involving students?
> She wonders what would happen if she did not do it?
> Concerned about others level o f interest because it isa specialty area
'r More networking needed on our own (SIS???)
> Nationally a lot o f interest
> Emerging Practice Area ?-yes, funding is difficult
> Hope? More people wanting it through the grapevine? appropriately? Billing?
'r Education and awareness are important.
> This intervention is a great match fo r her

> great if it was reimbursed, some people are more business minded to figure out how to
get this paid fo r within OT practice. She is more healthcare oriented
203
Faculty interviewed- DM
curriculum?
□ his interest and other faculty drove the topic, it was not a mandate
□ became interested in a couple o f different ways: as a modality and occupational
behavior. Uses it in the maturity class and pediatric: -children's practice class which is
an intro class to SI and modulation issues. Teaches how a big dog in home environment
can give deep modulation to a child.
□ field trip to hippotherapy with physically disabled kids. This is introduced in classroom,
too and students learn from practitioners in field
□ animals part o f lifestyle, families, rewards, caring, nurturance
□ Elderly- social networks imp, nurturance, companionship, loss o f friends and relatives.
□ Worked with kids with sensory modulation problems in his clinical practice
□ Interest through hippotherapy group through Easter Seals
□ ECF next to their university which has facility cats
□ A service animal brought into classroom by a client
2. How did you leam about this topic ? Was it part of an OT curriculum ? Are you certified in
AAT?
□ Not in his curriculum, not certified

□ Began by having his own cats and dogs. Saw programs in many environments such as a
rehab institute, hospital, through the humane society and therapeutic recreation. (AAA)
□ 'everybody lit up ’ 'a little Chihuahua sat on som eone’s lap
□ SI courses-deep pressure and mod. Problems: A big dog can help, families can
incorporate into a home program.
□ Adapt with Aging course
□ Took continuing education courses which talked about this therapy
assignments.
□ Field trip to hippotherapy mentioned in syllabi

□ Mentioned in evaluation/intervention with SI course, conditions course and occupations
topics
□ Aging course: topic mentioned in outlines o f this and above courses
□ Emerging Practice A rea? Tried through a Level I I F W swimming with the dolphins in the
Florida keys—yes i f in addition to the normal curriculum— didn ’t work out fo r logistics
reasons— they have an OT
204
in your curriculum.
□ Hippotherapy
a Service animals
□ Dolphin-assisted therapy—as above, exposure
□ Facility animal— the ECF cat
□ AAA/AAT mentioned in above courses
clinical site?
□ Clinical site only-cats, dogs, horses
(no form al material used)
involved in this?
□ In peds practice, through Easter Seals, therapeutic recreation provides AAA and animals
visit fo r the day in SI clinic.
□ Clients are referred fo r hippotherapy, as appropriate
□ Occasionally, students actively involved, mostly observation. No animals brought to
classroom
□ SI
a Everyday life-occupation— part o f our lives
□ Just hint at the theories
□ Responsible as a contributing member o f our community, can't hold down a job— can
care fo r an animal as an occupation, reciprocity, role/occupation
□ Thought o f these as he was talking??!!
□ Having visited a facility and watched the interactions at Detroit Medical Center
□ Saw depressed, low motivated, stroke pats have increased animation, get closer to the
animal and increase motivation.
□ Need to care fo r an animal. A Role or meaningful responsibility
□ Had animals all his life. Has meaning to you in your own life.
205
□ P- most students can relate personally when expose this in the classroom.(has adult
weekend program)
□ N- adverse reactions/allergies to animals
□ N-supplementary modality only
□ WOULD LIK E TO IN C LU D E IN AD VANCED M A S T E R ’S PROGRAM — SE E S

RO OM FOR I T H E R E - -uses in intro now, but could see it as an elective or special
topics course in OT
□ This is one part o f many things covered
(no comment given)
206
Faculty Interviewed■ CH
curriculum?
S Practiced in a mental health clinic which had AAA with dogs

