Insights into Canadians' Perceptions of Service Dogs in Public Spaces.

Service Dogs (SDs) are an increasingly common type of working dog supporting people with disabilities in Canada. One of the groups being paired with SDs is Veterans diagnosed with posttraumatic stress injuries (PTSIs). In past research, Veterans have expressed stress over negative interactions with people in public spaces because an SD brings attention to their disability. There is a dearth of research exploring perceptions of SDs in public settings. METHODS: A total of 485 Canadians were surveyed via an online questionnaire about their demographic information and beliefs about SDs in public spaces. Data were analyzed using robust ordinary least squares (OLS) regression to determine which demographic features, if any, contribute to perceptions. RESULTS: Generally, the Canadian public holds highly positive perceptions of SDs being in public spaces. Our analysis found that women, people who currently have pets, and Indigenous people were more supportive of SDs in public spaces than others. People with certain cultural heritages were less receptive. CONCLUSION: These findings are an important beginning contribution to the growing SD and Veteran health field.

Case report: A community case study of the human-animal bond in animal-assisted therapy: the experiences of psychiatric prisoners with therapy dogs.

Prisoners frequently experience chronic loneliness and lack social support, which can exacerbate their struggles with incarceration. According to attachment theory, individuals who are insecurely attached may be more likely to develop unstable relationships and engage in antisocial behavior as adults. In 2015 an animal-assisted therapy (AAT) program was implemented in a Canadian forensic psychiatric facility/prison, a "hybrid" facility that adheres to federal legislation regarding correctional services but follows provincial mental health legislation. The program centers on the development of a human-animal bond (HAB), which serves as a connection between the animals and prisoners. The HAB also addresses issues related to toxic masculinity, which are often present among men incarcerated in correctional facilities, including psychiatric prisons. An instrumental community case study design involving 6 prisoners at a forensic psychiatric facility/prison over 24 AAT sessions between 2015-2019 was undertaken. Interviews with the prisoners and their mental health clinicians were thematically analyzed to explore how the HAB was experienced as a form of attachment. Four themes emerged: safety, physical touch, reciprocity, and acceptance. These themes suggest that the therapy dogs have the potential to serve as a surrogate attachment figure for prisoners, mitigating their experiences of disconnection and fostering their development of interpersonal connections. This suggests attachment theory underpins the HAB and highlights the contribution of AAT practice and research in forensic psychiatric facilities/prisons. This study also suggests that the program's offering of prosocial support and nurturance/caring aligns with the specific criminogenic risks and needs identified within Correctional Service Canada's Risk-Need-Responsivity (RNR) model for rehabilitation. Continued research and attention should be paid to AAT programs as a valuable addition to the range of support networks available to prisoners in psychiatric or non-psychiatric institutions.

An Experiential Approach to Canine-Assisted Learning in Corrections for Prisoners Who Use Substances.

ABSTRACT: Canine-assisted interventions are a promising approach to help address substance use and mental health issues in prisons. However, canine-assisted interventions in prisons have not been well explored in relation to experiential learning (EL) theory, despite canine-assisted interventions and EL aligning in many ways. In this article, we discuss a canine-assisted learning and wellness program guided by EL for prisoners with substance use issues in Western Canada. Letters written by participants to the dogs at the conclusion of the program suggest that such programming can help shift relational dynamics and the prison learning environment, benefit prisoners' thinking patterns and perspectives, and help prisoners generalize and apply key learnings to recovery from addiction and mental health challenges. Implications are discussed in relation to clinicians' practices, prisoners' health and wellness, and prison programming.

Unleashing compassionate care: canine-assisted intervention as a promising harm reduction approach to prisonization in Canada and its relevance to forensic psychiatry.

In recent years, there has been a global advancement in the offering of canine-assisted interventions (CAI) in prisons. However, these programs have focused primarily on the benefits to the dogs involved and not on the impact on the participants. The authors of this perspective study have been running a CAI program with therapy dogs, called PAWSitive Support, in a Canadian federal prison since 2016. Thoughts from the program facilitators and interviews with prison staff indicate that the program, and specifically the therapy dogs, provides a unique and integrated source of comfort, support, and love for participants. These benefits are consistent with those seen in CAI programs outside of prisons. Unique to the prison setting appears to be an improvement in participant-staff relations. The therapy dogs have helped participants to experience comfort and consequently express their emotions. This seems to contribute to their recognition of support within the prison system and specifically developing trust with staff. Additionally, the dogs have helped to create an experience of the feeling of love within the prison, interpreted as the feeling of being cared for, which is rare for this population. The authors suggest that the integration of a therapy dog intervention in prison could be a novel harm reduction strategy to address issues related to prisonization and associated mental health concerns, including substance use. This consideration can offer unique insight into the field of forensic psychiatry about providing compassionate care to patients.

