An Evaluation of Canine-Assisted Therapy at Our Lady of Peace Hospital / Childrens Peace Center

By Brian Mitchell EDTECH 505-4172 Summer, 2011 Dr. Ross Perkins August 1, 2011

OLOP Canine-Assisted Therapy Evaluation

Table of Contents: Learning Reflection ___________________________________________________ Executive Summary _____________________________________________________ Purpose _______________________________________________________________ Background ___________________________________________________________ Evaluation Design ______________________________________________________ Results ________________________________________________________________ Discussion _____________________________________________________________ Conclusion & Recommendations __________________________________________ Appendices Appendix A. Appendix B. Appendix C. Appendix D. Appendix E. 3 4 5 6 9 10 17 18

Evaluators Program Description _________________________ Evaluation Timeline ____________________________________ Patient Survey ________________________________________ Staff Survey __________________________________________ References ___________________________________________

19 20 21 24 28

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Learning Reflection Before taking this class, I thought that I already knew a lot about the process of evaluation. In some cases, there was a lot that I did already know. However, what I have learned more than anything is how informal my knowledge of evaluation really was. To me, the data collection and analysis were the entire process. Now I realize that there are so many more parts to a good, formal evaluation. I have learned that evaluation is almost a hybrid between research and instructional design. A good evaluation will have many of the same characteristics that an instructional design will have. This includes things like learner, audience, or stakeholder descriptions, objectives, etc. At the same time, a good evaluation will have many of the same things as a research project, like results, discussion, conclusion, etc. During the process of conducting this evaluation, one of the things I discovered is how important it is to narrow the focus of the evaluation. There are so many different aspects to a program and so many different ways and types of data gathering that it can quickly become a massive undertaking. A good focus will help keep the evaluation on task and to look only at those things sought by the person or organization requesting the evaluation. In the process of this evaluation, I realized that my focus was far too broad, and thus the results are a little more scattered than they should be. I discovered that my favorite part of the evaluation process is probably the least favorite of many people. That is the collection and analysis of data. Of course, this entire process is made so much easier by the modern tools available, like online surveys and the data analysis tools of modern spreadsheets. Regardless, I take great fascination in taking what seems like a series of disjointed responses and looking for the patterns that emerge from the data to form a cohesive set of results. In reality, I am not sure how often I will go through a formal evaluation process quite as extensively as we have in this project. Most of the evaluations I will be doing call for a far less formal procedure. However, it is good to know that when it comes to evaluating a major program for an organization that expects a formalized report, I will have the skills and knowledge necessary to give them what they want.

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OLOP Canine-Assisted Therapy Evaluation

Executive Summary The current animal-assisted therapy program at Our Lady of Peace has been in place for about three months. Right now, there is only one dog participating. Her name is Lucy, and she is the pet of a units Program Coordinator. While Lucy does spend most of her time on that unit, she does travel around to others, as well. Right now Lucy comes about 1-2 times per week, but there is no regular schedule to her visits. The goal of this survey is to evaluate the effectiveness of Lucys interactions on patient care. Surveys were done with 28 patients and 8 staff members. The surveys dealt primarily with rating scales regarding the participants impressions of Lucy and her effects on the patients. The staff surveys were more complex and included more questions than the patient surveys. The results of the evaluation show that the program seems to be a great success. Patients and staff alike noticed improvements in the happiness and stress levels of the patients when Lucy is around. There are mixed results on whether Lucy helps improve patient relationships or gets them to share more. However, the patients seem to have a great love and fondness for Lucy, which in itself has a strong therapeutic effect that the staff did notice. There is a bit of tension, because one of the staff members is afraid of dogs. This has caused some problems in the work environment. However, even the staff member acknowledges the benefits to the patients and said that he/she is able to avoid Lucy when needed. There seems to be a consensus among patients and staff that it would be nice if Lucy could come more often and on a more regular schedule. This is something that should be worked out. The success of this program also warrants an investigation into a possible expansion of the program with more dogs and units. This is something that could be investigated with WAGS.