S Started in Mental Health Theory and Practice Course gave a general assignment fo r
students to pick an intervention, research and present it. Options given and one was 'pet
therapy’. Every year a student picks this. Last year, a student looked at it very broadly:
AAA, AAT, hippotherapy and service animals.
S Saw it first in clinic and interest drove the idea
•S Hippotherapy is very popular now in Maine
AAT?
S Not certified.
■S Learned about topic as above through mental health clinical practice as above.
S Went to a hippotherapy conference
S Has a hearing impaired Springer spaniel and is interested in cert.
S Remembers vaguely some mentioning o f service animals in her graduate work in OT
assignments.
S MH theory and practice course as above— only presented as an optional assignment

S Another faculty member does a similar assignment in the PD course fo r an alternative
intervention...some pick hippotherapy
your curriculum.
S any general option is available through the assignment
site?
S Hippotherapy at a center only, a student did bring in her certified dog as part o f her
presentation and another student has a service animal guest speaker as part o f her
presentation
S Not mentioned by students as being part o f FW
207
(no materials used)
involved in this?
S No animals in her per diem practice, but has an idea on how to involve them in a
potential new practice with adolescents in a psychosocial setting using a pony
S Does not form ally teach it...just thoughts

S Ecology o f Human performance— the interventions outlined to manipulate/adapt
environment- can introduce animals as part
S PEO model- dog as an attribute o f the person; part o f occupation and environment
■S MOHO- relationship with the animal in sense o f self-motivation, habits, routines.
S EPA- Yes, in Maine a lot o f interest in hippotherapy and therapeutic riding. O T in
rehab—SCI/MS—options fo r adapting ways o f doing things.
S Animals should be thought o f as part adaptations—add to quality o f life
v' Heard about it. At psychiatric facility was running the O T dept and had a person
interested in visiting with their dog. Had logistical problems in setting it up. Once that
was over, set up regular visits with many teams. Used cats and rabbits, too. Became a
consistent part o f the volunteer services.
S Exciting, raved about it, satisfied, fe lt good, positive
S N- logistics o f setting up program

S N-students need to see this as not 'fluff' but as a real appreciation as an intervention
tool. Students need to articulate the value versus a diversion, as appropriate. “An
occupationally-based’ intervention. ”
y P- gives students a chance to explore EPA. Use only as an option inclass now
S P- A good practice model to investigate, stay current, creativity, take risks, research.
S P-a great learning exp
S P-mimic professional lifelong learning experience
208
S Would help as more O T ’s are involved and network. When it is part o f typical practice it
will be easier to teach and have people to present and places to go, (who drives—
academia or clinic question ? ?) Bring more to forefront
S Level IIplacem ents involved—can students bring their own animals??
■S VERY interested in looking at a curriculum such as a comprehensive manual that talked
more about both theory and practice, why it is an occupation-based intervention and
helps occupational performance. Why cost/benefit analysis...service dog issue
(no comment offered)
209
Appendix F
Coding of Survey Questions
Data Collection in Excel
210
Coding for Survey Questions
Question Coding
1 1= Yes, 2= No
2 1= elective course
2= required course
3= imbedded in a required course
3 1= assessment & intervention
2= occupation-based
3= OT theory-based
4= intro/OT seminar
5= rehab/healthcare
6= special issues
7= throughout curriculum
8= assessment/interview/introduction/OT seminar
9= occupation-based/introduction/OT seminar
4 I = ISI year
2= 2nd year
3= 3rd year
4= 4th year
5= 5lh year
6= Is' & 2nd year
7= Is' through 5th years
5 1= with a theoretical base
2=clinical application only
3= with both theory & clinical application
4= at fieldwork site
5= clinical application & at fieldwork site
6a 1= depends on the course
2=psychological theories
3= no specific theory
6b 1= guest speaker, no specific theorist
2=organizations, no specific theorist
3= no specific theorist
7 1= identify resources, learning & practice
2= understand animals, daily life and roles
3= understand therapeutic use of animals
4= introduce intervention techniques
5= introduce emerging practice areas/alternative medicine
6= too many to list
7= understand animals, daily life, roles, and therapeutic use of animals
8= understand therapeutic use of animals, introduce intervention
techniques
9= understand animals, daily life/roles and introduce intervention
techniques
8a 1= Yes, 2= No
211
8b 1= faculty
9a 1= Yes, 2= No
9b 1= Yes, 2= No
10a 1= lack of research on the modality
2= lack of physical space
3= lack of experienced faculty
4= lack of room in the curriculum
5= not a curricular priority
6= lack of resources (animals)
7= lack of interest
11 1= strongly disagree
2= disagree
3= neither agree nor disagree
4= agree
5= strongly agree
2= disagree
4= agree
5= strongly agree
2= disagree
4= agree
5= strongly agree
'2= disagree
4= agree
5= strongly agree
212
Dissertation Data Collection in Excel
ID# Q1 Q2 Q3 Q4 Q5 Q6a Q6b Q7 Q8a

