Policy initiatives for the use of canines in Army medicine.
Article Type: Report
Subject: Working dogs (Laws, regulations and rules)
Military animals (Laws, regulations and rules)
Medicine, Military (Laws, regulations and rules)
Author: Watkins, Kathleen L.
Pub Date: 04/01/2012
Publication: Name: U.S. Army Medical Department Journal Publisher: U.S. Army Medical Department Center & School Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 U.S. Army Medical Department Center & School ISSN: 1524-0436
Issue: Date: April-June, 2012
Topic: Event Code: 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation
Organization: Government Agency: United States. Army
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 288538039
Full Text: There is documented evidence dating from as early as 1940 citing the use of dogs to assist Wounded Warriors in therapeutic settings. Since that time, various efforts have emerged throughout the Army promoting the use of dogs to assist Warriors to attain higher levels of independence and self-reliance, allowing them to function more successfully in their communities and jobs. Most recent efforts include the use of service dogs and animal-assisted activities dogs in Warrior transition units, military medical treatment facilities, combat and operational stress control units and other settings.

As these service dog and animal-assisted activities efforts have emerged and expanded to support the Army's 9,661 * Wounded Warriors and the rest of the Army community, so has the need for policies that define and govern the appropriate use, accompaniment, and maintenance of dogs and related programs. While the Army is not governed by the Americans with Disabilities Act of 1990 (ADA) (42 USC ch 126), in the absence of an overarching Army animal-assisted activities policy, the ADA and Department of Defense Technical Bulletin TB MED 41 have become references for development of local policies throughout the Army.

The ADA prohibits discrimination against people with disabilities in employment, transportation, public accommodation, communications, and governmental activities. Specific sections of the Act are dedicated to the protection of people with physical and/or mental disabilities from discrimination in receiving public services, to include accompaniment by a service dog. Given the current climate of war, these provisions may have considerable impact on support available to disabled Veterans, as well as service members returning from Iraq and Afghanistan with both physical and psychological wounds.

Under the ADA, businesses must allow people with disabilities to bring their service animals onto business premises in whatever areas customers are generally allowed. Although not bound by these guidelines, the Army Medical Command has made a significant effort to develop policies and provisions that respect service members, Army personnel, and all other persons accompanied by a service animal on Army installations.

TB MED 4 (1) is the governing Department of Defense (DoD) regulation that establishes the processes necessary to maintain human-animal bond programs, animal visitation, animal-assisted activities, and animal-assisted therapy. This regulation promotes and supports human-animal bond programs by providing guidance on care, maintenance, and disease prevention of animals, including dogs. As of this writing, the US Army Veterinary Command, the DoD Executive Agent for Veterinary Services, is in the process of revising TB MED 4. The revision will include current definitions for animal-assisted activities, animal-assisted therapy, and service dogs.

History

In November 2009, the Army Veterinary Command (VETCOM) engaged the Behavioral Health Division of the Office of The Surgeon General (OTSG) in discussion concerning the growing interest in animal-assisted activities, and the numerous initiatives throughout the Army that involved use of dogs. To help coordinate these initiatives, VETCOM and the Behavioral Health Division held an animal-assisted therapy summit December 15 to 17, 2009 at Fort Myer, Virginia. The agenda included current efforts, research, metrics for program evaluation, and logistical and legal challenges. The forum brought together 8 nongovernmental organizations for the first half of the proceedings to discuss their programs. Other attendees included staff from the Warrior Care and Transition Office; Army medical treatment facilities; the OTSG Rehabilitation and Reintegration Division, Walter Reed Army Medical Center; US Air Force; US Navy; and combat and operational stress control staff who work with and handle the animal-assisted activities dogs in theater.

Products from the summit included mission priorities, a research agenda, and the corporate way ahead. During the meeting, the group discussed the significance of defining the different types of dogs and their appropriate use. The group defined and differentiated between animal-assisted activities, animal-assisted therapy, and service dogs. One of the outcomes of the meeting was the decision to develop an Army Medical Command (MEDCOM) policy to provide standardized guidance on the use and maintenance of dogs at all medical treatment facilities. The Walter Reed Army Medical Center (WRAMC), which had significant experience managing an animal-assisted activities program and was already working on a local policy to govern their thriving dog programs, was identified as the lead to begin developing the MEDCOM dog policy.