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Purpose This evaluation is being conducted at the request of a Program Coordinator in one of the long-term care units of Our Lady of Peace. Animal-assisted therapy has been used in the past in the hospital. However, this is the first time that a dog belonging to someone in programming management is being used on a regular and long-term basis. The coordinator requesting the evaluation is the owner of the dog being used for the therapy. She wishes to analyze the success of the program to this point, both in the interest of improving it and in the interest of recording the results of the program for hospital management. In an effort to provide full disclosure from myself, as the impartial evaluator, it should be noted that the coordinator of the program is also my wife. However, there is no conflict of interest, since her job is not dependent on the success of the pet therapy program. Thus, I have no vested interest in whether the program continues or not. The goal of this evaluation is to determine the extent to which this program of canine interaction in the long-term inpatient psychiatric treatment of adolescents is effective as a therapeutic tool. As discussed later in this report, there is a wealth of academic research in the field of animal-assisted therapy (AAT), so the effectiveness of such interaction, in a general sense, is already well-documented. However, the long-term care units at Our Lady of Peace present a unique environment for the use of this therapy. This evaluation will look at how well the therapy works with the children in this setting, who have a wide variety of physiological, mental, emotional, and social issues. This evaluation will also be used to look for ways the use of canine-assisted therapy can be improved in this setting. Specifically addressed will be the schedule and frequency of interaction, the effects on patients and staff, and whether the program should be expanded to other units or with more animals. The goal of any program at a hospital like Our Lady of Peace is ultimately what is best for those in treatment. Thus, this evaluation will pay particular attention to the effects on the patients. However, staff impressions are also important, in the interest of creating a safe and peaceful work environment and in the interest of their ability to provide the best care for the patients. Finally, this evaluation will look at the welfare of the dog in question. It is important that this activity be a safe an enjoyable undertaking for the dog, since a dog that doesnt enjoy this type of interaction could potentially have negative therapeutic effects. It is also important to look at whether this type of program produces positive health results for the dog.

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Background

Program Origin and Rationale Our Lady of Peace, a division of Jewish Hospital and St. Marys Health Care, is one of the largest, private non-profit psychiatric hospitals in the United States. The hospital treats a wide range of emotional, behavioral, and psychiatric disorders, and also chemical dependency. While both adults and children receive treatment, the majority of the hospital is comprised of the Childrens Peace Center, which specializes in the treatment of children. Animal-assisted therapy (AAT) has been shown to have tremendous benefits in the treatment of psychiatric patients, especially with children. Friesen (2010) points to the work of Boris Levinson, who in 1969 found that a therapy dog acted as a social lubricant between the therapist and the child, which allowed for a more relaxed environment conducive to selfdisclosure (p. 262). Friesen also points out a 1997 study by Limond, et al. which found that students tend to be more attentive, more responsive, and more cooperative with an adult when a dog is present. He goes on to cite other studies which showed that children have experienced increased alertness and attention span, and an enhanced openness and desire for social contact. Finally, Friesen discusses how children have an acceptance of dogs because they perceive the animals to be nonjudgemental (Friesen, 2010, p. 262). Brodie and Biley (1999) also point out some of the benefits of AAT. They cite a 1985 study by Francis et al. that found work with animals to reduce depression (p. 330). They go on to cite examples of studies that found AAT to decrease stress and loneliness and strengthen relational bonds. They also cite a 1981 study by Katcher which showed decreased blood pressure as a result of AAT (p. 331). Lastly, they refer to a similar study by Baun, et al. which showed that a larger reduction in blood pressure resulted from interacting with a dog with which a bond has form, over one with no bond (p. 331). That is just a small sampling of a wealth of research regarding the therapeutic benefits gained from AAT. It is clear that the research does support the benefits of having a canine therapy program in place. The Baun study also supports the notion of having the same dog come repeatedly, so that patients may form a relationship with it, thus increasing the therapeutic effects.

Program Goals and Standards The animal-assisted therapy program at Our Lady of Peace is operated in conjunction with Wonderful Animals Giving Support (W.A.G.S.). Dogs and their owners go through an extensive training program and must past a rigorous evaluation before being certified. The training and evaluation insure that the dogs obey basic obedience commands, are approachable and friendly,

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and show no signs of aggression. Their handlers must also be evaluated to be sure they have complete control of the dog and that treat the dog properly. The dog and handler must then go through a mentored visit at a health facility as the final stage of their evaluation. Only dogs certified as therapy dogs are permitted to work with the patients. The animal-assisted therapy program at Our Lady of Peace has the following goals: To improve the patient relationships with staff and with each other To improve patient self-esteem To promote empathy in the patients To decrease stress levels in the patients To help patients learn to handle stress in a healthy manner To help patients learn to have trust for others To help patients feel more comfortable sharing personal feelings To give the patients a healthy avenue of enjoyment To improve the experience of hospitalization by giving the patients something to look forward to To insure the health, safety, happiness, and well-being of the therapy dog