2 1 3 8 1 &2 2 3 2 1 2
3 2 1
7 2 1
8 2
10 1 3 1,4 1 2 4 4 6
12 2 1
13 1 3 2,4 1 2 4 4 7 1
16 1 3 1 1 2 4 4 2,3 1
17 2 1
22 2 1
23 1 3 7 NA NA 4 4 NA 1
25 2 1
26 2 1
31 2 1
32 1 3 3 1 &2 2 &4 4 4 4 1
33 1 3 4 1 2 4 4 7 1
36 2 1
39 1 3 2 1 2 4 4 2,3 1
40 2 1
41 2 1
43 2 1
45 2 1
47 2 1
49 2 1
50 2 1
51 2 1
52 2 1
53 2 1
54 2 1
56 2 1
60 1 3 8 1,2.3,4,5 4,5 1 4 3,4 1
64 2 1
67 2 1
68 1 3 5 4 2 4 4 2,4
72 2 1
74 2 1
75 2 1
76 2
77 2
80 2 1
81 1 3 4 3 3 2 4 5
83 2 1
86 2
93 1 1 6 5 2 4 4 5 1
94 2 1
98 2 1
99 2 1
100 1 3 5 2 1 3 1 5
102 2 1
103 2 1
213
Q8b Q8c Q9a Q9b Q10a Q10b Q11 Q12 Q13 Q14
2 2 5 4 3 4 4
4,5 6 2 2 1,2,3 4 4 3 5
3 2 2 1.3 4 3 4 4
1 2 2 3,5,7 1 3 2 2 1
2 2 1,2,3,4,5,6 2 2 3 1
3,4,5 2 2 1,2,3,4,5,6 4 3 2 4
3 2 2 2 2,3,4,6, 4 4 4 5
2,3,5 2 2 2,6 2 4 3 4 4
2,3,4,5 3 2 2 1,2,3,4,5,6 4 4 2 4
2,3,5 2 2 5 3 2 3 3
2.3,5, 3,4,5 2 2 1,5,6 2 2 2 4
4,5 1 2 2 5 3 2 2 4
3,5 1 2 4,5 3 3 3 3
3 2 2 1,2,3,6 3 3 3 3
4 ,5 1 2 3,4,5 4 3 3 4
3,4,5 2 2 5,6 4 4 4 4
3,5,6 4 2 2 1,2,3,4,5,6 3 3 3 4
1.5,6 5 1 1 4 4 5 4
2 2 1.4,5 3 3 3 3
3,5 2 2 4,5 5 5 2 4
4,6 6 2 2 4,5 3 2 3 3
3,5 2 2 2,3,6 3 3 3 3
3,4,5 2 2 1.5 3 2 1 2
4,5 1 2 5 3 1 3 4
3 2 2 1,2,3,4,5,6 4 3 3 3
3,5, 1 2 5 4 2 1 3
3,5 2 2 5 3 2 2 3
5 1 2 2 1,3,5,6,7 3 3 2 4
4 2 2 2,4.5,6 3 3 4 4
4 1 2 2 5 3 2 2 3
3 2 2 3,4,6 4 4 3 3
5 2 2 2 3,4,7 4 2 2 5
3,4,5 2 2 5 4 2 3 3
2 2 2,3,5,6 3 3 3 2
2,5 1 2 4,5 2 2 2 2
2 2 2 5 6 5 2 2 4
1 1 2 1,5 7 6 6 6 4
2 2 1.2,3.6 2 2 3 3
2 2 7 2 2 1 2
3,4,5 2 2 1.4,5 4 3 2 2
2 2 3,4 4 4 3 3
2,3,5 2 2 2,3,5,6 3 3 2 3
2 2 5 3 3 3 3
5 1 2 2 3,4 2 2 3 4
4,5 2 2 1,2,3,4,5,6,7 3 2 2 2
3 5 2 2 5 4 3 3 3
2,3,5 2 2 5 6 4 3 4 4
2 2 3,6 3 3 4 2
3,5 2 2 1,2,5,7 1 1 1 2
3,5 2 2 1.3,4,5 3 3 2 4
214
Appendix G
Curriculum Model
215
Department of Occupational Therapy

