Canines for Kids and the Pediatric Diff erentialLisa Kinsel

Content presented at the 2017 Hill’s Global Symposiumin Washington D.C., May 5 - 6, 2017.

Pediatric healthcare organizations oft en create innovative interventions to

promote the physical and emotional well-being of their patients and to provide a sense of normalcy for children in their care. At Children’s Healthcare of Atlanta, animal-assisted therapy (AAT) has proven its value over the past 30 years as a complementary, non-traditional therapy that can improve the quality of life and psychological state of vulnerable patients and families.

Children’s has created a unique pediatric therapy dog program called Canines For KidsSM. The program comprises a trained facility dog that is partnered with a Children’s employee, with whom they work and live. The program was created in collaboration

with an organization in Georgia that raises and trains service dogs, Canine Assistants©. At present 13 facility dogs trained at Canine Assistants© work with their handlers to meet the daily needs of children across multiple settings in our pediatric healthcare system.

A review of literature found early research studies of AAT that describe the feasibility of program implementation1 and delineate components of eff ective hospital policies to safeguard the patient in both outpatient and inpatient settings for children and adults.2,3 These studies evaluate biophysical metrics such as heart rate, blood pressure, and cortisol levels as indicators of physiologic changes related to stress reduction aft er AAT interactions.4

Flashes of Hope Photography by Rod Riley

Creed: "When I grow up, I want to be a doctor who walks Casper around and helps make kids happy."

Children’s has created a unique pediatric therapy dog program called Canines For KidsSM. The program comprises a trained facility dog that is partnered with a Children’s employee, with whom they work and live.1

The literature review concluded that AAT’s positive eff ect on children is consistent across studies from patient, parent, and healthcare provider perspectives. Although these multiple studies support positive consequences of AAT, the literature review identified concerns about possible negative consequences of animal visitation in the hospital setting including possible allergic reaction, injury, or infection.

The biggest barrier and possible source of resistance encountered by healthcare organizations that wish to start a facility dog AAT program is fear of potential injury or infection associated with animal encounters. Patient safety is integral to the success

of the facility dog program, and thus the protocol establishes that visitation must be at the request of clinical staff . All visits are documented in the patient’s chart. Patients who are on isolation or have open wounds, animal allergies, or fear of dogs are excluded from participation. Multiple studies supply evidence that supports the eff icacy and safety of a well-managed AAT program. Three hospitals published results that tracked the number of patient visits by therapy dogs in order to document any associated infections, but found none.5-7 Current AAT policy recommendations encourage diligent hand washing and grooming practices before and aft er patient encounters, similar to current practices that healthcare providers use to reduce risk of infection transmission between patients. To date, the therapeutic benefits of AAT for hospitalized children far outweigh potential risks.

Comprehensive recommendations published in the journal Infection Control & Hospital Epidemiology in 2015 were used in creating Children’s Healthcare of Atlanta’s current policy on Animal Visitation (Policy #2.07).8 Currently, because of the focus on patient safety and multi-disciplinary collaboration, AAT patient encounters with dogs provided by Canines For KidsSM and community based animal

The biggest barrier and possible source of resistance encountered by healthcare organizations that wish to start a facility dog AAT program is fear of potential injury or infection associated with animal encounters.2

Physiological Benefits

Psychological Benefits

Cost Eff ective Treatment

Improved Clinical Outcomes

therapy programs have resulted in no reported adverse events and no documented associated infections.

In 2009, Lisa Kinsel, Manager of Volunteer Services at Children’s Scottish Rite, saw the need to transition the current AAT program from occasional visits to a full-time dog on staff . What seemed as a natural partnership with Canine Assistants© led us to create Canines For KidsSM, as Canine Assistants’© service dogs in training were already visiting the hospital. Casper, an 18-month-old golden/lab mix, was chosen to pioneer the Canines For KidsSM program as the first full-time dog on staff . Casper stays by Kinsel’s side during the day as she works as the Manager of Volunteer Services. When visits are requested, Kinsel adjusts her schedule to allow Casper to do his job and meet the needs of patients and families. Flexibility, a strong bond, and belief

policy continues to be revised to allow greater access to wider populations such as ICU, hematology/oncology, transplant, and even the bone marrow transplant unit.

Based on the overwhelming success of the Canines For KidsSM program from the perspectives of patients, parents,

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in the value of the Canines For KidsSM program are key elements of their successful partnership that help Casper and Kinsel make a diff erence in the complex and oft en unsettling world of pediatric healthcare. Currently, the Canines for KidsSM program has expanded to 13 facility dogs and their handlers. The visitation

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1. Bouchard F, Landry M, Belles-Isles M, Gagnon J. A magical dream: a pilot project in animal-assisted therapy in pediatric oncology. Canadian Oncol Nursing J. 2004; 14:14-17

2. Lefebvre SL, Weese JS. Contamination of pet therapy dogs with MRSA and Clostridium difficile. J Hosp Infect. 2009; 72(3):268-269.

3. DiSalvo H, Haiduven D, Johnson N, et al.. "Who let the dogs out? Infection control did: utility of dogs in health care settings and infection control aspects." Am J Infect

Control. 2006; 34(5):301-307.

4. Sobo EJ, Eng B, Kassity-Krich N. Canine visitation (pet) therapy: pilot data on decreases in child pain perception. J Holistic Nursing. 2006; 24:1:51-57.

5. Urbanski BL, Lazenby M. Distress among hospitalized pediatric cancer patients modified by pet therapy intervention to improve quality of life. Jl Ped Oncol Nursing. 2012: 29(5):272-282.

6. Caprilli S, Messeri A. Animal-assisted activity at A. Meyer Children's Hospital:

A pilot study. Evid Based Complement AlternMed. 2006; 3:379-383.

7. Yamauchi T, Pipkin E. Six years’ experience with animal-assisted therapy in a children's hospital: is there patient risk? Am Infect Control. 2008;36(5):E117.

8. Murthy R, Bearman G, Brown S, et al. Animals in healthcare facilities: recommendations to minimize potential risks. Infect Control Hosp Epidem. 2015; 36:5:495-516

References

and staff, plans are underway to expand the AAT program to additional inpatient and outpatient locations at Children’s. Expanding the program requires finding the donor funding to support and sustain Canines For KidsSM. All costs associated with the Canines For KidsSM program are donor funded, and therefore the program does not incur any direct costs to the healthcare system. At present, research studies and a multi-

site quality improvement project are underway to study the unique interaction of dog, patient, parent, and staff. These studies will contribute to greater knowledge of this alternative therapy that brings so many smiles to all. As word of the success of the Canines For KidsSM program has spread nationally, Children’s is recognized as the flagship program for full-time AAT. As a result, healthcare organizations ask for guidance to

establish similar programs for their own hospitals. Canine Assistants© reports an increased number of requests for healthcare facility dogs each year, both locally and nationally. This enduring partnership coupled with Children’s research and advocacy efforts will continue to make a difference in the quality of life of hospitalized children and families as well as the morale of pediatric healthcare staff.