Overview of the IAHAIO meeting at University of California, Davis

June 2017

Impressions from Davis

By Marie-Jose Enders-Slegers, IAHAIO President

It was hot in Davis, very hot, above 40 degrees Celsius even. And there was a warm, very warm welcome from ISAZ for our board and our membership, at the DAVIS Conference of ISAZ.

Thanks to the hospitality of the world’s top ranking university on veterinary science, the University of California in Davis, we had a wonderful IAHAIO track in ISAZ’s Conference, organized by Lynette Hart and Abigail Thigpen.

It was so pleasant to meet with our members (ISAZ is a member of IAHAIO as well) and to learn about new research and practices in our field. In our track we built on data of our member survey on AAI practices, to move forward the work of our international taskforce on best practices and standards in AAI and animal welfare.

The every morning breakfast session at the university was a great opportunity: everybody ‘fresh’ again, all looking forward to a new day full of ‘scientific’ adventures. It was really good to catch up with you all, to get to know you all better, and to meet old friends such as our ex-president Rebecca Johnson.

I hope that IAHAIO and ISAZ will move forward together in this important area in our field. The launch of the online platform for researchers and practitioners by both organisations, to find each other for collaborations, is a good example of an initiative that we have launched to stimulate research and discussion.

At the auction I won several books with successful bids! What a great opportunity, a wonderful idea… hopefully to be followed up in other conferences.

Anyway, Davis, a lovely town, nice evening walks, lovely art exposition and wonderful company, what more can we ask?

Thank you to all who contributed to this event.

Two new initiatives

Marie Jose Enders-Slegers, announced two new initiatives. Firstly, an IAHAIO/ISAZ collaborative platform for researchers. An online forum has been launched – a dedicated, safe and secure space to share information and insights, upload documents and initiate discussion. This is open to all IAHAIO and ISAZ members. You need to set up a dedicated account. Please email admin@iahaio.org for the link.

IAHAIO also launched its digital photo contest and announced the inaugural winner as the San Francisco SPCA. (Image below).

Findings from first membership survey by IAHAIO international task force, “Standards of best practices for AAI programs and practitioners”

In 2014 IAHAIO published its White Paper “Definitions for AAI and Guidelines for the Wellness of Animals Involved”. This document was created through international collaboration of academics and practitioners.  IAHAIO is currently collating more information and views on the welfare aspects of AAI. This work is being undertaken by an international IAHAIO Task Force whose members are drawn from a wide range of relevant disciplines with representatives from every world region.  The aim is to create a benchmark to encourage high standards of practice. This will be of particular importance to people who are entering this rapidly expanding field. Updates to the White Paper will be published on the IAHAIO website in early 2018.

As part of this work, preliminary findings from a membership survey were presented by the co-chairs of the Task Force, IAHAIO Board members Brinda Jegatheesan and Elizabeth Ormerod.

The main themes and issues that arose from the survey were discussed:

  1. Interdisciplinary training and knowledge of AAI for practitioners
  • Courses taken are scattered (learning with interdisciplinary educators)
  • Need more centrally coordinated and well-planned knowledge and skills
  • Making learning materials available
  1. Credible platform for professions to reach out
  • A formal, credible ‘Go-To’ interdisciplinary team of people to reach out to when facing challenges
  • Right now it seems pretty fractured – when professionals encounter challenges they go to media sources, magazines, newspapers, guest lectures
  1. Training and education of handlers
  • Knowledge of positive training/general training issues
  • Making training mandatory and standardized
  1. Evaluation, assessment, accreditation
  • International accreditation and evaluation
  • Making them standardized
  1. Standardizing the field in
  • Using common terminology and definitions as outlined by organizations that are leaders in the field. Need to make sure that people are using the IAHAIO White Paper- we see many who know about it
  • Knowledge of zoonotic illness (seen as important due to varying beliefs of its dangers and knowledge of how to avoid zoonotic illness; casual attitudes towards or denial of this problem among colleagues)
  • Assessment materials – knowledge, skills, client and animal best practices and welfare issues
  1. Animal welfare knowledge
  • Animal behavior
  • Positive training of animals (also general training of animals)
  • Species selection specific to the goal of the intervention
  • Housing – with family, onsite, residential
  • Time offs, over-working
  • Basic needs for each species such as rest, recreation/play, housing, duration (length of time) work for working

