The Children's of Alabama SHINE (Support and Help in Nutrition and Exercise) Clinic is a comprehensive center designed to address the needs of one of Alabama's most common health issues for children and adolescents—childhood obesity. The SHINE team includes pediatricians, nurses, nurse practitioners, dietitians, physical therapists, social workers, and volunteers. There are also specific psychologists who are familiar with this population of children and adolescents and who work closely with the team as well. Many factors contribute to unhealthy weight in children and adolescents including diet, exercise, stress, genes, poverty, and a multitude of others. The goal of SHINE Clinic is to assist families in making permanent changes in as many ways as they can that result in weight loss and improved health and well-being.
Close to 600 patients are seen each year in SHINE Clinic, and because of the complex nature of the visit, patients often express feeling anxious and stressed during the appointment. Because each discipline assesses each patient every time, the visits are long and often reported to be boring, which adds to the stress. Most of the patients of all ages express low self-esteem and report bullying at home and at school adding to their overall sadness.
Team members noted that, on days that specially trained dogs visited, the children brightened up and responded in a way that was not seen otherwise. In an effort to capitalize on this and make SHINE Clinic feel safe and fun, the staff began exploring the possibility of incorporating animal-assisted therapy (AAT) as an additional therapeutic resource to SHINE Clinic. This article lays out the process the team is utilizing to add AAT to the SHINE program.
AAT, sometimes referred to as “pet therapy,” is the practice of using animals as a therapeutic tool to promote healing and rehabilitation to patients in a variety of settings. AAT is used in hospitals, schools, nursing homes, libraries, and any setting where a therapeutic atmosphere is beneficial to an individual or a family. Most often, the therapeutic animals are dogs and cats but may also include horses, rabbits, and other types of animals.
AAT has long been used to help treat mental and physical disorders to meet therapeutic goals. AAT may help ease anxiety, increase motivation, and improve fine motor skill (Goddard & Gilmer, 2015). This type of therapy differs from animal-facilitated therapy where the animal simply “visits” a facility without any specific treatment goal planned (Goddard & Gilmer, 2015). A review of the literature shows a crossover of the terms “animal-assisted therapy” and “animal-assisted intervention.” To avoid confusion, in this article, the definitions used by the nonprofit Pet Partners (a training facility for therapy dogs and their handlers) are used. Using this classification, animal-assisted intervention is the overall heading of the various human/animal interactions. See Table 1 for a clarification of terms used here (Pet Partners, n.d.).
The history of animal therapy began with nursing. Florence Nightingale, in the 1800s, noticed that children and adults in psychiatric institutions responded with decreased anxiety when around small pets (Ernst, 2014). Sigmund Freud began using his own pet dog to improve communication with patients in the 1930s, and Boris Levinson in the 1960s was able to assist a nonverbal boy to speak by bringing his dog to sessions with the child (Ernst, 2014). Pet Partners (https://petpartners.org; formerly the Delta Society) was instrumental in developing educational/certification programs for AAT training. Their programs were launched in 1989 (Ernst, 2014).
Studies suggest that using AAT in a pediatric setting helps reduce anxiety and pain and increase motivation and provides a calming experience in many cases (Bouchard, Landry, Belles-Isles & Gagnon, 2004; Goddard & Gilmer, 2015). Pediatric surgeons noted that children benefited from AAT postanesthesia through a more rapid recovery, lessened pain, and improved emotional and cardiovascular responses when visited by AAT dogs immediately postoperatively (Calcaterra et al., 2015).
Although some research (Barker, Knisely, Schubert, Green, & Ameriginger, 2015) was unable to show significant improvement in pain and anxiety using AAT, study limitations noted by researchers included possible problems with randomization and other confounding factors that may have affected findings. The research did not recommend forgoing AAT but suggested further study.
Herzog (2017), in a limited review, noted that there was no difference in the level of obesity among children with dogs and children without. Therefore, the goal in the SHINE Clinic is not to promote dog ownership but to assess the children in clinic in a less threatening way while having fun. Through the use of AAT, the therapist can assess the abilities of the child with regard to self-esteem, motor skills, attention, and willingness to interact with others (Goddard & Gilmer, 2015). Using this assessment, the therapist prescribes a plan to be carried out at home and followed through clinic visits.
Meet Shelby. Shelby is a standard poodle acquired by one SHINE team member with the hope and goal of training her to function as the official SHINE Clinic AAT dog. Before obtaining Shelby, extensive online research was done followed by conversations and meetings with local therapy-dog trainers to clarify the best type of dog and the process of training. Enthusiastic approval was provided both from administration for the project and from members of the SHINE team. The SHINE physical therapist is currently planning the type of assessment with which Shelby will assist to begin specific training once she is old enough.
Despite the fact that there is never a guarantee a dog will pass all the qualifications to become a certified AAT dog, Shelby passed her first veterinarian visit and has already been enrolled in “day care” to begin her training. Shelby must go through basic obedience training, be up-to-date on all vaccinations, and be 18 months old before beginning the official AAT training. Characteristics that Shelby must possess are as follows: enjoy human interaction; accept vigorous petting; show “sit,” “stay,” “down,” “come,” and “leave-it” commands; remain neutral around other dogs; and not exhibit jumping, pawing, or mouthing. Shelby must be comfortable around moving equipment and unexpected loud noises. She must not show aggression or fear around other animals or people (Hand in Paw, n.d.). After Shelby passes the initial screening, she will begin training at a local AAT organization. The entire process will take approximately 1–2 years.
Shelby partners with a “handler”; in this case, the primary handler is a SHINE team member who is with Shelby at all times in the clinic setting. The handler trains along with the dog to ensure safe interaction between the animal and humans. The handler will train to assist the medical professional in teaching the therapy goals desired. The team physical therapist and one of the long-term volunteers have also expressed plans to train with Shelby, too, to ensure assessments and interaction that are more productive.
Shelby will be used in SHINE Clinic to help reduce stress and create a “fun” atmosphere for our patients. This will largely include assistance by the trained volunteer (Figure 1). Shelby's handler and the physical therapy staff will incorporate active play between Shelby and patients to assess movement and active function. This may range from taking Shelby for a walk around the building to assisting in agility activities. Shelby will become part of the SHINE Team, and the hope is that patients will leave SHINE Clinic feeling loved and accepted and will have made a new friend. There is also hope that, because of Shelby's presence, the children will be excited to come back to the clinic and there will be decreased clinic attrition.
Research related to the use of animal-facilitated therapy in pediatric outpatient clinics (including weight management clinics) is sparse but positive. The Meet Shelby venture proposed here will allow assessment and research to show both the positives and negatives related to the use of AAT in a pediatric weight management clinic—research that, when replicated, may be generalizable to other pediatric clinics and scenarios.
Barker S. B., Knisely J. S., Schubert C. M., Green J. D., & Ameriginger S. (2015). The effect of an animal-assisted intervention on anxiety and pain in hospitalized children. Anthrozoös
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Calcaterra V., Veggiotti P., Palestrini C., De Giorgis V., Raschetti R., Tumminelli M., … Pelizzo G. (2015). Post-operative benefits of animal-assisted therapy in pediatric surgery: A randomised study. PLoS One
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Goddard A. T., & Gilmer M. J. (2015). The role and impact of animals with pediatric patients. Pediatric Nursing
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