Animals as a Therapeutic Modality in Occupational Therapy
[course number]
Year:
Credits:
Professor:
Office Hours: Posted
GENERAL COURSE INFORMATION

Course Description: This course offers theory and clinical application of the use of animals as
a therapeutic modality within the occupational therapy profession. Specific applications include:
Animal-assisted activities, animal-assisted therapy, companion animals, facility-trained animals,
hippotherapy/therapeutic horseback riding, and service animals.
Goals: To explore an adjunct therapeutic intervention which is used by occupational therapists

and is of specific interest to the student
Instructional Materials:
Required- Fine, A. (Ed.). (2000). Handbook on animal-assisted therapy: Theoretical
foundations and guidelines fo r practice. San Diego, CA: Academic Press.
Recommended- Delta Society. (2000). The Pet Partner's TEAM training course (4th ed.).
Renton, WA: Author.
On Reserve-
1. Alfano, T. (1998). A survey o f the use o f animal assisted therapy as a modality in the field o f
occupational therapy. Unpublished master’s thesis, D ’Youville College, Buffalo, NY.
2. Corson, S. A., Corson, E. O., & Gwynne, P. (1975). Pet-facilitated psychotherapy in a
hospital setting. Current Psychiatric Therapies, 15, 277-286.
3. Corson, S. A., & Corson, E. O. (1978). Pets as mediators of therapy. Current Psychiatric
Therapies, 18, 195-205.
4. Friedmann, E., Katcher, A. H., Lynch, J. J., & Thomas, S.A. (1980). Animal companions and
one-year survival of patients after discharge from a coronary care unit. Public Health
Reports, 95, (4), 307-312.
5. Friedmann, E. Katcher, A. H., Thomas, S. A., & Messant, P. R. (1983). Social interactions
and blood pressure influences of animal companions. Journal o f Nervous and Mental
Disease, 171, 8,461-465.
6. Friedmann, E., & Thomas, S. A. (1995). Pet ownership, social support, and one-year survival
after acute myocardial infarction in the cardiac arrhythmia suppression trial (CAST).
American Journal o f Cardiology, 76, 1213-1217.
7. Katcher, A. H. (1984). Emotional and cognitive responses to interactions with companion
animals. The Journal o f the Delta Society, 1, 34-36.
8. Katcher, A. H. (1985). Physiologic and behavioral responses to companion animals.
Veterinary Clinics o f North America: Small Animal Practice, 15, (2), 403-410.
9. Yerxa, E. J. (1998). Health and the human spirit for occupation. American Journal of
Occupational Therapy, 52, 412-418.
216
Instructional Methods: Demonstration, lecture, videos, participation, guest speakers,

visitations, case studies, literature review, research, and independent projects.
General Department Procedures:

