The early years.
The use of service dogs for physical disabilities is well established. Therapy dogs are increasingly used in disaster settings. Evolving trends include:
* The expanded use of dogs for wounded Soldiers and other service members and Veterans.
* The use of dogs in the overseas combat theater to assist with combat and operational stress control.
* Therapy dogs to assist with PTSD and other behavioral health issues.
The acceptance of canines in Army medicine and in the civilian world has virtually exploded. As with all innovations, there have been some lessons-learned. This article describes the early use of therapy dogs, both in the theater of war and at the Walter Reed Army Medical Center in Washington, DC. The evolution of current policy initiatives and formalization is detailed in the following article in this issue (see page 8).
Neither this article nor others in this dedicated issue of the AMEDD Journal discuss the use of other animals, such as horses for equine therapy or cats for companionship. Certainly there are valid and evolving therapeutic uses for those animals. However, due to the rapid expansion of interest, effort, and commitment of resources in the employment of dogs, as well as the unquestioned successes of such work, we elected to confine the articles in this issue to that species.
The Beginnings: The First Use of Therapy Dogs in Combat and Operational Stress Control Units
Combat and operational stress control (COSC) teams have been active in the US Army since 1992. They provide education and therapy in the theater of war, emphasizing prevention and seeking to prevent unnecessary evacuation. Easy accessibility to care and reduction of the stigma associated with behavioral/mental health care is a major goal.
In early 2007, the US Army Veterinary Command asked for a consultation from the Behavioral Health Division at the Office of The Army Surgeon General (OTSG). The topic was approval of the deployment of 2 dogs with a combat and operational stress control unit.
Animal-assisted therapy began in the Army in December 2007 when The Acting Surgeon General, MG Gale Pollock, approved the request of the 85th Medical Detachment (COSC) to send 2 dogs to Iraq. The commander of the detachment anticipated that the dogs would provide an element of stress relief unmatched by any human.
The use of dogs with COSC teams seemed like a great idea. Behavioral Health was all for it, initially. Yet there were a significant number of details to be addressed. The most pertinent questions included whether the Army could accept a donation of a dog, how to keep the dog healthy in theater, and how to measure the effectiveness of the intervention. The underlying theme reappears in several of the articles in this issue: "seems like a great idea," but the "devil is in the details."
The donation part was relatively straightforward. Since the dogs were each valued at roughly $25,000, the ethics advisors had to determine that it did not show undue influence on OTSG by the donors. America's VetDogs (Smithtown, NY) donated 2 black Labrador retrievers, SFC Boe and SFC Budge, to the Army. Two occupational therapy assistants traveled from Iraq to New York for dog handling training, and then returned to Iraq with their new charges.
Fortunately, the US military deploys Army veterinarians to ensure the public health and food safety of service members. They also care for other working dogs, such as those working with military police and explosive ordnance disposal. It was, therefore, relatively easy to ensure that the animals entered with a clean bill of health and remained healthy.
Much more difficult was the issue of how to measure effectiveness. How would we, or The Surgeon General, know if the dogs were actually working? It was easy to measure contacts and good press articles, but very hard to measure PTSD symptoms averted, suicides prevented, or marriages saved. Such questions led to some of the research described in articles in this issue.
Another major question was the optimal length of stay for the dogs in theater. No policy had been developed before SFCs Budge and Boe deployed to cover how long they should be there, or what should happen to reintegrate them into a normal environment upon return. Those first dogs ended up in Iraq for 2 deployments, a total of 24 months. The Veterinary Command and the Behavioral Health Division were reluctant to approve more dogs in theater until the details were resolved.
Upon return, the first dogs, SFCs Boe and Budge, went to the Eisenhower Army Medical Center at Fort Gordon, GA, and worked at the Residential Treatment Facility. The clinicians who worked with SFC Boe soon noticed that she seemed to be traumatized by her experience, and consequently might not relate well to Soldiers. After 6 weeks of reconditioning at VetDogs in Smithtown, NY, SFC Boe was returned to Eisenhower without any difficulties and is doing wonderful work with Soldiers with mild traumatic brain injuries. A plan was developed with VetDogs under which they would take the dogs to retrain and recondition them for 6 weeks upon return from deployment. Eventually, the continuing uncertainty about deployment policy resulted in a December 2009 summit of commands, agencies, specialists, and nongovernmental organizations with involvement or interest in such use of therapy dogs (details on page 8 of this issue).