On February 5, 2010, a follow-up meeting was held to review the progress since the summit. Participants included the OTSG Behavioral Health Division, WRAMC, Europe Regional Medical Command, the Veterans Administration, and a host of nongovernmental organizations and subject matter experts in animal-assisted activities, and research. Topics included (a) optimizing the use of dogs in the combat and operational stress control teams in Iraq; (b) moving forward with research opportunities at WRAMC and the Europe Regional Medical Command; (c) potential use of dogs in Warrior Transition Units; (d) development of a MEDCOM-wide policy and updating a number of animal policies, including DoD TB MED 4, (1) WRAMC facility policy, and the combat and operational stress control policy; (e) various models which may be helpful; (f) visiting animal-assisted activities program/facilities, and (g) the importance of clarifying the diverse use of dogs (service, animal-assisted therapy, and animal-assisted activities). Participants at the meeting also noted that Army Family Action Plan (2) Issue #653 which recommended funding a program to provide service dogs to Wounded Warriors was assigned to the Warrior Transition Command for exploration and proliferation. On March 8, 2010, Issue #653 was transferred from the Warrior Transition Command to the OTSG Behavioral Health Division for examination by senior officials within OTSG and MEDCOM.

In March 2010, the Behavioral Health Division visited America's VetDogs--an organization in Long Island, New York, that trains and provides guide and service dogs to assist wounded service members and Veterans who have visual, physical, occupational, and/or emotional impairments--to gain further understanding of how dogs were being used to assist wounded service members and Veterans. The visit included an overview of the program, a tour of the facility, observation of service dog training, and interaction with Veterans who were currently enrolled in the program. A class of 11 Soldiers, Marines, and Veterans were observed as they learned to train their service dogs to perform specific tasks to address their individual needs.

The VetDogs Chief Executive Officer provided information to assist the Behavioral Health Division with its expanded mission related to animal-assisted therapy and funding service dogs for Wounded Warriors. Topics included: (a) pros and cons of developing an army animal-assisted therapy/service dog program versus use of existing, accredited nongovernmental organization programs, (b) optimizing the use of dogs in the combat and operational stress control teams, (c) logistics related to sending dogs to Afghanistan with the 254th Medical Detachment from Germany, and (d) developing research strategies and metrics. America's VetDogs offered a donation of 2 service dogs specifically trained for the tasks they will perform with the 254th Medical Detachment. The donation was later approved by The Surgeon General.

On April 12, 2010, the OTSG Behavioral Health and Rehabilitation and Reintegration Divisions visited the National Education for Assistance Dog Services (NEADS)/ Dogs for Deaf and Disabled Americans in Princeton, Massachusetts. NEADS, a nonprofit organization that uses inmates to train their dogs, provides canine assistance dogs to combat Veterans and people with hearing and physical disabilities. The use of inmates, while cost effective, is also intended to provide a therapeutic support for the inmates.

The visit to NEADS included an overview of the program, a tour of the facility, observation of the training, demonstrations, and interaction with Veterans in the program diagnosed as having physical disabilities, posttraumatic stress disorder, and traumatic brain injury. The NEADS Chief Executive Officer and staff provided information on the impact of their program and expansion into animal-assisted therapy. Topics included: (a) NEADS expanded programs to help persons with disabilities, (b) metrics and NEADS Traumatic Alert Dog Program pilot study regarding the impact of placing service dogs with Veterans diagnosed with posttraumatic stress disorder, and (c) pros and cons of developing an Army animal-assisted therapy/service dog program versus use of existing accredited programs. Following the visit to NEADS, the OTSG Rehabilitation and Reintegration Division briefed the MEDCOM Chief of Staff on the therapeutic use of dogs in the Army, resulting in a request for a follow-up brief in May 2010.