■ Faculty is here to help you.
■ Please approach faculty whenever assistance is needed.
■ In the event an assignment cannot be handed in on time, please contact professor ASAP.
■ Professionalism is a part of the grading criteria and points may be deducted from an
assignment for grammatical errors, sloppiness, spelling errors and lack of referencing. Typed
papers are required.
■ All written documents must be in 12-font and double-spaced.
■ All references must be in APA format.
■ All work is to be completed independently, unless it is a formal group project.
Course Objectives:
Cognitive Domain:
■ Students will understand how this modality fits into occupational therapy framework and
standards.
■ Students will differentiate between the specific areas of using animals as a therapeutic
modality.
■ Students will identify appropriate populations, domains and contexts which will benefit from
the use of animals as a therapeutic modality.
■ Students will learn theory as well as clinical application of the topic.
■ Students will be exposed to a variety of programs and animals using animals as a therapeutic
modality.
■ Students will review and analyze the literature and research on the topic.
Affective Domain:
■ Students will appreciate the impact of this modality on the client’s physical, psychosocial and
emotional well-being.
■ Students will examine Occupational Therapy's role in using this modality.
■ Students will reflect on how this topic may be used in service learning and volunteerism.
■ Students will appreciate the characteristics needed in a perspective pet and handler involved in
therapy.
Behavioral Domain:
■ Students will learn and practice basic dog obedience skills.
■ Students will observe, then handle, animals in an ongoing program.
■ Students will design an animal-assisted therapy session.
■ Students will research organizations involved with using animals as a therapeutic modality,
such as the Delta Society.
■ Students will research additional programs of their interest including service animals and
hippotherapy.
■ Students will interact with clients who are participated in therapy programs using animals.
217
■ Students will design a research study in a specific topic area of using animals as a therapeutic
modality.
Occupational Therapy Standards Addressed in this Course:

Section B: 5.2, 5.3, 5.4, 5.5, 5.10, 5.11,5.12, 5.17, 7.6, 8.6, 8.7
Method of Evaluation:
/. Choose 1 o f the following: 20 pts
a. Design and implement animal-assisted therapy session.
b. Interview, and 3-page report on, an individual who raises, trains, or owns a service animal.
c. Observe, and 3-page report on, an occupational therapist using this modality in a chosen area.
Areas may include: hippotherapy, service animals, AAA, or AAT.
2. Research and summarize 2 articles from each o f the following 6 areas: 20 pts
animal-assisted activities, animal-assisted therapy, companion animals,
facility-trained animals, hippotherapy, and service animals.
3. Design a basic research study on topic o f interest 30 pts.
4. Compile a notebook with all materials from class and o f interest 30nts.
lOOpts
Class Schedule
CLASS# TOPIC Readings/Assets.
1. Introduction
Planning/Schedu les
Goals
Syllabi and Assignments
Explanations and Discussion: The Use o f
Animals as a Therapeutic Modality
2. History of the Human Animal Bond Fine- Ch’s 1-4

History of Using Animals as a Therapeutic Modality Reserve Articles- #7
3. Description of Specific Uses of Animals as a Therapeutic Fine- Ch. 5

Modality
National Organizations Delta Society (2000)
Basic Dog Handling/Obedience
How to Become a Handler/Choose an Appropriate Animal
Familiarize Students with Animals
4. Benefits and Negative Implications Using of Animals as a Fine- Ch’s 2-4,6-7
Therapeutic Modality Reserve Articles- #2-8
Designing a Program/Strategies to Avoid Problems
Related Laws/Other Legal Issues/Insurance Assignment #1 due
218
5. Use of Animals as a Therapeutic Modality in Reserve Articles-

Occupational Therapy #1, #9
Related OT Theory
Referrals and Reiumbursement
6. Visitation: Animal-Assisted Activity Program Assignment #2- due

Delta Society (2000)
7. Visitation: Animal-Assisted Therapy Program
8. Guest Speaker: Service Animals Article to be assigned

Video: Canine Companions, Service Dogs
and Puppy Raisers
9. Visitation: Hippotherapy Program Article to be assigned
10. Wrap-up Assignment #3 due and

