“The veteran population is close to my heart,” says Kelsie Fournier, OTD ’21. She is one of two Doctor of Occupational Therapy (OTD) students who chose to explore how working with animals can help veterans recover from post-traumatic stress disorder (PTSD) and other issues. Dr. Fournier worked with veterans and service dogs, while her classmate Collin Cooper, OTD ’21, worked with veterans and equine-assisted therapy. Both are graduates from the Spring 2021 cohort on the San Marcos, California, campus. (Their choice of similar topics was coincidental, but they were able to share information with each other.)
Veterans and Service Dogs
When a close friend of Dr. Fournier returned from a tour of duty in Iraq, he suffered flashbacks from PTSD. “He got a dog and it really helped him,” she says. So for her OTD capstone project, Dr. Fournier chose to investigate how occupational therapists (OTs) can be part of the process of matching service dogs and their veteran handlers—an area where little to no previous research had been done.
Dr. Fournier explains that service dogs can be task-trained to alleviate disabilities. For anxiety, they can block the handler from a crowd, such as from others in line at a grocery store. Or they can sense when the handler is having an anxiety attack and will climb into their lap and do a kind of pressure massage. They can also retrieve medication and other objects.
However, getting the match right can be challenging. According to one study, more than one-third of service dogs don’t work out in their initial placement, which suggests inadequacies in the matching process. Dr. Fournier saw a role for OTs, thanks to their training in assessing clients’ personal factors, environments, occupations, routines, and goals.
For her capstone project, Dr. Fournier had intended to work directly with veterans and their dogs, but pandemic-related shutdowns scuttled those plans and she had to gather information remotely. She interviewed staff at two Southern California assistance dog organizations, Canine Support Teams and Mobility Service Dogs – West Coast Project. She sat in on virtual “puppy meet ups,” where handlers ask their peers questions and discuss challenges. As her main source of original data, she conducted an online survey of veteran dog handlers and spoke at length with two participants, both women in their 20s who had PTSD that impacted their work and daily activities and who had been handling service dogs for some time. (She kept their identities anonymous.)
“My life has just been so much better.”
Participant A said that when she left the military, she was being treated for PTSD with therapy and medications but felt no relief. She set out to get a service dog, but the first facility she worked with did not conduct an interview to determine her needs for breed, type, or tasks. “They really just threw this dog at me and were like, ‘here is a dog,’” she says. The placement did not work out, and she tried again with a different facility. This match stuck. “Now my life has just been so much better,” she says. Her dog gives her a sense of purpose and creates routines for her to follow, providing structure to the day.
Participant B said that before she was matched with her service dog, “I was completely isolated; I only went to work and stayed home.” Now she has several hobbies associated with her dog, and this has benefited her mental health and social life. Recently, her dog accompanied her while she attended a community-based rehabilitation program. “Having her there was really good for me,” she says. “I can’t imagine doing anything without her these days.”
The Role of OTs
Dr. Fournier concluded that OTs have a valuable role to play both before and after the match. OTs can:
- Evaluate the prospective handler in advance to determine whether their condition allows for proper care of the animal.
- Assess the handler’s roles and routines, identify their needs, and suggest characteristics to look for in a dog.
- Collaborate with the dog trainers after the match to hone needed skills, such as blocking, retrievals, dressing tasks, and more.
- Make adjustments to the home environment and provide resources to ensure that the animal is well cared for.
She recommends that assistance dog agencies work with OTs as a contract service. As part of the project, Dr. Fournier created a website for veteran and civilian dog handlers, with resources on finding a dog and how OTs can help. She says that service dogs are becoming a more widely accepted form of therapy in the veteran world. The VA has programs to help in this process, and veterans may qualify for reimbursed expenses.
“The agencies loved the project,” Dr. Fournier says. Janie Lynn Heinrich, the founder of Mobility Service Dogs, has personal experience with OT and recognized the value. Dr. Fournier, who was the Student Occupational Therapy Association (SOTA) president at the time, brought Heinrich in for a virtual Lunch and Learn with OT students in June.
Dr. Fournier and her husband have two puppies: a German shepherd and a hound mix. She plans to get them involved in training classes as therapy dogs. The family is currently living in Kansas, where Dr. Fournier is working as an OT at a skilled nursing facility and a hospital. She hopes someday to work in a VA hospital clinic for traumatic brain injuries. She says, “Veterans do so much for us that it’s only right to try to help them when they get back.”