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In an effort to gain further insight into the impact of dogs on Wounded Warriors, during April 2010 representatives from the OTSG and VETCOM also toured the Army's most robust animal-assisted therapy program located at the Walter Reed Army Medical Center. Also present were representatives from the MEDCOM, DoD, nongovernmental organizations, and congressional staffers from Senator Barbara Boxer's office, the US House of Representatives Committee on Veterans' Affairs, the Minority Staff of the House Veterans Affairs Committee, and the Subcommittee on Health of the House Committee on Veterans' Affairs. The group observed the Specialized Therapy K-9 program; the Warrior Transition Brigade occupational therapy work and education program "Paws for Purple Hearts" Service Dog Training Program; and the Warrior Transition Brigade occupational therapy work and education program, the Washington, DC Humane Society Warrior in Transition Behavior and Grooming Training Program. Wounded Warriors diagnosed with posttraumatic stress disorder demonstrated methods for training service dogs, which is part of their therapy. Wounded Warriors also gave testimony regarding the positive impact of the program on their lives. The day ended with a research meeting at which the topics of discussion included: (a) establishing qualification criteria and identifying the number of Wounded Warriors who may benefit from having a service dog, (b) research and data collection, (c) identification of funding sources, and (d) scheduling a follow-up teleconference at the end of May for further discussion regarding research.

Following the OTSG/VETCOM tour of the Walter Reed Army Medical Center in May 2010, there was discussion initiated by WRAMC on whether or not to move forward with development of an Army-wide MEDCOM dog policy, or direct efforts towards the revision of DoD TB MED 4, (1) lead by VETCOM. It was determined that while both efforts were significant to the advancement of animal-assisted activities, a comprehensive MEDCOM policy was needed to provide standardization for use of dogs at Army medical treatment facilities. Policies existed at the local level but were not applicable to all medical treatment facilities, therefore creating inconsistencies between the medical treatment facilities on the maintenance, care, and use of dogs, and causing lack of differentiation between pets, animal-assisted activities, animal-assisted therapy, and service dogs. The task of writing the MEDCOM dog policy was transferred from WRAMC to the Office of The Surgeon General, with the author as action officer.

On November 9, 2010, the OTSG Behavioral Health Division published the first MEDCOM-wide policy on use of canines in Army medicine. OTSG/MEDCOM Policy Memorandum 10-077 (3) provides guidance on the authorized use, ownership, and accompaniment by service dogs at military medical treatment facilities and Warrior Transition Units.

To further explore the possible benefits of dogs for Wounded Warriors, on December 3, 2010, the Behavioral Health Division held a teleconference with WRAMC subject matter experts on animal-assisted activities. The teleconference focused on current uses of dogs with Wounded Warriors and surveying to determine how many Wounded Warriors may benefit from having a dog. The teleconference resulted in a recommendation to use components of the Functional Independence Measure and Functional Assessment Measure (tools which are currently used at WRAMC) to assist with determining cognitive and physical disabilities of Wounded Warriors and the appropriateness of referral to a nongovernmental organization that donates service dogs to service members and Veterans.

On April 11, 2011, the OTSG Rehabilitation and Reintegration Division published OTSG/MEDCOM Policy Memorandum 11-030. (4) The policy recognizes that dogs have long assisted healthcare professionals in various rehabilitative treatments, including combat and operational stress control. Policy Memo 11-030 establishes the role of animal-assisted therapy and animal-assisted activities dogs in combat and operational stress control units, operational employment with combat and operational stress control units, and animal-assisted therapy and animal-assisted activities dog programs throughout the battle space. The policy also identifies Army occupational therapists as the primary handlers of these dogs in the Army, with behavioral health professionals as alternates.