Special focus lectures

Three experienced leaders in the field shared their views on AAI best practice:

  • Kathy Alm from PATH International (pathintl.org) gave a presentation on AAI and horses
  • Miyako Kinoshita from Green Chimneys (greenchimneys.org) shared experiences and insights about AAI best practice and farm animals
  • Jennifer Henley from San Francisco SPCA (SFSPCA.org) shared her insights on how to achieve best practice when delivering AAI with dogs and cats

Elizabeth Ormerod shared her reflections on these talks:

Dr Jennifer Henley, Animal Assisted Therapy Program Manager, San Francisco SPCA

Jennifer oversees the long-standing and extensive AAI program operated by the SF SPCA.  Staff training is key. People require human service skills, in addition to animal handing ability.  Many of their teams include volunteers with minimal training in working with animals.  Holding volunteer teams to a high standard is a challenge.  Ensuring the well-being of the animals can also be challenging due to misunderstandings of their handlers. Anthropomorphising animals can lead to problems, and their guardians tend to become defensive.  Also, people need to work within their expertise.

Ensuring the good health, as well as welfare of the animals and having policies for infection control are of great importance.  Therefore kittens, pups, shelter animals and stray animals are not involved in their programmes – to avoid stressing these animals and to avoid the heightened risk of zoonoses that they pose.

Jennifer states that as her program has become more aligned with best practices, they have better visits, stronger teams and deliver better services. She recommends that collaboration is needed to address challenges in AAI to agree upon best practices. Practices that she highlights that need to be changed include allowing extended visitation and projecting human desires onto animals. She stresses the need for standardisation of terminology, and of training and evaluation across national and international borders.

Kathy Alm, CEO, Professional Association of Therapeutic Horsemanship International (PATH International)

Kathy addressed issues relating to Equine Assisted Activities and Therapies (EAAT) in the USA. This field is expanding rapidly and now serves over 60,000 individuals annually. The documented benefits of EAAT have led to increased awareness and insurance companies are beginning to fund the work of licensed therapists.

There has been a change in the perception of the human-horse interaction in AAI, with horses now being viewed as partners – however Kathy cautioned about the challenges in partnering with a species when it is humans that have the power in the relationship; there is a power differential. People are becoming more aware of equine welfare and the impact of such work on the horse. PATH International has devised 10 standards specifically to address welfare issues in the horse. Kathy explained that education, training and assessment is required and that this should be both species specific and programme specific.

She calls for objective data on therapeutic effectiveness and the impact upon animals involved; and for the use of clear and consistent messaging for clients and public. Another of her concerns relate to sustainability of the field. To address these issues Kathy advises that organisations and individuals need to collaborate to discuss data, research and best practice – and reach a consensus.

Miyako Kinoshita, Farm Education Program Manager, Green Chimneys, New York

Green Chimneys is another very longstanding HAI organisation, having been founded in 1952 by Dr Sam Ross.  Miyako demonstrated in a video how animals at Green chimneys are conditioned through positive interactions to enjoy and to invite interactions. People working in AAI need to be knowledgeable about both people and animals and work as a team.  They also need to stay within their boundaries. According to Miyako the field has become more professional.  For example awareness of the needs of animals has improved and research has become more rigorous, but there is still a long way to go.

Green Chimneys aims to follow best practices and standards. Careful observation of animals and knowing them as individuals is important in treating them ethically. HAI should never compromise an animal’s wellbeing. Environment enrichment is very important. Miyako favours activities relating to animal care and this is also beneficial to the children, their client group.

More views from leaders in the field

The views of other leaders were also sought on key AAI and HAI issues, as published in the event flyer.