Recognizing Zooeyia to Promote Companion Animal Welfare in Urban Bangladesh.

The One Health concept of zooeyia refers to the benefits of companion animals in human health and is gaining global research attention. This exploratory study aimed to understand contemporary experiences and perceptions of the social benefits and challenges of living with a companion animal in urban Bangladesh. Thirty-five qualitative interviews were conducted with companion animal owners (20), animal sellers (10), and livestock service department officers (5) from two major cities in Bangladesh, Dhaka and Khulna. Thematic analysis found that historically, animals had a utilitarian purpose, such as livestock for food and dogs for security. The role and perceptions of companion animals began to change for some around the turn of the century. Today, companion animal caretakers report social, psychological and physical health benefits from integrating companion animals into their lives. They also report that companion animal ownership can contribute to social problems due to the prevailing stigma against companion animals. This is rooted in the continued utilitarian role attached to companion animals by the majority of the Bangladesh population as well as religious-based non-acceptance. As a result, the Animal Welfare Act (2019) is not well implemented, posing a key concern for companion animal welfare. To tackle this, we propose various ways in which the emerging concept of zooeyia can help promote the welfare of companion animals by challenging the stigma associated with them in Bangladesh.

Outcomes of a controlled trial with visiting therapy dog teams on pain in adults in an emergency department.

CONTEXT: Pain is a primary reason individuals attend an Emergency Department (ED), and its management is a concern. OBJECTIVES: Change in symptoms and physiologic variables at 3 time points pre-post a ten-minute St. John Ambulance therapy dog team visit compared to no visit in ED patients who experienced pain. DESIGN, SETTING AND PARTICIPANTS: Using a controlled clinical trial design, pain, anxiety, depression and well-being were measured with the Edmonton Symptom Assessment System (revised version) (ESAS-r) 11-point rating scales before, immediately after, and 20 minutes post- therapy dog team visit with Royal University Hospital ED patients participating in the study (n = 97). Blood pressure and heart rate were recorded at the time points. Control data was gathered twice (30 minutes apart) for comparison (n = 101). There were no group differences in age, gender or ethnicity among the control and intervention groups (respectively mean age 59.5/57.2, ethnicity 77.2% Caucasian/87.6%, female 43.6% /39.2%, male 56.4%/60.8%,). INTERVENTION: 10 minute therapy dog team visit in addition to usual care. MAIN OUTCOME MEASURES: Change in reported pain from pre and post therapy dog team visit and comparison with a control group. RESULTS: A two-way ANOVA was conducted to compare group effects. Significant pre- post-intervention differences were noted in pain for the intervention (mean changeint. = -0.9, SD = 2.05, p = .004, 95% confidence interval [CI] = [0.42, 1.32], ηp2 = 04) but not the control group. Anxiety (mean changeint. = -1.13, SD = 2.80, p = .005, 95% CI = [0.56, 1.64], ηp2 = .04), depression (mean changeint. = -0.72, SD = 1.71, p = .002, 95% CI = [0.39, 1.11], ηp2 = .047), and well-being ratings (mean changeint. = -0.87, SD = 1.84, p < .001, 95% CI = [0.49, 1.25], ηp2 = .07) similarly improved for the intervention group only. There were no pre-post intervention differences in blood pressure or heart rate for either group. Strong responders to the intervention (i.e. >50% reduction) were observed for pain (43%), anxiety (48%), depression (46%), and well-being (41%). CONCLUSIONS: Clinically significant changes in pain as well as significant changes in anxiety, depression and well-being were observed in the therapy dog intervention compared to control. The findings of this novel study contribute important knowledge towards the potential value of ED therapy dogs to affect patients' experience of pain, and related measures of anxiety, depression and well-being. TRIAL REGISTRATION: This controlled clinical trial is registered with ClinicalTrials.gov, registration number NCT04727749.

Patient Opinion of Visiting Therapy Dogs in a Hospital Emergency Department.

