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Veterinarians and the clinics for whom they work routinely establish collaborations with multiple and varied stakeholders. This might include a laboratory for processing samples and the corresponding courier company needed to deliver samples to the lab or a partnership with a local dog rescue organization for whom discounted rates are offered. One community partnership that stands to benefit both the clinic and the community agency, is for veterinarians to work in tandem with a local canine-assisted therapy program. The benefits to such an alliance are multifold and address aspects of veterinary medicine including client recruitment, community education, and access to a network of devoted dog enthusiasts.","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/description","classmap":"dpla:SourceResource","property":"dcterms:description"},"iri":"http:\/\/purl.org\/dc\/terms\/description","explain":"A Dublin Core Terms Property; An account of the resource.; Description may include but is not limited to: an abstract, a table of contents, a graphical representation, or a free-text account of the resource."}],"DigitalResourceOriginalRecord":[{"label":"Digital Resource Original Record","value":"https:\/\/circle.library.ubc.ca\/rest\/handle\/2429\/70814?expand=metadata","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO","classmap":"ore:Aggregation","property":"edm:aggregatedCHO"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO","explain":"A Europeana Data Model Property; The identifier of the source object, e.g. the Mona Lisa itself. This could be a full linked open date URI or an internal identifier"}],"FullText":[{"label":"Full Text","value":"veterinarysciencesArticleWhen Veterinarians Support Canine Therapy:Bidirectional Benefits for Clinics andTherapy ProgramsJohn-Tyler Binfet 1,*, Haley J. Silas 2, Sean W. Longfellow 2 and Katrina Widmaier-Waurechen 21 Faculty of Education, University of British Columbia, Kelowna, BC V1V 1V7, Canada2 Faculty of Arts & Sciences, University of British Columbia, Kelowna, BC V1V 1V7, Canada;hsilas84@gmail.com (H.J.S.); longfellowsean@gmail.com (S.W.L.); katrinawidmaier@gmail.com (K.W.-W.)* Correspondence: johntyler.binfet@ubc.ca; Tel.: +1-250-807-8420Received: 28 November 2017; Accepted: 3 January 2018; Published: 4 January 2018Abstract: This paper proposes a mutually beneficial model of collaboration between veterinariansand canine therapy programs. Veterinarians and the clinics for whom they work routinely establishcollaborations with multiple and varied stakeholders. This might include a laboratory for processingsamples and the corresponding courier company needed to deliver samples to the lab or a partnershipwith a local dog rescue organization for whom discounted rates are offered. One communitypartnership that stands to benefit both the clinic and the community agency, is for veterinariansto work in tandem with a local canine-assisted therapy program. The benefits to such an allianceare multifold and address aspects of veterinary medicine including client recruitment, communityeducation, and access to a network of devoted dog enthusiasts.Keywords: canine therapy; client recruitment; community collaboration1. IntroductionVeterinarians and their associated clinics routinely establish connections, collaborations,and partnerships with a variety of community stakeholders that help their practice thrive. The clinic orclinician has either a need (e.g., lab samples to process) or offers a service (e.g., the treatment of animalsfrom a local rescue group at a discounted rate) that drives these relationships. One relationship thatremains underexplored is the relationship between the veterinarian and his\/her local canine therapyprogram. The aim of this paper is to outline a collaborative model between veterinarians and their localcanine therapy program and explicate the bidirectional benefits of this collaboration to each agent.Veterinarians establish collaborations with a variety of community stakeholders. In fact, veterinaryclinics are typically situated within communities where they will be in direct contact with variousclients, businesses, and organizations. Some of the partnerships between veterinarians and clients mayinclude but are not limited to: breeders, pet owners, law enforcement, dog daycare facilities, sportingor agility groups, and training or behavioural programs. The businesses that veterinarians collaboratewith are of even larger variety, including but not limited to: lab services and supplies, couriers, officesupply companies, pharmaceutical companies, and food manufacturers. Finally, the organizationswith whom veterinarians collaborate with may vary by region and by community, but often includeorganizations such as local dog rescue groups, local societies for animal welfare, wildlife organizations,animal control agencies, and volunteers and\/or volunteer programs. It is important to note that theorganizations with whom veterinarians collaborate with may be large-scale, or small not-for-profitorganizations that are locally established, and are therefore unique to the clinician\u2019s community.Vet. Sci. 2018, 5, 2; doi:10.3390\/vetsci5010002 www.mdpi.com\/journal\/vetsciVet. Sci. 