From care homes to classrooms, therapy dogs are making a difference across England, but this new study warns that without clear standards, both people and pets could be at risk.
Study: Dog-assisted interventions to support health and wellbeing: a national survey of current practice in England. Image credit: New Africa/Shutterstock.com
A study published in Frontiers in Public Health explored data on dog-assisted interventions (DAI) from providers in England. DAI is used to help people with mental or physical illness experience better health and well-being. The aim was to gain a detailed picture of which groups are targeted, the structure and content of the intervention, the extent of variation, difficulties during DAI, and how best to select and train suitable dogs and ensure they remain happy and healthy.
Introduction
DAIs form the most common class of animal-assisted interventions (AAIs). They may be classified as dog-assisted therapy (DAT) and dog-assisted activities (DAAs), differentiated by the degree of structuring, goal setting, documentation, and therapist certification.
DAI guidelines have been developed to ensure adherence to safety recommendations. However, the field remains mostly unregulated, and DAI delivery is largely non-standardized. This is a significant research gap, preventing data comparison and sharing, which hinders regulatory policy development and reduces DAI quality.
The current study sought to provide a picture of how DAI is carried out in England and how real-world practices differ from those in research settings. Such data would also make it easier to compare DAI practices across countries, refining best practices and helping to improve evaluation and further development.
Study findings
The study was based on a customized survey developed by academicians, animal welfare organizations, and DAI service providers.
This small sample of 31 DAI providers revealed that DAI was mainly used to help mentally ill or neurodivergent individuals, in non-NHS health and care settings (80.6%), within the National Health Service (32.3% for mental health and 29.0% for physical health services), in educational contexts (41.9%), and in other private healthcare settings (80.6%). DAI was provided across 7,679 institutions, with settings ranging from mental health facilities, care homes or nursing homes, to assisted living facilities, hospices, and physical healthcare centers.
Standardization of DAI
Participants were asked to choose what type of DAI their services most closely resembled: dog-assisted therapy (goal-directed, documented, therapeutic intervention as part of a treatment plan, delivered by specialist-trained dog-handler teams); dog-assisted activities (i.e., activities focused on spontaneous interactions that volunteers and untrained dogs can deliver), both of these types of services; or any other type.
The responses revealed a lack of standardization for DAI therapy. Most sessions were weekly, up to an hour long. Again, most DAI (61%) was made of planned treatment sessions, and just over half (51.6%) also included spontaneous activities.
Individual sessions were the norm (90.3%) rather than group sessions, although over half of providers also ran group sessions with peers. The duration ranged from 1 to 15 weeks, but 58.1% said this varied considerably depending on client needs, with the commonest intervention being 6 to 10 weeks.
Training
Nearly 40% of DAI providers were unclear on whether each session had an individualized goal of promoting mental, emotional, or physical health in specific ways. Spontaneous DAI occurred during community programs, social events, or sports.
About 54.8% of dog handlers were formally trained; most had training in dog wellbeing/safety, risk assessment (94.1% for both), and reading dog body language (88.2%), meaning most trained handlers had these skills. However, there was no standard curriculum for DAI.
About 90% of them used only their own observation to monitor the dog’s welfare, access to basic resources like water, and a safe place to be alone. Fewer than one-third used formal checklists, and only 16.1% relied on veterinary consultations to monitor dog well-being and health.
Other potential training areas included dog obedience or skill training, bonding between the dog and handler, mental health in general, training for specific medical conditions, and safeguarding. Most dogs were trained in basic obedience, to obey their handlers, to greet humans in social environments, and to bond with humans. Crossbreeds were as common as gundogs (48.4% each) among DAI dogs.
Most participants said their organization required them to report unwanted dog behavior or handler injury as part of safeguarding. Other aspects were explored, such as the number of handlers per dog, the hours of DAI interaction expected of the dog, and how often the dog was expected to participate in DAIs. The youngest age for starting work varied from under six months to over two years, and the dog's working life was largely unregulated.
DAI challenges
The biggest challenges included limited access to delivery spaces, the potential risk of introducing infections, and being unable to correctly choose the right dogs for each client, mostly due to temperament mismatches.
Interestingly, temperament was the only criterion all participants used to match dogs to users. Others included health, obedience testing, and other physical or breed-related characteristics. Gundogs were the most selected, but the study also found substantial representation from other breed groups and crossbreeds. The considerable range of dogs involved indicates the need for further research to understand what criteria make dogs most suitable for specific DAI types.
Conclusions
Despite the felt value and widespread use of DAIs in healthcare and educational facilities across England, primarily to assist individuals with mental health challenges or neurodevelopment disorders, DAI planning and delivery remain unregulated. This pilot study attempts to begin to fill the gaps.
The wide variation in DAI delivery reflects differences and gaps in the training and monitoring of handlers and dogs, as well as in defining intervention goals. These gaps leave questions about the safety and effectiveness of DAIs and dog welfare. The impact of DAI on long-term outcomes, by type, structure, and frequency, remains to be studied further.
The authors also note that handler confidence was generally high (average 8.7 out of 10), despite the variation in training. They caution that the small sample size, self-reported data, and limited representativeness mean the results should be interpreted carefully.
“These findings underscore the clear need for standardized good practice guidelines encompassing aspects related to outcome reporting, dog selection and welfare monitoring, and provider training.” This will help develop best practices in this field to maximize its value and impact.
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