Dr Sandra McCune, scientific leader for HAI, the Waltham Centre for Pet Nutrition, UK (www.waltham.com).  Sandra calls for more funding for HAI research, particularly outside the USA.  There is also difficulty in linking with experienced international HAI partners. Waltham-funded research is subjected to a strict animal ethics and welfare review. The field currently lacks clear guidelines to ensure the welfare of animals in AII. There are practices that need to be changed. AAI should not be conducted at the expense of animal welfare. Animal welfare safeguards should be included in all HAI research studies and AAI protocols. Sandra advises IAHAIO could provide guidance on animal welfare in AAI. Improved standards are also required in research and IAHAIO could also provide training in scientific skills.

Dr Didier Vernay, neurologist, Clermont-Ferrand University Hospital and Medical School, France

www.u-clermont1.fr/sof/formation/idFormation/27613

Didier Vernay states that HAI advancement is being hindered by lack of standards, regulations and good practice. This allows unethical or uninformed behaviour.  He differentiates between “integrated” HAI practitioners with a background in health, social care or education; animal-oriented professionals with skills in animal care or training; and “eclectic” practitioners with a background in neither and who therefore have twice as much to learn. Training HAI practitioners is a challenge. Didier states that cleanliness and hygiene issues can block HAI and encourages HAI practitioners to work with staff to address these constructively. He finds that HAI is a consistently effective and enjoyable way to effect positive change.

Roswitha Zink, Founder and MD, e.motion Equotherapy, Austria www.equotherapie.at

Roswitha acknowledges that although there is much to do in advancing AAI, there are now examples of best practice and research documenting positive outcomes. In addition standards are being raised to improve animal welfare, ethics and empathy towards animals. She states as a first step that we must identify problems and share these with others. In Austria collaboration in AAI is important. She regards IAHAIO as important in promoting change and dissemination knowledge.

Workshops

Three workshops oriented around eight key questions provided the opportunity for much discussion, focused mainly on some of the challenges encountered in the field, and how to address these and achieve best practice.

Q1 Knowledge, skill and experiences required to deliver AAI

  • Existing training courses are random; no one officially recognised and endorsed course internationally
  • Should include public health protocols for different types of services
  • Need public education on what AAI is, rules and protocols
  • AAA/E and AAT require different sets of knowledge and skills, but social skills and dog handling training/experiences are prerequisites
  • People/practitioners should know about the personality, likes and dislikes of the therapy dog/animal

Q2 Barriers encountered in your area

  • Need accreditation for practitioners/therapists in addition to their professional qualification – this isn’t available always
  • Agencies don’t understand what the animal/welfare needs are
  • Need funding for capacity building

Q3 How to make standards/guidelines for multi countries?

  • Very tricky for any organisation to enforce guidelines – perhaps need to work with the professional bodies
  • Basic animal needs must be met – don’t work outside handler expertise

Q4 Dog selection and screening

  • Must be knowledgeable about body language and stress signals and monitor these during sessions

Q5 Training for practitioners and handlers

  • Health and infection control
  • Social skills, dog handling

Q6 Dog welfare concerns

  • Lack of training is leading to welfare of dogs being ignored – they may be just tolerating the work, not enjoying it
  • Motivation of handler/practitioner to deliver AAI should be clarified as this is related to the welfare of the dog eg dressing of dogs costumes for services
  • Should set limit of working hours for dogs due to accumulated stress
  • Ensure stress signals are understood and acted upon
  • Respect dogs’ natural needs as part of welfare

Q7 Monitoring and ensuring dogs welfare

  • Videotaping, watching back, feedback from supervision
  • Thorough assessment for dogs to exclude those not ready and in appropriate (Pet Partners have this)
  • Regular evaluation as dogs health, characteristics and tolerance levels may change over time

Q8 Prevention of diseases

  • Annual vet check
  • Bath not more than 3 days before visit
  • Place barrier or towel between client and dog
  • Decline or check treats

Special topic: Current global and local factors increasing zoonotic risks

Whilst collating information on animal welfare in AAI Drs Elizabeth Ormerod and Brinda Jegatheesan have identified risks to human and animal health from zoonoses and presented on this work at the meeting. Programmes need to implement robust protocols to address these.  A number of factors predispose to zoonotic risk.