Veterans and Horses
Collin Cooper grew up in a military family; his father served in both the Marines and the Air Force Reserves. He also grew up riding horses, and he still rides. “When you’re on the back of a horse, you just feel different,” he says. “The horse feels what you feel; the horse knows what you know.” Some veterans are resistant to talk therapy, he says; they prefer a more active, physical approach. As one organization he worked with writes on its website, “Therapeutic programs are not necessarily appealing to [veterans] until they reach a breaking point and feel like they have limited options. This is one of the many reasons why [we] developed a program that does not look or feel like traditional therapy.”
Dr. Cooper was interested in equine-assisted therapy (EAT), which encompasses therapeutic riding as well as the occupations around taking care of horses, such as feeding and grooming the animals and maintaining the stable and grounds. He explains that EAT usually takes a backseat to hippotherapy within the world of rehabilitative services. While hippotherapy is a reimbursable intervention that uses the movement of the horse to facilitate change in the patient’s gait and proprioception, EAT is more about the broader occupations surrounding horsemanship (which can also be therapeutic), and it isn’t recognized by insurance.
For his capstone project, Dr. Cooper focused on the role of occupational therapy in facilitating the use of EAT with veterans. “The OT’s approach depends on the individual and their symptoms,” he says. “If the individual is high-strung, angry, or closed off, the OT would work with them before the horse work, because you can’t approach the horse in that state. You have to work through your emotional barriers first.” The OT also tailors the treatment plan to the veteran’s occupations of interest on the ranch.
Dr. Cooper had planned to start a program for veterans at a local equine center, but pandemic shutdowns and quarantines rendered this impossible. So he worked closely with his faculty advisor, Dr. Becki Cohill, to adapt his project to meet the changing restrictions. “Dr. Cohill was very helpful, especially when the wheels were falling off the wagon,” he says.
“She was the glue that held me together.”
His mentor was USAHS alum Brian Inglis, MOT ‘18, a Navy veteran and occupational therapist. “Brian was awesome. He spoke about what he’s seen with guys he’s helped,” Dr. Cooper says.
Dr. Cooper conducted a literature review and surveys involving OTs, vets, and riding facilities. He interviewed the co-founder of the Kansas facility War Horses for Veterans, an Army vet and professional horseman who spoke about how this work had helped him and others. He also interviewed the director of Cornerstone Therapeutic Riding Center, a facility in Escondido, California, where active-duty veterans recover from trauma through horsemanship and work on the ranch. And he spoke with USAHS alumna Lauren Janusz, MOT ‘99, OTR/L, HPCS, the president of the American Hippotherapy Association (AHA), who is reaching out to veterans in her practice.
He also created a website that summarizes his findings, including three main themes:
- Working with horses can have a significant positive impact on a veteran’s occupational performance in several areas, including social participation, well-being, activities of daily living, work, sleep, and more.
- OTs have a valuable role to play in the EAT setting, whether as facility staff, consultants, or horse trainers.
- Some of the barriers to practice include funding: Facilities are typically nonprofits with no money to pay staff or OTs. And because insurance doesn’t recognize this service, the OT also needs to fundraise, write grants, and advocate for this role on the legislative level.
Dr. Cooper came to OT after he dislocated his elbow playing college soccer and lost function in his forearm, wrist, and hand. Occupational therapy helped him regain most of his function. “I developed a love for OT because of what it did for me,” he says. He had intended to be an OT in the service, but his plans changed after he and his wife recently welcomed their son.
“I loved St. Augustine,” he says. “It’s like a family relationship, with a tightknit cohort. The faculty is knowledgeable and approachable, and they come from a wide range of practice areas.”
About the simulation lab, he says, “I wouldn’t trade it for the world—all those long nights spent in the lab, practicing transferring patients into the bed, wheelchair, or walker, using the bed equipment. We were so fortunate to have that experience.”
The University of St. Augustine for Health Sciences (USAHS) offers hands-on Master of Occupational Therapy (MOT) and Doctor of Occupational Therapy (OTD) degrees. Join a collaborative cohort of peers who learn under the mentorship of expert faculty-practitioners. Practice with mock patients in our state-of-the-art simulation centers and learn anatomy with our high-tech tools. Train for clinical practice with patients across the lifespan. In the OTD program, prepare for advanced roles in research, practice leadership, and policymaking. Residential (online coursework + in-person labs on weekdays) and Flex (online coursework + in-person labs on weekends) formats are available.