#4- Notebook due
219
The following optional assignments may be implemented within specific courses. The
assignments all focus on using animals as a therapeutic modality in occupational therapy and
are specifically designed to address the many areas involved with this topic such as: AAT, AAA,
facility-trained animals, hippotherapy, and Service Animals. This strategy fo r the curriculum
model was chosen as the data analysis o f this study found occupational therapy programs
involved to have limited room in their curriculum fo r this topic, limited time, limited resources,
and few faculty interested or skilled in the topic. The study found although, programs have a
high student interest and therefore, have chosen to infuse the topic within various areas o f the
curriculum, as well as student assignments, such as research projects, presentations, and field
trips. Thus, these assignments are examples o f potential assignments to be used within specific
courses.
I. Theory or Frames of Reference Course:
Example* Choose one occupational therapy theory and apply it to the use of animals as a
therapeutic modality based on the following case.
Betty is an 85 year-old woman who has recently been moved to a long-term care facility,
as her family could no longer care for her at home. Betty had been living with her son and
daughter-in-law who both work full-time. Betty had been spending the majority of her time at
home alone. Over the past few months, she has become increasingly forgetful as evidenced by
her frequently leaving the stove on until family arrived home to discover it. Most recently, Betty
fell while letting one o f the two family dogs out and fractured her hip. She is no longer able to
take care of herself safely and independently. Much to the family’s dismay, they have realized
they cannot care for her on a 24-hour basis any longer, as well. While helping Betty unpack
clothes in her new room, the daughter-in-law found that Betty had also brought pictures of the
220
family dogs. Betty’s eyes filled with tears and she said “Who will take care of the dogs now
while you are at work? Who will keep me company during the day ?”
a Pick a specific OT theory that relates to this case, give a general explanation of the theory
and how it applies to OT.
□ Describe how the theory specifically relates to this case.
□ Choose and describe a specific area of using animals as a therapeutic modality to apply
and use with this case, and why. (AAA, AAT, Service Animals)
□ Explain how the OT theory links to the area of using animals as a therapeutic modality
you have chosen, via the case example, be specific using examples from the case.
a Also, use references in the literature as they relate to the assignment and the case.
II. Administration. Management or Leadership Course:
Example- Apply management principles to initiating/creating a program in AAA/AAT, or a
facility-trained animal in an OT clinic or facility.
Create a hypothetical occupational therapy clinic or facility, OR preferably, find an
existing clinic or facility interested in initiating an AAA or AAT program, or facility-
trained animal.
□ Meet (or create a meeting) with the director of rehabilitation and any other involved
administrators. Ask them to write a ‘wish list’ of their anticipated needs, regulations and
programmatic goals/issues regarded as important in order to create this program.
Categories may include:
o what is the mission and philosophy of the clinic or facility
o choosing AAA and/or AAT programs
221
o choosing a facility-trained animal
o choose type of animals to be involved, should they be certified?
o provide group, individual sessions, or both
o decide who will oversee, implement, and supervise program
o which clientele are, or are not, appropriate to be involved? contraindications to
involvement? screenings?
o what are the limitations and specific regulations to keep in mind?
□ Create a needs and interest assessment to be given to staff, clients and family members,
as appropriate.
□ Create a policy and procedure manual based on above information obtained, which may
include:
o goals of program
o infection control and safety policies
o volunteer screening policy
o policy for consideration of appropriate therapy animal and handler, certification
required?
o policy for keeping records of animals entering facility and their appropriate
paperwork, such as immunizations
o policy for restriction of animals to specific areas of facility
o policy for staff supervision of program
o training of staff/inservices to new employees
□ Contact outside community agencies involved with AAA/AAT. These agencies may
provide visiting volunteer ‘teams’ of handlers and their animals.
222
□ Design a documentation, monitoring, evaluation, quality assurance, and outcomes plan.
□ Identify needed resources for the program.
□ Cost/benefit analysis.
□ Identify potential problems before they occur.
□ Search the literature for related articles on administrative/management/leadership issues
on this topic.
Example- Apply management principles to marketing a program in AAA/AAT in an OT clinic or
facility.
Develop a marketing plan for an AAA or AAT program designed to reach and promote
awareness to clients, families, doctors, staff, and the community-at-large. Depending on
the target market, options may include the following:
□ Create fliers
□ Initiate a client newsletter. If one exists, submit an article with a photo of the program,
a Use bulletin board to educate as well as display photos of the program.
□ Provide staff inservices and family informational meetings or table.
□ Provide local newspaper brief of the program with a photo.