Previous Programs Animal-assisted therapy is not new to the hospital. However, with past programs, the animals would just visit on a periodic basis, around once a month. The animals were brought by volunteers from the WAGS program. With the current program, the dog is brought once or more per week by a licensed social worker employed at the hospital who has expertise in therapy and an established relationship with the patients. While the previous program was successful, in order to get the most benefit, staff concluded that the interaction with patients needed to take place on a more regular basis. The fact that the volunteers who brought the animals had no developed relationship with the patients also inhibited the therapeutic effects of the visits.

Program Participants In the WAGS program, only the certified handler is allowed to be in charge of the dog while it is interacting with patients, and that handler must be in complete control of the dog at all times. In this case, the handler is also the units Program Coordinator and a licensed social worker and recreational therapist. Other staff do interact with the dog, but in incidental ways. The patients at Our Lady of Peace who participate in the animal-assisted therapy program range in age from nine to seventeen years old. They are all hospitalized in the inpatient longterm care program. They have a variety of diagnosed mental health issues. The problems with which they struggle include alcohol and drug abuse, aggression issues towards themselves,

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others, or property, victims and/or perpetrators of physical, sexual, or animal abuse, autism, and victims of neglect. Many of the patients have issues relating to others in healthy ways. Because most private health insurance plans have very limited mental health coverage, a large number of the patients have been signed over as wards of the state by their parents. This allows them to be eligible for government health coverage. The therapy dog, Lucy, works with patients in several different units, including those with autism and those in the forensic units, which means that they have histories of being violent.

Program Description The therapy dog, Lucy, is brought to the hospital at least once a week and most weeks she is there two or three times. She was certified in April, 2011, which means she has been working with the patients for approximately three months. The days and frequency that Lucy comes to the hospital is dependent upon the school and programming schedule and activities for any given week. Lucy visits several units on each visit, including the standard long-term care units, the autism units, and the forensic units, which house patients with histories violence. Lucys visits with patients includes them physically and socially interacting with her in a small group setting. The patients work with her to do tricks and try to teach her new ones. There is also lots of time for them to interact with her through petting and playing. Lucy will sometimes interact with the patients during their process groups. These are small group settings which help the patients examine and discuss the decisions they make and the ways they interact with others. Often, the therapist will frame discussions to include Lucy in an effort to help the patients share or relate better.

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Evaluation Design While the AAT program being evaluated here does indeed have some stated objectives, the short time frame of this evaluation and the unquantifiable nature of the objectives make a goalbased evaluation model difficult or impossible. Therefore, this particular evaluation is better suited to the systems analysis model (Boulmetis & Dutwin, 2005, p. 90). The systems analysis model looks at the program as a whole, including the impact on the patients, the impact on the staff, the resources involved with operating the program, and the overall benefit of the program, as a result of the above impacts. In order to accomplish this, surveys were created for both staff and patients. Both surveys consisted primarily of quantitative questions of scale regarding the respondents impressions and satisfaction with the program. Questions of scale in terms of agreement with certain benefits of the program were also included. Finally, there were opportunities for the respondents to add their own comments about both the dog and the program as a whole. The staff surveys were more involved and included questions about their experience with AAT, their knowledge of research in the field, and their impressions of the therapeutic effects on the patients. There were also some questions about staff satisfaction with the program. Patient surveys asked many of the same questions, but framed them in the first person and simplified the language to make them easier to understand. This was necessary both because of the ages of the respondents and because of their generally lower intelligence levels. In terms of both patients and staff, surveys were the only realistic way to collect data. A psychiatric hospital, especially one with children, has strict privacy and security measures in place, making it nearly impossible for an outsider to enter the units and question either staff or patients in an interview setting. The surveys were distributed by the program coordinator to both staff and patients. She then collected them after they finished. An interview with the coordinator was also conducted in order to clarify some of the hospital, treatment, and AAT program information. She was also questioned regarding the patient surveys and their ability to accurately answer the questions and/or to be able to take the survey seriously. She clarified some of the answers that were reported by both staff and patients. The surveys were to be anonymous, but several of the patients and even a few of the staff chose to identify themselves. During the data analysis, this information was ignored. Finally, in order to evaluate the health and well-being of the therapy dog, a physical exam by the dogs veterinarian was conducted three months into the program. The dog was also required to undergo an exam in order to be certified for the program. So the two examinations were compared in an effort to evaluate the impact of the program on the dogs health.