The Behavioral Health Division consulted with the Rehabilitation and Reintegration Division on use of the Functional Independence Measure and Functional Assessment Measure as instruments for determining the number of Wounded Warriors that may need or benefit from having a service dog. Noting the Functional Independence Measure and Functional Assessment Measure scales are not widely used by Army occupational therapists, OTSG Rehabilitation and Reintegration recommended a general survey as an alternative measure. Other options presented during this meeting included obtaining data for the past 3 years from the Army programs that support animal-assisted activities, the Veterans Administration funded dog program, and nongovernmental organizations that match service members and Veterans with service dogs. As a result, in May 2011 the author developed a survey to determine the trend of service dog matching and placements with Wounded Warriors and service members over the past 3 years. Survey participants included the Veterans Administration, Army regional medical commands, and America's VetDogs and NEADS, the 2 nongovernmental organizations who primarily provide service dogs to Soldiers and Veterans.

In December 2010, the Clinical Services Division, Office of the MEDCOM Assistant Chief of Staff for Health Policy and Services, convened a meeting with the Army animal-assisted activities stakeholders to review the Army's efforts and policies related to dogs. During the meeting, the Clinical Services Division was identified as the lead division for all MEDCOM animal-assisted activities efforts. There was also discussion regarding the need for an Army-wide animal policy to provide guidance for not only dogs, but for use of all animals in Army healthcare settings. Following the meeting, the Clinical Services Division examined the Army's animal-assisted activities efforts and trends, and reviewed the OTSG Behavioral Health Division survey on Wounded Warriors who may benefit from having a service dog. In October 2011, the Clinical Services Division began staffing a draft policy on the use of animals in the healthcare setting. The draft policy provides guidance on use of service animals, animal-assisted therapy and animal-assisted activities to include canines, equines, and other species. When published, this policy will apply to all Army medical treatment facilities using animals in the healthcare setting, Wounded Warriors, and beneficiaries treated within medical treatment facilities, regardless of component or duty status. Publication is expected in the near future.

Recognizing the growing interest in the use of dogs to assist service members, the Deputy Assistant Secretary of Defense for Wounded Warrior Care and Transition Policy (DASD WWCTP) held a DoD service dog policy development meeting off-site in March 2011. The meeting was held to discuss development of a comprehensive DoD service dog policy that will provide clear guidance to all of the military services, commanders, healthcare providers, and service members who work with, qualify for and/or will benefit from the use of service dogs on DoD installations. Leaders and subject matter experts, including the Behavioral Health Division, convened at this meeting to discuss development of the DoD service dog policy that will assign responsibilities and provide instructions for the use of service dogs by service members within the DoD. The DoD service dog policy will also establish policy for the authorized use of animal-assisted activities and animal-assisted therapy on DoD installations. A draft policy was developed at the conclusion of the meeting. Since that time, the DASD WWCTP has continued to refine the document. A publication date has not been determined.

References

(1.) Department of Defense Technical Bulletin TB MED 4: DoD Human-Animal Bond Principles and Guidelines. Washington, DC: US Dept of the Army; June 16, 2003. Available at: http://armypubs.army.mil/med/dr_pubs/dr_a/pdf/tbmed4.pdf. Accessed January 10, 2012.

(2.) Army Family ActionPlanpage. US Army OneSource Web site. Available at: https://www.myarmyonesource.com/FamilyProgramsandServices/FamilyPrograms/ ArmyFamilyActionPlan/Default.aspx. Accessed January 10, 2011.

(3.) Office of The Surgeon General. Memorandum: MEDCOM Policy on Use of Canines and Other Service Animals in Army Medicine. Fort Sam Houston, TX: US Army Medical Command; November 9, 2010. OTSG/MEDCOM Policy Memo 10-077.

(4.) Office of The Surgeon General. Memorandum: MEDCOM Policy on Animal-assisted Therapy (AAT)/Animal-assisted Activity (AAA) Dog Utilization in Combat and Operational Stress Control (COSC). Fort Sam Houston, TX: US Army Medical Command; April 2011. OTSG/MEDCOM Policy Memo 11-030.

* Data current as of January 9, 2012. Source: US Army Warrior Transition Command Report.

Author

LCDR Watkins is Chief, Administrative Branch, Behavioral Health Division, Office of The Army Surgeon General, Alexandria, Virginia.

LCDR Kathleen L. Watkins, HSO, USPHS
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