□ Contact local television station for coverage of program.
□ Provide a demonstrational event and/or kick-off of the program,
a Design an informational packet.
□ Search the literature for related articles on marketing this program.
223
Example- Staff inservice
Create an inservice for staff on the specific program to be implemented and how occupational
therapy is involved. Review ail policies and procedures of the program and how staff may be
involved, as well as give feedback.
Example- Market OT to an AAA/AAT national organization
Create a marketing plan to a national organization such as the Delta Society in order to promote
how occupational therapy is involved with AAA/AAT. A plan may include an informational
booth on OT at a Delta Society national conference, for example.
Example- Research funding sources
Research how programs providing AAT and Service Animals are reimbursed and what obstacles
are involved.
III. Legal/Ethical Course or Topic:
Example-Research government, state, licensure regulations and restrictions regarding the
use of animals as a therapeutic modality, (an examples may include service animals an access
to public facilities)
Example- Research potential ethical implications regarding the use of animals as a
therapeutic modality.
IV. Research Course:
224
(The depth of this assignment should be determined upon the level of the course, for example, an
introductory course may only do the first two steps presented below, the next level may do the
first three steps, etc.)
Choose an area of using animals as a therapeutic modality (AAA, AAT, companion animals,
facility-trained animals, hippotherapy or, service animals and:
□ Review and summarize the literature. Collect ideas for the research project from this
search.
□ Analyze the research tools and methods.
□ Develop a research proposal for a project based on your above choice.
o The study may be a new idea or be a replication of an existing study,
o Explain your qualitative or quantitative study.
o Describe the subjects, materials, methods, procedures, hypothesis, research
questions, data collection plan, and data analysis plan, as appropriate,
o Explain the ‘so-what’ of your research.
□ Initiate the study with your advisors approval and guidance,
a Collect and analyze the data.
□ Complete written and oral presentation of the data including summary and
recommendations.
Example- Perform a needs assessment on the interest of the use of animals as a therapeutic
modality to a population such as: students, faculty, residents or staff of a rehabilitation facility,
community agency or school which provides occupational therapy. Analyze and present your
data.
225
V. Intervention Course:
Example- Choose an area of using animals as an occupational therapy intervention based
on one o f the two cases below: (AAT or Service Animals)
Case Ml Greg is a six year-old boy who was diagnosed with autism at the age o f three. He
receives occupational therapy while in the classroom, as well as individually in the OT room.
Greg has made very slow improvements in the areas o f socialization, eye contact, verbalizations,
and preservation. While watching the video '101 Dalmations', Greg's eyes light up.
Case M2 Mandy is a 22 year-old female who has multiple sclerosis. She is unable to ambulate
and has an increasingly difficult time pushing and negotiating her wheelchair. Mandy attends
the local college on a part-time basis and lives at home with her family. Mandy needs assistance
with opening doors, reaching items from the floor, transfers, and lower extremity dressing, to
name a few . Since her diagnosis, Mandy has become increasingly isolated and lonely. She is
frequently seen sitting alone in front o f the window or on her porch.
□ Explain your reasons for choosing this area of using animals as a therapeutic modality,
a Embellish the case as you need to make specific points.
□ Establish strengths, problem areas, and goals.
□ Choose and describe an appropriate intervention using AAT or Service Animals.
Explain, specifically, how AAT or the use of Service Animals is an adjunct to the overall
therapy process.
□ Describe your expected outcome of this intervention.
□ Search the literature for related articles in the area of the intervention process.
226
Example- Create an adaptive device for a client with a service animal to use for increased
independence.
Example- Research funding sources available to a client in need of a service animal.
VI. Service Learning Course:
Examples o f experiences include: student involvement in the training of service animals,
adapting environments and equipment for service clients and service animals, involvement in
volunteer AAT/AAA programs and hippotherapy, and possibly targeting potential therapy
animals who are in shelters.
VII. Independent Study Course:
Options may include:
□ With the assistance of the Delta Society, the student will train and become certified in
AAT/AAA with their own animal and then, create and initiate an AAA/AAT program.
□ With the assistance of a service animal organization, the student may become a puppy
raiser and learn how to train a service animal.
□ With the assistance of a service animal organization, the student will learn how to refer,
request, orient and train a client to receive and train a service animal.
□ With the assistance of an animal obedience trainer, the student will learn how to assist
disabled clients with animal obedience training.
□ The student will work with an occupational therapist providing AAT to clients.
□ With a representative from a service animal agency, the student will volunteer adapting
equipment and environments for service animals and their owners.