To date there have been no studies examining whether patients want emergency department (ED) therapy dog programs. This patient-oriented study examined the opinions of patients about whether they would want to be visited by a therapy dog in the Royal University Hospital ED. Cross-sectional survey data were collected over a six week period from a convenience sample of 100 adult patients who had not been visited by a therapy dog in the ED. Most (80%) indicated they would want a visit by a therapy dog as an ED patient. A higher proportion of individuals who currently have a pet dog (95%) or identify as having lots of experience with dogs (71%) were more likely to indicate this want compared to those without a dog (90%) or little to no experience with dogs (62%). The majority were also of the opinion that patients may want to visit a therapy dog in the ED to reduce anxiety (92%) and frustration (87%) as well as to increase comfort (90%) and satisfaction (90%) and to a lesser extent to reduce pain (59%). There was no significant difference in findings by gender or age, other than a higher proportion of older adults and females identifying cultural background and tradition as a possible reason that patients may not want to be visited by a therapy dog. The findings of this study can help guide considerations for future ED therapy dog programs.

Reconciling America's Research Response to Binge Drinking among American Indians and Alaskan Natives.

Binge drinking among American Indians and Alaskan Natives is an acute health issue in the United States. The Radcliffe Institute for Advanced Study at Harvard University convened a one-day meeting with North American experts to identify key elements for developing research methodologies to measure treatment outcomes founded in Indigenous cultural ways of knowing. Three were identified: recognize culture as treatment, overcome Western interpretations of research, and apply culturally appropriate research methodologies. Common across the elements is respectful relationship development, which mirrors the efforts of the Canadian Truth and Reconciliation Commission that was established to address the destructive legacy of residential schools among First Nations. Reconciling America's research response to binge drinking among American Indians and Alaskan Natives requires a similar commitment.

Reflections on How a University Binge Drinking Prevention Initiative Supports Alcohol Screening, Brief Intervention, and Referral for Student Alcohol Use.

What's Your Cap: Know When to Put a Lid on Drinking (WYC) is a student-led and research-based binge-drinking prevention campaign at the University of Saskatchewan, Canada. It was formed to encourage a culture of alcohol moderation on the university campus through peer-to-peer engagement that emphasizes promotional items and activities of interest to students. Since its development in 2011, WYC has been guided by a logic model that promotes: 1) perceived and actual student drinking norms on campus; 2) benefits of a student-led initiative; and 3) merits of working with community partners. With the release of a clinical guide in Canada for alcohol screening, brief intervention, and referral (SBIR) in 2013, WYC was prompted to consider whether it is a form of population-based SBIR. SBIR is commonly undertaken in the substance use field by health care practitioners, and this paper shares the potential for a student-based SBIR modification on a university campus.

A scoping study of cultural interventions to treat addictions in Indigenous populations: methods, strategies and insights from a Two-Eyed Seeing approach.

BACKGROUND: This paper describes the methods, strategies and insights gained from a scoping study using a "Two-Eyed Seeing" approach. An evolving technique, Two-Eyed Seeing respects and integrates the strengths of Indigenous knowledge and Western sciences, often "weaving back and forth" between the two worldviews. The scoping study was used to inform a tool for measuring the impact of culturally based addictions treatment services on wellness in Indigenous populations. It formed part of a three-year study, Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment. The scoping study identified and mapped literature on cultural interventions in addictions treatment, and described the nature, extent and gaps in literature. METHODS: Using a Two-Eyed Seeing approach, we adapted, applied and enhanced a common framework of scoping studies. In the end stage of the scoping review process, an Ad Hoc Review Group, led by our project Elder, reviewed and interpreted Indigenous and Western understandings within the mapped information. Elements of the scoping study were joined with results from community focus groups with staff at treatment centres. RESULTS: Two-Eyed Seeing contributed differently at each stage of the scoping study. In early stages, it clarified team expertise and potential contributions. At the mid-point, it influenced our shift from a systematic to a scoping review. Near the end, it incorporated Western and Indigenous knowledge to interpret and synthesize evidence from multiple sources. CONCLUSIONS: This paper adds to the collective work on augmenting the methodology of scoping studies. Despite the challenges of a Two-Eyed Seeing approach, it enables researchers using scoping studies to develop knowledge that is better able to translate into meaningful findings for Indigenous communities.

Taking a PAWS to Reflect on How the Work of a Therapy Dog Supports a Trauma-Informed Approach to Prisoner Health.

Canada's Correctional Investigator has found that mental health disorders, alone or in combination with alcohol and drug abuse, challenge public health and safety. Trauma is a key contributor among Canada's inmate population. Therapy dogs can assist in supporting individuals with mental health, addiction, and trauma concerns. This case report presents the work of a St. John Ambulance therapy dog in a trauma-informed approach to prisoner health. The Substance Abuse and Mental Health Services Administration articulates six evidence-based trauma principles for service providers; safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues. These principles are used as a lens to examine what the therapy dog appears to offer instinctively and effortlessly in its interactions with prisoners. Illustrative examples are provided.Video Abstract available for additional insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JFN/A16).