2018, 5, 2 2 of 82. A Model of Clinic-Organization PartnershipA common partnership found within veterinarian clinics is their relationship with local dog rescueorganizations. These organizations typically take in dogs from high-kill shelters or dogs who, for avariety of reasons, are surrendered and require rehoming. Some of these rescue organizations are breedspecific and thus require specialized clinical knowledge and treatment (e.g., treating brachycephalic inbull breeds). What is evident in this partnership is the bidirectional benefits to both the clinic and therescue organization. From the clinic\u2019s perspective, the relationship brings in a steady stream of caninepatients, patients who typically receive a wellness check, vaccinations and sterilization if not yet done,and additional treatment pending their health profile. Once adopted, and providing the adoptivefamily is in the same geographic catchment area, the adopted dogs typically stay on as clients. As mostrescue organizations rely on donations to operate, the standing benefit to rescue organizations arisingfrom an established partnership with a veterinarian or clinic includes the negotiation of discountedclinic rates. It will be argued shortly that a similar partnership can be established between veterinariansand canine-therapy organizations.3. Understanding Canine-Assisted TherapyThere has been a surge in Animal-Assisted Activities in the past decade with programs movingbeyond the traditional model of one volunteer handler and canine working with a health-impairedclient in a static setting [1,2]. As an illustration of this, within the context of post-secondary educationalone, Crossman and Kazdin (2015) identified 925 on-campus canine therapy programs across NorthAmerica [3]. The field of canine therapy is burgeoning and now sees the innovative incorporation oftherapeutic canines into a variety of settings. We now routinely see therapy dogs working in elementaryschools to assist reluctant readers [1,4], in courtrooms to support children giving testimony, in airportsto reduce traveler stress, in funeral homes to comfort mourners, and on college campuses to supportstudent mental health and well-being [5\u20138].The popularity of therapy canines is a reflection of the public\u2019s appetite for two distinct interactionswith canines: (1) intentional or purposeful interactions with dogs; and (2) the desire for ambientinteractions (i.e., just being in the presence of a dog). This may be a reflection of the extent to whichdogs are considered family members [9]. Conservative current estimates indicate that, when promptedto identify their family members, participants in studies include their dog as a family member 63% ofthe time [10]. As an illustration of this, new research on canine weight loss reveals that weight gainis common within families and both family members and canines themselves correspondingly gain(and lose) weight [11]. As a reflection of this repositioning of dogs from the backyard to the familyroom, dogs are routinely incorporated into the day-to-day life of their owners (e.g., dogs are often seenattending move-in day on college campuses to bid freshmen students farewell). There is a societaldesire to interact with dogs and we increasingly see the incorporation of dogs into day-to-day routines.This is evidenced by the sheer number of businesses and corporations allowing employees to bringtheir dogs to work [12].One means of providing purposeful interactions with canines is through participation in a caninetherapy program. Here, the client is afforded an opportunity to interact with one or more therapydogs within a specified setting. Overseeing a canine therapy program is no small undertaking anddirectors of such programs bear great responsibility in ensuring that dogs used in their programs areof sound temperament and well-suited to this public work. Though interest runs high from the generalpublic around participating in canine therapy, finding well-qualified volunteer handlers and caninescan prove problematic for many agencies [6]. A well-qualified handler must demonstrate caninemanagement skills that provide adequate support, restraint, and direction [13]. Further, assessingdog-handler teams is time consuming and finding reliable teams is a challenge for those working inthe field [7]. Across programs, there are standard behavioural benchmarks used by agencies to assesstherapy canines in the areas of reliability, predictability, controllability and suitability [14]. BecauseVet. Sci. 2018, 5, 2 3 of 8veterinary visits may be stressful for both the handler and his\/her dog [13], this is an ideal setting toinformally assess or initially screen the suitability of dog-handler teams.It can be argued that when assessing dog-handler teams for participation in canine therapy,the emphasis has traditionally been on assessing canine disposition and behaviour, with handlerqualifications underemphasized [15]. Increasingly, there is discussion around the importance ofassessing handler knowledge and skill and ensuring that the handler is well-suited to the targetclient population [15]. Strong canine therapy programs will thoroughly assess canines but also providetraining and ongoing assessment of volunteer