There were other important lessons learned from that first deployment. Like most people, Soldiers want to feed the dogs treats and snacks, and they gained weight. Close attention had to be paid to their diet. The dogs had to be isolated from local feral animals. Other lessons emerged over the next few years. For example, well-intentioned individuals tried to bring in other dogs, often not as well-trained and/or without command approval. Those efforts were most always unsuccessful.
Consequently, it was very hard to persuade the command in Afghanistan to accept dogs. They were also worried about the potential for disease transmission, especially rabies, which is a serious problem there. Eventually, the command was persuaded, and in June 2010, 2 dogs were allowed into theater with the 212th Medical Detachment (COSC). As of this writing, both are still in Afghanistan.
The First Use of Dogs at The Walter Reed Army Medical Center
Several occupational therapists at the Walter Reed Army Medical Center (WRAMC) brought their personal dogs to work with the Wounded Warriors. They were an instant success. Wounded Warriors who were very tired of all the human attention and had withdrawn responded very well to the touch of an animal.
Predictably, there were also issues that developed concerning policies related to the use of animals at WRAMC. Again, there were unanticipated wrinkles. For example, there was no good way to screen all animals entering WRAMC to ensure that they were well-trained service animals, rather than simply a "pet in a vest." Another concern was about the potential transmission of disease, specifically methicillin resistant staphylococcus aureus. However, the Commander, WRAMC was sympathetic to the use of canines, so the Occupational Therapy Department developed policies for the use of animals. One result was an internal policy that service animals should not be issued until a service member was ready to move off post to other housing. That made sense, as someone would have to care for the dog if the service member was still undergoing surgeries or other therapies.
A major internal debate was the level of training that service or therapy dogs should receive. The early service dogs received about 2 years of training, which made them very expensive, between $25,000 and $50,000 per animal. Some advocates claimed that dogs could be trained by their service member handlers, at much less expense. The Warrior Transition Brigade Service Dog Training Program, described later in this issue (see page 58) used rigorous methods to teach service members how to train service dogs. Still, there are proponents of much less training. At present, there are no studies available to address this question.
Benefit of Dogs in Decreasing PTSD Symptoms
Meanwhile, anecdotal examples of psychological benefits continue to be documented, and are discussed in other articles in this issue. In the authors' visits to Vet-Dogs and the National Education for Assistance Dog Services, we heard statements such as:
I used to take five different medications for my PTSD. Now I take two. I could not be in malls or other crowded places. Now, with my dog, I can tolerate them, knowing he will rescue me. When my husband returned from Iraq, he was a jerk. Since we got our dog, we have reunited as a family. When I have a nightmare, he puts his muzzle into my face, and the nightmare stops.
We also heard a number of accounts about dogs who allegedly could abort seizures, ie, "my dog senses when a seizure is about to come on, and his touch stops it."
Personal accounts are compelling, but not usable as a basis for designing protocols or justifying the commitment of resources. There is a need for scientific data to more fully understand how the human-animal bond can continue to help our service members. Medical science professionals are moving to use evidence-based and evidence-informed research to develop practice guidelines, such as those in planning at the National Intrepid Center of Excellence in Bethesda, Maryland. This issue of the AMEDD Journal presents the beginnings of this body of knowledge.
There were many in the Army Medical Department who contributed to these efforts. Specifically, we would like to acknowledge LTG (Ret) Eric Schoomacher, MG (Ret) Gale Pollack, BG (Ret) Tim Adams, COL (Ret) Gary Vroegindewey, MAJ (Ret) Stacie Caswell, and Mr Herb Coley.
COL (Ret) Ritchie is the Chief Clinical Officer, District of Columbia Department of Mental Health, Washington, DC.
COL Amaker is the Assistant Chief, Army Medical Specialist Corps and Occupational Therapy Consultant to The Army Surgeon General. She is also Director and Associate Professor in the Doctor of Science in Occupational Therapy program, US Army Medical Department Graduate School, Fort Sam Houston, Texas.
COL (Ret) Elspeth C. Ritchie, MC, USA
COL Robinette J. Amaker, SP, USA
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|Author:||Ritchie, Elspeth C.; Amaker, Robinette J.|
|Publication:||U.S. Army Medical Department Journal|
|Date:||Apr 1, 2012|
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