Applying One Health to the Study of Animal-Assisted Interventions.

The use of animal-assisted interventions in therapeutic programs is a growing phenomenon. Animal-assisted interventions (AAIs) involve a variety of species (dogs, cats, horses, domesticated birds, etc.) in primary health care. Despite their increasing application in a wide range of therapeutic services, the empirical evidence base of AAIs is limited. The authors of this paper propose that the public health framework of One Health can be adapted to advance AAI research. One Health's perspective on the environment is primarily ecological. The environmental impact on the human-animal interactions within AAIs, however, incorporates social, cultural, political, and economic factors. The environment has received minimal attention in AAI research. The authors discuss how this framework has been used in their prior AAI research and work with Indigenous people. Applying this framework to AAIs may guide future AAI research.

The Helping Horse: How Equine Assisted Learning Contributes to the Wellbeing of First Nations Youth in Treatment for Volatile Substance Misuse.

There has been recent interest in Canada exploring the benefits of equine assisted interventions in the treatment of First Nations youth who misuse volatile substances. Using the richness of an exploratory case study involving the White Buffalo Youth Inhalant Treatment Centre and the Cartier Equine Learning Center, our community-based study examined the question of how an Equine Assisted Learning (EAL) program contributes to the wellbeing of First Nations female youth who misuse volatile substances. Both programs are grounded in a holistic bio-psycho-social-spiritual framework of healing. Our study shares how the EAL horses, facilitators and program content contributed to youths' wellbeing in each area of the healing framework (bio-psycho-social-spiritual), with emphasis on the cultural significance of the horse and its helping role. The horse is a helper in the girls' journeys toward improved wellbeing-the horse helps through its very nature as a highly instinctive animal, it helps the facilitators do their jobs, and it also helps put the treatment program activities into practice. In addition, the role of First Nations culture in the girls' lives was enhanced through their encounters with the horses. The findings support the limited literature on equine assisted interventions and add important insights to the youth addictions treatment literature. Key implications to consider for EAL and volatile substance misuse policy, practice and research are identified.

"I Got to Know Them in a New Way": Rela(y/t)ing Rhizomes and Community-Based Knowledge (Brokers') Transformation of Western and Indigenous Knowledge.

Drawing on three culturally specific research projects, this paper examines how community-based knowledge brokers' engagement in brokering knowledge shaped the projects' processes. Informed by Deleuze and Guattari's (1987) conceptualization of the "rhizome," we discuss how community knowledge brokers' engagement in open research-creation practices embrace the relational foundation of Indigenous research paradigms in contrast to mainstream Western research practices that are engaged as linear, objective, and outcome-oriented activities. In turn, we offer propositions for building team environments where open research-creation practices can unfold, informing a periphery of shared space for Indigenous and Western paradigms.

Outcome assessment of a triangular clinic as a harm reduction intervention in Rajaee-Shahr Prison, Iran.

BACKGROUND: Transmission of the human immunodeficiency virus (HIV) among incarcerated injection drug users (IDU) is a health epidemic in the Islamic Republic of Iran. Triangular clinics (TCs) were established in prisons as a harm reduction measure to decrease the risk of HIV transmission and other blood-borne infections. The objective of this study was to assess the immediate outcomes of one TC among male IDUs in Iran's Rajaee-Shahr prison. METHODS: This study was conducted in two stages between 2003 and 2005. In the preparatory stage, focus group data was collected to update the prison's TC education and medical interventions and construct the self-report questionnaire. In stage two, 150 male IDUs were recruited in a closed cohort study design to assess the immediate outcome of the TC. Participants were measured at baseline and followed up to six months to measure their drug use, attitude toward and knowledge of high risk behaviours, serological conversion for HIV, HBV and HCV, and engagement in risky behaviors. The TC outcomes were determined through random urine analysis testing, a self-administered questionnaire and behaviour report cards, and viral infection testing. RESULTS: The findings of the urine analyses indicated a minimal yet consistent decrease in drug use over the six months. The pre and post- self-administered questionnaire data relayed a modest change in IDU risky behaviours associated with sexual practices; this was greater in comparison to the knowledge and attitude measures. It was determined that age may have a detrimental effect as may viral infections (HIV and HBV) on knowledge, attitude and behavior change. Both education and employment may have a protective effect. Data collected from the self-report behaviour cards similarly showed a modest reduction in high risk practices. At the six month follow-up, only one case became HIV positive, 9 HCV and 17 HBV. CONCLUSIONS: Considering that HIV is concentrated among Iranian prisoners who inject drugs at a high level, the results of this study indicate that TCs are a possible effective intervention. However, many prisoners continued with risky behaviors even if they were participating in harm reduction measures, such as methadone maintenance therapy.