canine handlers.4. Complementary NeedsThe above illustrates the primary needs of a canine therapy program\u2014notably, to identify strongpotential dog-handler teams who are able to fulfill the program\u2019s mission through their reliableparticipation in sessions. Veterinarians and clinics too have needs and certainly one need drivingthe economic viability of clinics is client traffic. Although reports have revealed that Canadians arespending more money on their pets than ever, veterinary visits are declining [16,17]. It is proposedhere that a key benefit to a collaboration between veterinarians and canine therapy programs is thebidirectional recommendation of clients. As the total number of clients per clinic can be a misleadingindicator of clinic productivity (due largely to clinics maintaining inactive files), active clients (clientswho have been to the practice in the past year) are the clients generating clinic revenue [18].Although no turnover rates of dog-handler therapy teams could be found, the clients of veterinaryclinics, due largely to the relatively short lifespan of animal clients, experience relatively high rates ofclient turnover. Urfer and colleagues (2011) reported the mean life expectancy for 72 different caninebreeds. Collapsing their data across breeds, we calculated the mean life expectancy across breeds to be12.2 years (SD = 1.97; range 7\u201316.5 years [19]). In light of this constant turnover of clients, much hasbeen written on the importance of generating new clients to build and maintain the economic viabilityof small animal practices [17]. Graham-Mohl (2013) argues that, to maintain economic viability, clinicsmust be community-focused and tailor their marketing efforts to the needs of the local community [20].Rowe (2007) argues that the key challenge to a clinic is, in fact, to maintain its client base [21]. Below,we argue that an under-accessed client population lies in clients who volunteer with their dog withinthe context of canine therapy.5. Volunteer Handlers Make Ideal ClientsWithin the dog owning community, therapy dog handlers are particularly invested in their dogs.This is evidenced by the sheer commitment required to: (a) be accepted into a reputable canine therapyprogram; and (b) the ongoing time and energy required of handlers to ensure their dog is preparedfor therapeutic work (e.g., grooming, transporting to and from site visits). Canadians are spendingmore than ever on their pets. The annual cost of care for a dog reported by the Ontario VeterinaryMedical Association is $1386 [22]. Additionally, spending associated with owning a pet is predicted toincrease [23]. In 2016, pet owners in the U.S. spent $66.75 billion on their pets, with $15.95 billion spenton veterinary care [24]. It can be argued that of the pet owning population, canine therapy volunteerhandlers are particularly devoted to the care and well-being of their dogs. This, in turn, translatesto frequent clinic visits to ensure their dog is in optimal health. The average number of veterinaryvisits per household per year for dogs is 2.6 [10]. Though the rate of clinic visits by canine therapy doghandlers has not been reported, it is likely that their annual number of visits surpasses the average perdog owning household. Canine therapy dog handlers are, in many ways, the ideal client.Extending beyond actual clinic visits, canine therapy volunteers are typically active withintheir local dog community. Certainly, this is evidenced by participation in social media and viainformal, word-of-mouth communication typical of the communication pathways of members ofmicro-communities. Thus, an established relationship with a local canine therapy program provides aclinician with access to a network of dog enthusiasts\u2014enthusiasts who are devoted to the care andVet. Sci. 2018, 5, 2 4 of 8well-being of their dogs and who are high consumers of veterinary services. Such a relationship standsto boost referrals well beyond the immediate realm of a given canine therapy program.6. Veterinarians and Community ResponsibilityAs reflected in regional, national, and international codes of professional conduct, there isan expectation that veterinarians engage in different forms of community engagement and publiceducation (see Table 1). Liaising with a local canine therapy program provides an avenue throughwhich veterinarians may both directly and indirectly engage with local communities. Directlyand through their recommendations, veterinarians may impact the quality of dog\/handler teamsparticipating in local canine therapy programs thus potentially augmenting the skills offered byvolunteers within such programs. Indirectly, and an outcome arising from their recommendations,veterinarians can contribute to the well-being of the clients served by these programs by helpingensure that well-qualified dog\/hander teams work on behalf of canine therapy programs offeringsupport to clients.Table 1. Professional responsibilities of veterinarians across associations.Association: Code of conduct regarding community education:British ColumbiaVeterinary MedicalAssociation (BCVMA) [25]\u2022 All veterinarians as members of a learned medical profession, owe a duty ofservice to the public and in fulfilling this duty must maintain the higheststandards of integrity and ethical conduct.