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Results Patients
Interacting with Lucy

Increases Happiness
0% 7% 4% 7% 5 - Agree 4 3 2 1 - Disagree 82%

Reduces Stress
0% 0% 7% 18% 5 - Agree 4 3 2 75% 1 - Disagree

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Improves My Relationships
11% 7% 11% 46% 5 - Agree 4 3 2 1 - Disagree 25%

Improves My Coping Skills

7% 4% 7% 5 - Agree 4 11% 3 2 71% 1 - Disagree

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Makes Me More Open to Sharing

4% 7% 5 - Agree 4 50% 29% 3 2 1 - Disagree

11%

Makes This a Better Place

0% 11% 11% 4% 5 - Agree 4 3 2 75% 1 - Disagree

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Staff
Lucys interactions with patients

Makes them happier

0% 13% 5 - Agree 4 3 2 1 - Disagree 88% 0% 0%

Decreases their stress

0% 13% 5 - Agree 13% 50% 4 3 2 25% 1 - Disagree

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Makes them more cooperative with staff

5 - Agree 38% 4 3 2 25% 13% 0% 1 - Disagree

25%

Makes them more cooperative with each other

0% 13% 38% 5 - Agree 4 3 38% 13% 2 1 - Disagree

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Has a positive therapeutic effect

0% 0%

5 - Agree 38% 4 3 63% 0% 2 1 - Disagree

Makes them more open to sharing personal feelings

0% 5 - Agree 38% 38% 4 3 2 13% 13% 1 - Disagree

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Lucys presence has had a

Positive effect on patient environment

0% 0% 13% 5 - Agree 4 25% 63% 3 2 1 - Disagree

Positive effect on work environment

5 - Agree 38% 50% 4 3 2 13% 0% 0% 1 - Disagree

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Dog Welfare
After having Lucy inspected by the vet, it seems that the only real concern is weight gain. She has gained several pounds since the program began. This seems to be the result of the number of treats Lucy gets when doing tricks at work. Lucy also seems greatly fatigued when she finishes the day. This is also something to consider. Overall, Lucy seems to look forward to going to the hospital and also seems to really enjoy her experience there.

Discussion There seems to be an overwhelmingly positive response to Lucys work as a therapy dog. This is especially true among the patients. Over and over again, the patients commented on how much they love Lucy and how happy she makes them. A large majority of patients and staff alike said that Lucy makes the patients happier and reduces their stress. The majority of the staff also thinks the program produces a positive therapeutic effect. A majority of both groups also said that Lucys presence makes for a better environment for the patients. When it comes to other benefits, both the staff and patients presented mixed views as to whether or not Lucys work makes the patients more cooperative with each other or with staff. There were also mixed results among the staff about whether the program makes the patients more willing to share their feelings. However, half of the patients said that they feel more comfortable sharing. The only real negative result came from the staff. One staff member indicated that he/she has a large fear of dogs, and it has caused some problems in the workplace. Several other staff members commented on the tension resulting from this. However, the same staff member also said that he/she does not have contact with Lucy, because she avoids her whenever possible. This staff member also acknowledged the positive benefits for the patients. Several questioned why Lucy couldnt come on days when the staff member was off work. However, in questioning the program coordinator, there is only one day every other week when that happens. Comments from both sides expressed interest in having Lucy come to the hospital more often. Most of the staff were glowing in their comments. There were things said like, Lucy gives them hope, because they look forward to her coming. Several commented on how happy Lucy makes the patients and how much they look forward to her coming.