Current factors increasing zoonotic risk

  • Increase in and speed of global traffic
  • Expansion of exotic pet trade
  • Lack of screening for pathogens
  • Antimicrobial resistance
  • Global warming
  • Lack of multidisciplinary approach
  • Rejection of evidence-based medicine
  • Increased acceptance of AAI

The increased awareness of the benefits of AAI has led to a mushrooming of programmes. Unfortunately many of these are being introduced by individuals, with good intentions, but lack the professional training, understanding and skills to safely deliver these interventions. The need for a multidisciplinary board with veterinary presence cannot be overstated.

It is of great concern that the majority of emerging diseases are zoonotic, and some 75% arise in wild and exotic species. These emerging diseases include Lyme, Ebola, Hanta virus, E. coli 0157; Hendra virus; Australian bat Lyssa; CJD, SARS and H1N1 influenza. Such diseases require collaboration between veterinarians and the medical profession in diagnosis, treatment and prevention.

The need for an interdisciplinary approach to infectious disease has been a major stimulus to the development of One Health. The human-animal bond and AAI are increasingly recognised as requiring a One Health approach.  Essential steps to be applied to minimise risks from zoonoses include not involving wild animals or exotic species; ensuring the health of animal participants through following standard veterinary protocols for vaccination, worming and application of ectoparasite treatments; ensuring that animals in programmes are not fed raw meat or unpasteurised milk or products thereof. A multidisciplinary approach should always be applied, with veterinary involvement. Greater care is required in HAI involving immune compromised people and many of our client groups in AAI are in this category.

Examples of people who are immunocompromised

  • Children, pregnant women, foetuses
  • Older people
  • People with diabetes, Cushing’s disease, hypothyroidism, hypoglycaemia
  • People that are malnourished
  • People with anemia
  • Some cancer patients
  • People undergoing chemotherapy or radiation therapy
  • People receiving treatment with glucocorticoids or anti-rheumatic medicines
  • Transplant patients
  • People with HIV/AIDS
  • Smokers, alcoholics, drug abusers
  • People with chronic infections
  • People with renal or hepatic disease

Extensive zoonoses have been identified, but many more are anticipated.  We have an incomplete knowledge of these pathogens and their zoonotic potential. For example, all reptiles and amphibians should be regarded as excreting salmonella. Salmonella bacteria coat the bodies of these species and the infective dose is very low. Handwashing helps to reduce infection but is not fully effective.  The greatest risk of infection is to children. In addition, the behaviour of exotic species is unpredictable, leading to greater risks of injury to both clients and animals. Other risks to the animals’ welfare arise from the inability to determine their stress levels. Captive environments are inadequate in meeting their environmental and spatial needs. Insufficient is known about their dietary requirements.

Veterinary advice should be followed to minimise zoonotic risk. The Italian government mandates that veterinarians must be involved in the delivery of AAI programmes. Zoonoses pose serious risks, but these are largely preventable by implementing public health protocols. This was demonstrated by a one year study of 284 nursing homes with pet presence conducted by the Minnesota Department of Public Health.  There were no reported incidences of infection or of allergy. For every 1 million hours of exposure to pets there was one pet related incident and 200 non pet-related incidents. For every 1000 nursing home incidents 4.5 were related to pets whilst 995.5 were not related to pets.

Basic protocol to minimise zoonotic risk

  • Veterinary involvement
  • Use of licensed treatments for vaccination and parasite control
  • Do not give animals raw meat or by-products or raw milk or by-products
  • Good hygiene
  • Careful animal selection and screening
  • Avoid high risk animals; exotics; young animals owned less than 6 months; animals imported from some regions

Next steps   

IAHAIO will continue to engage its members and those working in the field of AAI to work with them to promote good practice in AAI. An international task force focused on standards of care and welfare considerations is currently working on advice and guidelines. Revisions to the IAHAIO White Paper (2014) will be published in Spring 2018.