The scope of occupational therapy in assessment and referral for assistance dogs:

Dr Jessica Hill, Lecturer in Occupational Therapy, The University of Queensland

Claire Dickson, Occupational Therapist, Assistance Dogs Australia

Nat O’Neill, Occupational Therapist, Team Leader of Autism Assistance Dogs, Kites Therapy

Although assistance dogs have been around since the First World War, the introduction of the National Disability Insurance Scheme (NDIS) has resulted in a rapid increase of interest in, and demand for, assistance dogs to increase the independence and occupational performance of people with disability (Iong et al., 2021). Occupational therapists are increasingly being asked to complete assessments and funding applications for clients seeking assistance dogs. Minimal education on the occupational therapy role related to assistance dogs is currently provided at a tertiary level or offered in professional development courses or mentorship post-graduation (Hill et al., 2023). Occupational therapists consistently report that they lack confidence in clinical reasoning when supporting clients to obtain and care for assistance dogs (Chan et al., 2021; Hill et al., 2023; Iong et al., 2021).

The NDIS requires an assessment and report from a relevant allied health professional to confirm a client’s need for an assistance dog. It is imperative that occupational therapists have adequate education prior to assessing for and recommending an assistance dog to ensure they work within their scope to provide effective services to clients (Chan et al., 2021; Hill et al., 2023; Iong et al., 2021).

Definition of an assistance dog

Therapists must have a clear understanding of the difference between an assistance dog, therapy dog and companion dog. Under Australian Law, the rights of assistance dogs and handlers are protected under Section 9 of the Disability Discrimination Act 1992 that cites the legal definition of an assistance dog as a dog that: a) is accredited under a State or Territory law to assist a person with a disability to alleviate the effects of disability; or b) is accredited by an animal training organisation prescribed in the regulations; or c) is trained to assist a person with a disability to alleviate the effect of the disability and meets standards of hygiene and behaviour that are appropriate for an animal in a public space (Australian Human Rights Commission, n.d.). The National Disability Insurance Agency (NDIA), states that to be funded by the NDIS, an assistance dog must be “trained to perform at least three tasks or behaviours which mitigate the effects of a person’s disability.” (National Disability Insurance Agency, 2023).

In Australia, types of assistance dogs include guide, hearing, psychiatric, autism, physical, and medical alert. The NDIS website states they may fund guide and hearing dogs, as well as assistance dogs to support an individual with a physical disability and some participants with post-traumatic stress (National Disability Insurance Agency, 2023). The NDIA states that as there is limited available research demonstrating that medical alert and autism assistance dogs are more effective than other forms of support, these applications are unlikely to be approved (National Disability Insurance Agency, 2023).

A therapy dog is trained to work with a health professional handler to support client motivation and engagement in sessions (Hill, 2020). Therapists who involve trained therapy dogs in their practice require additional training and continuing professional development. A therapy dog, by definition, cannot be placed with an individual client.

The terms companion and emotional support dog are used to describe a pet dog that provides emotional and informal support to their owner (Howell, 2019).

Although the NDIA recognises the benefits of pets, including companionship, increased social interaction, physical activity, wellbeing, and quality of life (Meredith et al., 2022), they will not be funded by the NDIA. Therapist understanding and correct use of terminology when providing information to clients and writing reports is essential.

In Australia, assistance dogs can be ‘organisation trained’, for example Guide Dogs Queensland, or Assistance Dogs Australia, which means dogs are whelped, trained, assessed, and placed by an organisation. Or ‘owner trained’ which involves a person purchasing a dog and working directly with an assistance dog trainer, then completing a public access test externally (Hill et al., 2023). There are several considerations that must be made when working with clients to determine how to access an assistance dog.

If considering an owner trained assistance dog, the therapist must consider how to access an appropriately qualified/skilled dog trainer, the capacity of the client to train their dog, and the ability of the dog to perform the specific tasks required of the client (e.g., breed size, individual dog temperament, energy level, motivation). Organisation trained dogs may have long waitlists and high cost, whilst handlers working directly with an assistance dog trainer are typically charged per hour, with the additional fee for completing the public access test (Hill et al., 2023).

As the assistance dog organisation or trainer must provide the client with support for the life of their assistance dog, finding the right provider is essential. The Australian assistance dog training industry is unregulated, resulting in underqualified trainers placing clients at risk (Hill et al., 2023). Therapists must have enough knowledge of the industry to advocate for clients and ensure referral to appropriately qualified services (e.g., Guide, Hearing and Assistance Dogs Act, 2009). If a client decides to owner train, therapists must educate clients about the possibility that their dog may fail a public access test. This can be extremely disappointing for clients and therapists need to support clients to manage expectations and disappointment.

The process of suitability assessment is complex, multifaceted and requires a thorough understanding of the person, their environments, and the daily occupations in which the assistance dog has been proposed to support (Hill et al., 2023). It is important that therapists seek education and guidance. Assistance dogs have public access rights as they support a person to access the community. If your client does not require support in the community then they may not need an assistance dog (Howell, 2019). An assistance dog should never be considered as the first form of support, nor should it be the only form of support. If considering an assistance dog for a client, therapists must first trial and/or implement evidence-based supports including therapy, equipment, or assistive technology (National Disability Insurance Agency, 2023).

Animal health and wellbeing is paramount. Therapists must consider a client’s capacity to care for an assistance dog including provision of a safe home environment, feeding, grooming, exercise, enrichment, on-going training, and cost of food, veterinary care, and equipment (Animal Therapies Ltd, 2021). Although the NDIS state they may provide funding for on-going maintenance costs, this is not guaranteed, and additional unexpected costs such as veterinarian bills must be considered (National Disability Insurance Agency, 2023).

A funding request report should be completed collaboratively with an appropriately qualified assistance dog trainer/provider and therapists must have understanding of the following: the specific tasks different types of assistance dogs perform and how the support provided by an assistance dog differs from the support provided by a pet, if and how an assistance dog can be trained to perform the identified support tasks and specific and realistic tasks the assistance dog will perform to mitigate the effects of the person’s disability (Hill et al., 2023).

Continued next page