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Conclusions & Recommendations

Immediate Conclusions I think that the program has been an overwhelming success. The survey results have very strong things to say about Lucy and the program. My suggestion would be to come up with a regular schedule of 2-3 days per week for Lucy to come. Both kids and most staff suggested that she come more often. The tension caused by the staff members fear is a concern. It doesnt seem reasonable to only bring Lucy once every other week, when most think that she should come more than once a week. My recommendation would be work out a schedule of when Lucy will be there, so that the staff member always knows and can avoid her. It is an unfortunate situation, but the benefits to the patients, which should be the most important consideration seem to far outweigh the fear of one person. This is especially true when that person is able to avoid contact with Lucy. It might also be helpful to visit other units on certain days when that staff member is around. As far as Lucys health is concerned, it might be helpful to try to use more verbal and physical praise as a reward, rather than treats. If that doesnt work, and no healthier treats can be found, then her food ration on days that she works should be cut back, in order to maintain a healthy weight. As far as fatigue, it would be good to try to stagger the days, so she has at least one day of rest in between her work days. Long-Range Planning Because the program seems to be such a great success, it seems that the hospital would benefit from an expansion of the program. The coordinator might consider talking to WAGS to see if more dogs could visit the hospital on a regular basis. Because of the documented benefits of a developed relationship with the dogs, it might also be good to get word out to other employees with dogs to go through the WAGS program to be certified. Then they, too could bring their dogs in to work. OLOP is a huge hospital, with a lot of units. It would be almost impossible to have too many dogs for a program like this. It would be ideal if each unit could have its own dog that visited on a regular basis. This would take some coordination with WAGS and would probably require other dogs to go through the program. Evaluation Insights The biggest thing that would have improved this evaluation is more time. It would have been nice if more staff and patients could be surveyed. It would also be better to compare data from different units. Most of the data here came from the primary unit where Lucy works. If there were a way to do personal interviews with the staff, this would also have improved the results. I realize that doing so with patients would be impossible, but there is no reason that it could not be done with staff. I think the evaluation could have also benefited from narrowing its focus. There were too many immeasurable objectives. It would have been better to narrow those down into something more quantifiable. Overall, I think the evaluation went very well and yielded some valuable results.
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Appendices Appendix A Evaluators Program Description This evaluation will look at a newly implemented pet therapy program at a psychiatric hospital in Louisville, KY. The program has been instituted in a residential unit for children. Right now, there is only one dog being used in the program. The dog is certified by a pet therapy organization (WAGS). It is used in group and individual therapy sessions and is under the control of a Program Coordinator who is a certified social worker and recreational therapist. Evaluation Questions 1. 2. 3. 4. Is this program an effective therapy tool? What are the therapeutic benefits to this program? Are there any risks or problems associated with a dog in a hospital setting? Is the dog being used in the most effective and efficient way possible?

Stakeholders

Patients receiving therapy with the dog Staff who interact with/care for the dog The dog being used Staff who have no direct interaction with the dog but work in the units where the dog is being used Patients who have no direct interaction with the dog but are in the same units where the dog is being used Hospital management WAGS staff who helped train and certify the dog Data Collection Data will be collected through surveys and personal interviews. The majority of the data will be qualitative, in the interest of determining the effectiveness of the program. There will be some quantitative data collected in regard to the amount of time the dog is used, number of patients and staff involved, etc. Challenges Data collection from patients will be the primary challenge. Many of the patients have diagnosed social disorders, meaning they may not have the emotional capacity, intellect, or truthfulness to give an accurate assessment of the program. However, the high training level of the staff that allows them to give accurate assessments of therapeutic benefits will help to offset this challenge. The program itself has a challenge, mainly in the form of one staff member who has an extreme phobia of dogs.

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Appendix B Evaluation Timeline

Date(s) 6/29/2011 6/30/2011 7/3 - 7/9 7/10 - 7/13 7/14/2011 7/15/2011 7/16 - 7/20 7/21 - 7/24 7/25 - 7/28 7/29 - 7/31 8/1/2011

Task Meet with program coordinator to discuss EPD and program and evaluation needs Revise Evaluation questions and EPD Conduct academic and medical research on pet therapy Create survey and interview questions Discuss surveys with program coordinator Revise surveys and interview questions Program coordinator distributes surveys and conducts interviews (privacy policies do not allow evaluator to enter units) Data analysis Report draft writing Report revision Report Due

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Appendix C Patient Survey

Our Lady of Peace / Childrens Peace Center Pet Therapy Survey - Patients
Please take a few minutes to fill out this survey on the effectiveness of pet therapy, based on your experience with Lucy. We welcome your feedback and your answers will be anonymous and kept confidential. Thank you for your participation.
How do you feel about dogs in general? 1 Bad Have you ever owned a pet? Dog Cat Other None 2 3 4 5 Good

How has Lucy affected your feelings about dogs? 1 Made worse 2 3 4 5 Improved

What is your general feeling about Lucy? 1 Poor 2 3 4 5 Excellent

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Please indicate how much you agree or disagree with the following:
When Im around Lucy, I feel happier 1 Disagree Lucy makes me feel more relaxed 1 Disagree 2 3 4 5 Agree 2 3 4 5 Agree