\u2022 Members should make efforts to contribute to the education of the public inmatter relating to and promoting the health and safety of animals and thereby thepublic; but members must do so in accordance with generally recognizedstandards of integrity and professionalism.Canadian VeterinaryMedical Association(CVMA) [26]\u2022 A veterinarian should continue to study, apply, and advance scientific knowledge,make relevant information available to clients, colleagues, the public andmaintain a commitment to veterinary medical education.\u2022 The responsibilities of the veterinary profession extend beyond individualpatients and clients to society in general. Veterinarians are encouraged to maketheir knowledge available to their communities and to provide their services foractivities that protect public health and environmental health.American VeterinaryMedical Association(AVMA) [27]\u2022 A veterinarian shall continue to study, apply, and advance scientific knowledge,maintain a commitment to veterinary medical education, make relevantinformation available to clients, colleagues, the public, and obtain consultation orreferral when indicated.\u2022 A veterinarian shall recognize a responsibility to participate in activitiescontributing to the improvement of the community and the betterment ofpublic health.\u2022 The responsibilities of the veterinary profession extend beyond individualpatients and clients to society in general. Veterinarians are encouraged to maketheir knowledge available to their communities and to provide their services foractivities that protect public health.Federation of Veterinariansof Europe (FVE) [28]\u2022 Veterinarians should make animal owners aware of their responsibilities tothe public.\u2022 Veterinarians should, whenever appropriate, advise their customers aboutmeasures to minimize the risk of zoonotic agents, food borne pathogens, residues,contaminants (biological and chemical agents) and antimicrobial resistance.\u2022 Veterinarians may inform the public about their services in an accurate and notmisleading manner. Such communication must be truthful, transparentand correct.Vet. Sci. 2018, 5, 2 5 of 87. The Clinic Visit\u2014An Informal Assessment OpportunityIt is argued here that the clinic visit provides a rich opportunity for an informal screening byveterinarians of potential dog-handler teams for referral to local canine therapy programs. The visitshowcases the handler\u2019s ability to manage the dog in public, maintain control of the dog in thepresence of ample distractions (e.g., the waiting room where other dogs\/pets may be present), and theintroduction of the dog to clinic staff (e.g., for an initial weigh-in by a technician) and to the treatingveterinarian. As Fine (2015), in his Handbook on Animal-Assisted Therapy, has argued, observingthe dog\/handler team in action in a setting where the team encounters an unknown person in anunknown setting is a strong predictor of therapy canine success [29].In addition to providing insights into the handler\u2019s ability to manage his\/her dog, the veterinarianis able to discern the dog\u2019s temperament in a public setting and his or her willingness\/interest inmeeting new people. In short, the visit provides ample fodder for the veterinarian to make a holisticor general impression of suitability for potential participation in canine therapy initiatives throughan informal assessment of dog-handler skills in what could be deemed a stressful situation. Thougharguments have been made around reducing stress during clinic visits [13], the clinic visit can be astressful event for both human and animal clients. Within the context of a clinic visit, the veterinarianis able to see how the dog handles a potentially stressful setting and interaction [30]. The veterinarianis particularly well positioned to discern clients and dogs who stand out given the sheer number ofclients a clinician sees in a given day. Recognizing too that the veterinarian is an influential agent inthis transaction and his\/her suggestion to a client to investigate the possibility of participating in acanine therapy program carries weight. There is thus a greater likelihood of follow-through on theclient\u2019s part to seek additional information regarding local therapy programs.We would be remiss in not addressing the potential risks associated with establishing thepartnership described above. Over time, and as a veterinarian becomes linked to, or known forrecommending clients to, a local canine therapy program, there is a risk that the clients the clinicianrecommends to the program do not pass the program\u2019s assessment\/evaluation practices. This, in turn,could potentially compromise the veterinarian-client relationship and risk the client seeking serviceselsewhere. To reduce this risk, the veterinarian must consider: (1) investing time in familiarizinghim\/herself with the program\u2019s screening, assessment, and selection criteria; and (2) phrasing therecommendation as a suggestion and not an explicit endorsement (e.g., \u201cIn light of your dog\u2019sbehaviour in the clinic today and how I\u2019ve seen you manage your dog, you might consider lookinginto volunteer work with a canine therapy program. Let us know if you\u2019re curious to learn more andwe can direct you to a local agency.