Animals As A Therapeutic Modality A Curriculum Model For Occupational Therapy

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INFORMATION TO USERS

The quality of this reproduction is dependent upon the quality of the

Oversize materials (e.g., maps, drawings, charts) are reproduced by

ProQuest Information and Learning

This reproduction is the best copy available.

A CURRICULUM MODEL FOR

DONNA M. LATELLA, Ed.D

BA, Southern Connecticut State University, 1983

SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE

All rights reserved.

ProQuest Information and Learning Company

Date 7 Lori'NOto, Ph.D.

ANIMALS AS A THERAPEUTIC MODALITY: A CURRICULUM MODEL FOR

programs are teaching this topic within their curriculum.

as a therapeutic modality in occupational therapy.

presentations, and research projects.

intervention and animals.

assignments/activities which may be included in existing curricula.

Further research is needed specifically by occupational therapists, in order to identify

Thank you, Cody. We love and miss you deeply.

Table of Contents.......................................................................................................... vii

■ Statement of the Problem.............................................................................. 7

■ Definition of Term s.......................................................................................8

■ Significance of the Study..............................................................................11

■ Limitations of the Study............................................................................... 12

■ Organization of the Study............................................................................. 13

Chapter 2: Review o f the Literature

■ History of the Human-Animal Bond...........................................................15

■ History of Using Animals as a Therapeutic Modality...............................19

■ Description of Specific Uses of Animals as a Therapeutic M odality.. ..23

■ Benefits, Negative Implications of Using Animals as a Therapeutic

■ Referrals and Reimbursement.................................................................... 58

■ Related Surveys by Occupational Therapists............................................59

Chapter 3: Design of the Study

■ Materials: Survey and Interviews............................................................. 76

■ Procedures: Data Collection Plan andData Analysis Plan..................... 78

Chapter 4: Analysis o f Findings

■ Quantitative Analysis/Results of Survey..................................................86

■ Qualitative Analysis/Results of Interviews............................................. 107

■ Synthesis of Quantitative and Qualitative Findings............................... 117

■ Description of Curriculum Model.............................................................119

Chapter 5: Conclusions and Recommendations

■ Recommendations for Further Research.................................................. 127

■ Other Findings and Considerations........................................................... 128

A. Standards for an Accredited Educational Program for the Occupational

B. Accredited Entry-Level Master’s Degree Programs...............................165

C. Cover Letter, Survey, and Reminder Post Card...................................... 178

D. Survey Review Letters................................................................................ 184

E. Interview Introduction Statement

Field Interview Data Sheet

Compiled Interview Data

Individual Interview Data...........................................................................189

F. Coding of Survey Questions

Data Collection in Excel............................................................................ 209

G. Curriculum M odel...................................................................................... 214

Table 1. Summary Table o f Benefits from the Literature......................................................... 29

Table 2. Summary Table o f Conditions and Environments Involved

Table 3. Summary Table o f Negative Implications from the Literature..................................53

Table 4. Research Questions, Hypotheses, and Statistical Analysis.........................................81

Table 6. Is it offered in an elective course, or imbedded in a required course?.................... 88

Table 7. What is the name o f the course in which it is taught?................................................ 89

Table 11. Which clinical experts are referred to?........................................................................ 92

Table 15. I f yes, how?..................................................................................................................... 96