Lucy helps me to get along better with others 1 Disagree 2 3 4 5 Agree

I feel like having Lucy around helps me cope with my problems better 1 Disagree 2 3 4 5 Agree

Lucy helps me feel more comfortable sharing how I feel 1 Disagree 2 3 4 5 Agree

Having Lucy around makes this a better place 1 Disagree 2 3 4 5 Agree

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Additional Feedback
Are there any other good things you would like to say about Lucy? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Are there any negative things you would like to say about Lucy? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Is there anything you would do to improve Lucys work or the pet therapy program? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Do you have any other comments about your experience with Lucy or pet therapy in general? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________

Thank you for taking the time to fill out our survey. We rely on your feedback to help us improve our services. Your input is greatly appreciated.

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Appendix D Staff Survey

Our Lady of Peace / Childrens Peace Center Pet Therapy Survey - Staff
Please take a few minutes to fill out this survey on the effectiveness of pet therapy, based on your experience with Lucy. We welcome your feedback and your answers will be anonymous and kept confidential. Thank you for your participation.
What is your age range? 18-29 30-39 40-49 50-59 60+

What is your highest level of education? High School Some College Associate or similar degree Bachelor or similar degree Graduate degree

What is your impression of dogs in general? 1 Unfavorable Do you have a pet at home? Dog Cat Other None 2 3 4 5 Favorable

How has Lucy affected your impression of dogs? 1 Negative Effect 2 3 4 5 Positive Effect

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Prior to your experience with Lucy, what was your awareness of pet therapy? Never heard of it Passing knowledge Slightly experienced Very experienced

What is your knowledge of pet therapy research? 1 None 2 3 4 5 Extensive Knowledge

How often do you directly interact with Lucy? Never Monthly Several times a month Weekly Several times a week

What is your general impression of Lucy? 1 Poor 2 3 4 5 Highly Favorable

What is your general impression of Lucys interaction with patients and staff? 1 Poor 2 3 4 5 Highly Favorable

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Please indicate how much you agree or disagree with the following:
Lucys interaction with patients makes them happier 1 Disagree 2 3 4 5 Agree

Lucys interaction with patients decreases their stress level 1 Disagree 2 3 4 5 Agree

Lucys interaction with patients makes them more cooperative with staff 1 Disagree 2 3 4 5 Agree

Lucys interaction with patients makes more cooperative with other patients 1 Disagree 2 3 4 5 Agree

Lucys interaction with patients has a positive therapeutic effect 1 Disagree 2 3 4 5 Agree

Lucys interaction with patients makes them more open to sharing personal feelings 1 Disagree 2 3 4 5 Agree

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Lucys presence has had a positive effect on patient environment 1 Disagree 2 3 4 5 Agree

Lucys presence has had a positive effect on staff working environment 1 Disagree 2 3 4 5 Agree

Additional Feedback
Are there any other positive effects you have noticed from Lucys therapy work? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Are there any negative effects you have noticed from Lucys therapy work? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Is there anything you would do to improve Lucys work or the pet therapy program? _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Do you have any other comments about your experience with Lucy or pet therapy in general? _______________________________________________________________________________

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_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________

Thank you for taking the time to fill out our survey. We rely on your feedback to help us improve our services. Your input is greatly appreciated.

Appendix E References Boulmetis, J. & Dutwin, P. (2005). The ABCs of Evaluation: Timeless Techniques for Program and Project Managers. San Francisco, CA: John Wiley & Sons, Inc. Brodie, S. J. & Biley, F. C.. (1999). An exploration of the potential benefits of pet-facilitated therapy. Journal of Clinical Nursing, 8(4), 329-337. doi:10.1046/j.1365-2702.1999.00255.x Friesen, L. (2010). Exploring Animal-Assisted Programs with Children in School and Therapeutic Contexts. Early Childhood Education Journal, 37(4), 261-267. doi:10.1007/s10643009-0349-5 Jalongo, M., Astorino, T., & Bomboy, N. (2004). Canine Visitors: The Influence of Therapy Dogs on Young Children's Learning and Well-Being in Classrooms and Hospitals. Early Childhood Education Journal, 32(1), 9-16. Retrieved from EBSCOhost.

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