Back to the basics: identifying positive youth development as the theoretical framework for a youth drug prevention program in rural Saskatchewan, Canada amidst a program evaluation.

BACKGROUND: Despite endorsement by the Saskatchewan government to apply empirically-based approaches to youth drug prevention services in the province, programs are sometimes delivered prior to the establishment of evidence-informed goals and objectives. This paper shares the 'preptory' outcomes of our team's program evaluation of the Prince Albert Parkland Health Region Mental Health and Addiction Services' Outreach Worker Service (OWS) in eight rural, community schools three years following its implementation. Before our independent evaluation team could assess whether expectations of the OWS were being met, we had to assist with establishing its overarching program goals and objectives and 'at-risk' student population, alongside its alliance with an empirically-informed theoretical framework. METHODS: A mixed-methods approach was applied, beginning with in-depth focus groups with the OWS staff to identify the program's goals and objectives and targeted student population. These were supplemented with OWS and school administrator interviews and focus groups with school staff. Alignment with a theoretical focus was determined though a review of the OWS's work to date and explored in focus groups between our evaluation team and the OWS staff and validated with the school staff and OWS and school administration. RESULTS: With improved understanding of the OWS's goals and objectives, our evaluation team and the OWS staff aligned the program with the Positive Youth Development theoretical evidence-base, emphasizing the program's universality, systems focus, strength base, and promotion of assets. Together we also gained clarity about the OWS's definition of and engagement with its 'at-risk' student population. CONCLUSIONS: It is important to draw on expert knowledge to develop youth drug prevention programming, but attention must also be paid to aligning professional health care services with a theoretically informed evidence-base for evaluation purposes. If time does not permit for the establishment of evidence-informed goals and objectives at the start-up of a program, obtaining insight and expertise from program personnel and school staff and administrators can bring the program to a point where this can still be achieved and theoretical linkages made after a program has been implemented. This is a necessary foundation for measuring an intervention's success.

Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers.

BACKGROUND: People who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action. METHODS: Data were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes. RESULTS: Four barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services. CONCLUSION: The results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID's complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions.

Researching Prescription Drug Misuse among First Nations in Canada: Starting from a Health Promotion Framework.

The intentional misuse of psychotropic drugs is recognized as a significant public health concern in Canada, although there is a lack of empirical research detailing this. Even less research has been documented on the misuse of prescription drugs among First Nations in Canada. In the past, Western biomedical and individual-based approaches to researching Indigenous health have been applied, whereas First Nations' understandings of health are founded on a holistic view of wellbeing. Recognition of this disjuncture, alongside the protective influence of First Nations traditional culture, is foundational to establishing an empirical understanding of and comprehensive response to prescription drug misuse. We propose health promotion as a framework from which to begin to explore this. Our work with a health promotion framework has conveyed its potential to support the consideration of Western and Indigenous worldviews together in an 'ethical space', with illustrations provided. Health promotion also allots for the consideration of Canada's colonial history of knowledge production in public health and supports First Nations' self-determination. Based on this, we recommend three immediate ways in which a health promotion framework can advance research on prescription drug misuse among First Nations in Canada.

The creation of the expected Aboriginal woman drug offender in Canada: Exploring relations between victimization, punishment, and cultural identity.

This article illustrates how the Aboriginal female drug user is responded to as an expected offender based on the intersection of her gender, race, and class. Drawing on the findings of a national Canadian study documenting the lived experiences of First Nations, Métis, and Inuit female drug users, we argue that the strengthening of cultural identity can potentially disrupt this expected status at both the individual and social system levels. Within the framework of critical victimology, the challenge then becomes to translate this understanding into praxis. In response, we suggest advancing women's agency at the individual level in the face of disempowering images and practices related to the offender, the victim, and Aboriginality. For change at the system level, we return to Christie's notion of the need to dismantle the stereotypical construction of the Aboriginal female drug user. We illustrate both levels of change with an innovative form of knowledge sharing, which aims to evoke transformation with respect to individual and socially constructed conceptualizations of identity.