\u201d). An additional risk or complexity lies in larger urban centreshaving multiple canine therapy programs in operation. Whether to establish an exclusive relationshipwith one therapy program or to simply provide clients with a list of all programs serving the area, issomething for clinicians to decide. A last risk, and one seen more recently within the expanding fieldof canine therapy, is that some programs are charging an assessment fee, a membership fee, or both.Directing clients to a canine therapy agency that charges an assessment fee, could be misinterpretedby clients as a money-grab, especially if the client and his\/her dog are not selected by the program.Despite the above-mentioned risks inherent in community-engagement work of the nature proposedhere, there is potential for veterinarians to work in harmony with a local canine therapy program.Next, we propose a stepwise model to illustrate how such a partnership might unfold.8. Proposing a Model for Clinic-Therapy Program PartnershipA review of the extant veterinary and anthrozoological literature revealed no stepwise modelto connect a veterinary clinic to a canine therapy program. A model that could successfully connectthese two parties is proposed in Table 2. The model proposed below requires minimal time, effort,and resources from both parties in order to create a bidirectional, mutually beneficial partnership.Vet. Sci. 2018, 5, 2 6 of 8Table 2. Stepwise model to build clinic\u2014canine therapy partnership.Therapy Program Personal Veterinarian\/Clinic Staff1. Therapy program identifies and contacts apotential collaborating local veterinary clinic tobook an appointment with a veterinarian.1. Veterinarian accepts appointment todiscuss opportunity.2. Therapy program attends appointment withdocumentation and explains the benefits ofa partnership.3. Therapy program invites veterinarian toobserve a new handler\/new dog session toobserve desired behaviors. Provides explicitinstruction to veterinarian on all aspects ofscreening, assessment, and selection ofdog\/handler teams.2. The veterinarian learns the program\u2019s screening,assessment, and selection practices.4. Therapy program invites veterinarian to attenda therapy session familiarizing them with theprogram operation and environment.3. Veterinarian is familiarized with therapyprogram goals and expectations byattending session.5. Therapy program enters informal agreementwith participating veterinarian clinic.4. Veterinary clinic enters informal agreementwith therapy program.6. Therapy program endorses veterinary clinic onwebsite or social media and through doghandler referrals.5. Veterinarian informally screens clients duringroutine clinical visits for potentialrecommendation to therapy program.7. Therapy program maintains regularcommunication with veterinary clinic aboutpotential therapy candidates.6. Veterinary clinic maintains regularcommunication with therapy program aboutpotential therapy candidates.8. Therapy program follows through onrecommendations by veterinarian.9. ConclusionsBoth veterinarians and canine therapy programs have clients or participants with restrictedenrolment. That is, despite optimal care, the canine clients of a veterinary clinic will expire and theclinic has a standing need to bring in new clients. This is paralleled by canine therapy programswho see dogs retire due to advanced age or whose handlers move or have life events that preventparticipation in programming. Thus, both agencies have a need to replenish their client base and it hasbeen argued here that a collaborative model in which veterinarians informally assess and recommenddog-handler teams for participation in local canine therapy programs and canine programs in turn,help cultivate clientele for the veterinarian, is a model that stands to benefit both parties.Acknowledgments: The University of British Columbia\u2019s canine therapy program \u201cBuilding Academic Retentionthrough K9\u2019s\u201d (B.A.R.K.; barkubc.ca) is supported by funding from the Associate Vice President, Students Officeand VEDA Exclusive Student Living.Author Contributions: J.-T. Binfet (50%), as lead author, conceptualized paper, oversaw writing and synthesisof other authors\u2019 contributions; H.J. Silas (20%) identified and summarized resources, contributed to writing,developed Table 1); S.W. Longfellow (15%) identified resources, developed Table 2) and K. Widmaier-Waurechen(15%) identified resources, summarized community partnership findings.Conflicts of Interest: The authors declare no conflict of interest.References1. Brelsford, V.L.; Meints, K.; Gee, N.R.; Pfeffer, K. Animal-assisted interventions in the classroom: A systematicreview. Int. J. Environ. Res. Public Health 2017, 14, 669. [CrossRef] [PubMed]2. Crossman, M.K. Effects of interactions with animals on human psychological distress. J. Clin. Psychol. 2016,73, 761\u2013784. [CrossRef] [PubMed]Vet. Sci. 2018, 5, 2 7 of 83. Crossman, M.K.; Kazdin, A.E. Animal visitation programs in colleges and universities: An efficient model forreducing student stress. 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